A Clinical Study and Management of Small Bowel Perforation

Background: Perforation of the small bowel is a common abdominal surgical emergency faced by the general surgeon. Perforation of the small bowel from a wide variety of causes comprises one of the major entity among emergency surgical admissions.The perforated small bowel viscus challenges the surgeon’s knowledge of pre-operative, intraoperative and post operative care of severely ill surgical patient. Surgery plays on important role in the management of perforations. Hence this study is undertaken to find out the age, sex incidence, etiological factors, Clinical features and various surgical procedures for small bowel perforations and its complications in our set up.Materials and Methods:A prospective study of 100 patients presenting to Kamineni Institute of Medical Sciences, with a clinical diagnosis of small bowel perforation between October 2019 to March 2020. The clinical data, investigations done and the surgical procedure undertaken are recorded.Observations:Small intestinal perforation is the commonest surgical emergency among all cases of acute abdomen. Male to Female ratio observed was 90:10 Most commonly affected age group is among 31 to 40 years. Majority of patients presented to causality after 24 hours. Among small bowel perforation 70% were duodenal, 23% ileal and 7% jejuna. Overall mortality in small bowel perforation is 15%. Mortality rate in ileal perforation (39%) being greater than duodenal perforation (8.5%)Conclusion:Incidence of small bowel perforation is more in economically productive age group, 2nd to 5th decade. Most of the cases of perforation presented with sudden onset of pain. The physical signs like tenderness, rigidity and diminished bowel sounds are the common signs.Commonest complications in duodenal perforation were wound infection, toxaemia and uraemia, in ileal perforation wound infection, toxaemia, Uraemia, fecal fistula and hypotension. Mortality and Morbidity rate is attributed to late presentation, toxaemia, hypotension and renal failure. Closure of perforation with omental patch and peritoneal wash was the main stay of treatment. Resection with end to end ileal anastomosis was done in selected cases. Early presentation to hospital, fluid resuscitation and immediate operative intervention had better outcome