A Study on Non Traumatic Ileal Perforation

BACKGROUND: Ileal perforation is a common problem seen in tropical countries, the commonest cause being typhoid fever. Over the years a definite changing trend has been observed in ileal perforation both in terms of causes, treatment and prognosis. AIMS AND OBJECTIVES: 1. To study the clinical presentation of suspected ileal perforation due to non traumatic cause. 2. To study different methods of surgical management of non traumatic ileal Perforation. 3. To study the prognosis and outcome in non traumatic ileal perforation. METHODS: The study was conducted in Institute of General Surgery, Madras Medical College, Chennai from Sep 2013 - Sep 2014. A minimum of 50 patients of ileal perforations included in the study. Patients with traumatic perforations and those who came with a delayed presentation with shock and septicemia whose general condition didn’t warrant any operative management have been excluded. Factors were tabulated and statistically analysed to study their contributions. RESULTS: In our study the commonest cause of ileal perforation was typhoid followed by non specific causes. Perforation commonly occurred in the third and fourth decade of life with 50% of patients between the ages of 30 and 50. Pneumoperitoneum in chest x-ray and erect abdominal x-ray was seen in 80% of patients. In our study lag period was around 24 to 150 hours with an average of 55 hours. Over 96% of perforations were within 1 feet (30 cms) from the ileocaecal junction. Simple 2-layer closure was the commonest procedure done (50%). Conclusion: - Typhoid is the most common cause of ileal perforation, followed by non-specific perforation. Other Causes of ileal perforation include non-specific, TB, and meckel’s perforation. Widal test is useful in the diagnosis of typhoid fever. Morbidity was significantly influenced by age greater than 50, hypoalbuminemia, azotemia, HB