Background:
Gastrointestinal perforations constitute one of the commonest surgical emergencies encountered by surgeons in India. Gastrointestinal perforation can occur at any anatomical location from the upper oesophagus to the anorectal junction, the most common site being the small intestine. Small bowel perforation can be secondary to many factors, the most common being inflammation, infection, obstruction, trauma, or invasive surgery. Early operative procedures are highly beneficial to patients as small bowel perforation has high mortality and morbidity.
Aims and Objectives:
To study various causes and clinical features of small bowel perforations and various surgical procedures undertaken with its impact on mortality and morbidity at M.K.C.G. Medical College and Hospital, Berhampur, Odisha.
Materials and Methods:
All the patients of small bowel perforation of both sexes and of different ages, who were admitted to the Department of General Surgery of M.K.C.G. Medical College and hospital, Berhampur, Ganjam, Odisha during the period between July 2018, to June 2020 (including 6 months of follow up period) were included in this study.
Results:
Out of 52 patients in our study group,41 patients (78.84%) were male with a mean age of presentation of 35.76 years. Abdominal pain and distension were the most common mode of presentation(100%) followed by vomiting (44.23%), fever(36.5%) and constipation (32.7%). Perforation due to duodenal ulcer was found to be the most common aetiology(69.25%) followed by trauma (19.25%), TB (3.85%), Malignancy (3.85%) while Typhoid & Chrons disease is the least common causes(1.9%). The majority of patients were managed by toileting & simple closure of the perforation (80.77%) while 13.47% of patients required resection & anastomosis,3.84% patients by drainage only and 1 patient (1.9%) required ileostomy.
Conclusion:
Duodenal perforation is the most common cause of small intestinal perforation. Smoking and consumption of alcohol & NSAIDS are the most important risk factors for small bowel perforation. Patients mainly presented with abdominal pain and distension with features of peritonitis. X-ray abdomen suggested pneumoperitoneum in most of the patients. Resuscitation followed by the closure of perforation with the omental patch was the most common management procedure done.
Key words: Perforation, Peritonitis, Laparotomy
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