OBJECTIVE: To evaluate the role of a defunctioning ileostomy in the prevention of morbidity
and mortality in patients with small bowel perforation.
DESIGN: A prospective randomized study.
PLACE AND DURATION OF STUDY: Department of Surgery, Liaquat University of Medical &
Health Sciences, Jamshoro / Hyderabad between October 2005 and September 2006.
SUBJECTS AND METHODS: Total 108 patients who underwent laparotomy for ileal perforation
RESULTS: There were 67 males and 41 females. The age of patients ranged from 15 to 72 years
with 80% of the patients being in age group of 17-70 years. Typhoid was the commonest cause
for ileal perforation which was seen in 69 (63.8%) patients, followed by intestinal tuberculosis
which was present in 23 (21.3%) patients. Out of a total of 108 patients, a proximal defunctioning
ileostomy was constructed to protect the primary repair or the intestinal anastomosis in 57
patients (group I). In the remaining 51 patients, primary repair or intestinal anastomosis was
done without a defunctioning ileostomy (group II). Two (3.5%) patients in group I and 7 (13.7%)
patients in group II died postoperatively. Six of the 51 patients in group II who underwent primary
closure of perforation or resection and end-to-end anastomosis without a defunctioning
ileostomy developed postoperative faecal fistula. None of the patients with defunctioning ileostomy
developed this complication.
CONCLUSION: We conclude that construction of a temporary ileostomy to provide defunctioning
for repair of ileostomy perforations reduce the incidence of fatal complications like faecal
fistula. Ileostomy, however, is associated with a number of ileostomy-specific complications.
We recommend that defunctioning ileostomy should be preferred over all other surgical options
in cases of ileal perforations.
Ileostomy. Faecal fistula. Ileal perforation. Primary closure. End-to-end anastomosis.