Abstract

Background: Small intestinal perforation peritonitis is a surgical emergency which remained a challenge to the surgeons since time immemorial. Independent of its aetiology all the cases of small intestinal perforation have similar clinical features leading to peritonitis with fulminating secondary bacterial  infection for which the  condition is studied  as one entity.

Material and Methods: A prospective study of 40 patients presenting to VSSIMAR, Burla with a diagnosis of Small bowel perforation between November 2017 and October 2019 was done. The history, clinical features, the investigations done, the surgical procedure performed, the post-operative ICU care, the complications, the secondary procedures undertaken and mortality rate were recorded.

Results: The maximum number of cases were in the age group of 21-30yrs  (32.5 %)  followed by 31- 40yrs (25 %)  with a male to female ratio 7:3 . Pain abdomen was the most common symptom. Majority of patients (42.5%) were presented between 24-48 hrs. The most common abdominal findings were guarding / rigidity, abdominal distension each 95%, Free gas under diaphragm found in 90% of cases. Widal test was positive in 35% cases. 8 cases (20%) didn’t respond to fluid therapy alone and required vasopressors. 85% were ileal perforation,15% were jejunal  perforation. Simple closure with drainage was the most performed procedure (65% of cases). Typhoid & non specific inflammation tops the aetiology (35% each) followed by Tuberculosis (22.5%). The most common complication was wound infection in 14 cases (35%). Seven patients who required critical care and later on also secondary procedure were stayed longest with mean 26.28 days and range 19-36 days. The overall mortality rate was 10%. Elderly (p <0.001), delayed presentation (p 0.001) and need of preoperative vassopressor (p <0.001) were associated with high mortality.

Conclusions: Combined resuscitation and surgical management are the key for better out come. Age >50yr, delay in initiation of treatment and pre-op shock requiring vasopressor support are associated with high mortality.

Keywords: Non traumatic; Small intestine; Perforation; Management; Mortality; Morbidity.