Clinical Study and Management of Ileal Perforations

• Main Author: T. Damodar, Binoy
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2010
• Subjects: Antibiotics; Bone marrow; Drug dosages; Electrolytes; Epidemiology; Fever; Gastrointestinal diseases; Hernias; Hospitals; Illnesses; Industrialized nations; Infections; Injuries; Medical prognosis; Medicine; Morbidity; Mortality; Patients; Pharmaceutical sciences; Salmonella; Sepsis; Small intestine; Surgery; Tropical diseases; Tuberculosis; Urine
• ISBN: 9798380194907

Background & Objectives: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 & Objectives:To study the clinical presentation and causes of ileal perforation.To study different modes of management of ileal perforation.To study the complications of ileal perforation.To study the prognostic factors affecting the outcome of ileal perforation.Methods:The study was conducted in Bowring and Lady Curzon Hospitals attached the Bangalore Medical College and Research Institute from Dec 2007-Sep 2009. A minimum of 50 patients of ileal perforations included in the study. Age <12years, perforation including multiple hollow viscera and perforation including concomitant solid organ injuries 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. Perforation commonly occurred in the second and third decade of life with 44% of patients between the ages of 20 and 40. Pneumoperitoneum in chest x-ray and erect abdominal x-ray was seen in 56% of patients. In our study lag period was between 1 hours and 200 hours with an average of 57.46 hours. Over 96% of perforations were within 2 feet (60 cms) from the ileocaecal junction. Simple 2-layer closure was the commonest procedure done (82%).Conclusion: -Typhoid is the most common cause of ileal perforation, followed by non-specific perforation. Other Causes of ileal perforation include non-specific, TB, trauma, stab, round worms 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<8, shock and a diagnosis of typhoid as the cause of perforation. Mortality was significantly influenced by age greater than 50, hypoalbuminamia, typhoid and shock on admission. The type of surgical procedure did not influence outcome, either morbidity or mortality.