Patient management and clinical outcomes in non-traumatic small bowel perforations

Year 2015, , 130 - 134, 10.07.2015

Ahmet Türkoğlu , Burak Ülger Ömer Uslukaya Abdullah Oğuz Yılmaz Zengin İlhan Taş Mesut Gül Zülfü Arıkanoğlu

https://doi.org/10.5799/ahinjs.01.2015.02.0503

Cited By: 1

Abstract

Objective: The aim of this study was to report our management and outcomes of patients who underwent surgery with the diagnosis of non-traumatic small bowel perforation.

Methods: The records of 30 patients who underwent surgery for non-traumatic small bowel perforation between 2005 and 2013 were examined. Age, gender, complaints, duration of symptoms, comorbid disease(s), perforation location, length of stay in hospital, etiology, surgical treatment, morbidity, and mortality data were recorded. Patients were divided into two groups, survivors and non-survivors, and their features were compared.

Results: The mean age of the patients was 51.3±19.9 years. Signs of peritoneal irritation were present in 22(73.3%) patients. In surgical exploration, generalized purulent peritonitis was observed in 14(46.6%) patients, while localized peritonitis was observed in the others. Bowel resection was performed in 27(90%) patients, while primary suture was performed in only 3(10%) patients. A diverting ileostomy was performed in 18(60%) patients. Mortality was observed in 9 (30%) patients. Duration of the symptoms and multiple perforations were significantly higher in non-survivors.

Conclusion: A delay in diagnosis and presence of multiple perforations are the most important causes of mortality. Every effort should be made to avoid delay in diagnosis; however, once the diagnosis is delayed, especially in patients with multiple perforations, extensive surgery such as bowel resection and ileostomy should not be avoided. J Clin Exp Invest 2015; 6 (2): 130-134

Key words: Non-Traumatic, small bowel perforation, diagnosis, management

Keywords

Non-Traumatic, small bowel perforation, diagnosis, management

Travmatik olmayan ince barsak perforasyonlarında hasta yönetimi ve klinik sonuçlar

Abstract

Amaç: Bu çalışmanın amacı, travmatik olmayan ince barsak perforasyonu nedeniyle ameliyat edilen hasta yönetimimizi ve sonuçlarını sunmaktır.Yöntemler: Kliniğimizde 2005 ve 2013 arasında travmatik olmayan ince bağırsak perforasyonu nedeniyle ameliyat edilen 30 hastanın kayıtları incelendi. Hastalara ait yaş, cinsiyet, şikayetler, belirtilerin süresi, eşlik eden hastalık(lar), perforasyon yeri, hastanede kalış süresi, etyoloji, cerrahi tedavi, morbidite ve mortalite verileri kaydedildi. Hastalar yaşayanlar ve ölenler olmak üzere iki gruba ayrıldı ve grupların çeşitli özellikleri karşılaştırıldı. Bulgular: Hastaların yaş ortalaması 51,3±19,9 yıl idi. Periton irritasyonu bulguları 22 (% 73,3) hastada vardı. Eksplorasyonda 14 (% 46,6) hastada yaygın pürülan peritonit gözlenirken, diğerlerinde lokalize peritonit mevcuttu. Primer sütürasyon sadece 3(%10) hastaya uygulanırken, barsak rezeksiyonu 27 (%90) hastaya uygulandı. Saptırıcı ileostomi 18 (%60) hastaya uygulandı. Mortalite 9 (%30) hastada gözlendi. Semptom süresi ve çoklu perforasyon varlığı mortalite gelişen hastalarda anlamlı derecede yüksek bulundu.Sonuç: Tanıda gecikme ve çoklu perforasyon varlığı mortalitenin en önemli nedenleridir. Tanıda gecikmeyi önlemek için her türlü çaba harcanmalıdır; ancak, eğer tanı gecikmişse, özellikle çoklu perforasyonu olan hastalarda bağırsak rezeksiyonu ve/veya ileostomi gibi geniş cerrahi prosedürlerden kaçınılmamalıdır

Keywords

Travmatik olmayan, ince bağırsak delinmesi, tanı, yönetim

References

• Eid HO, Hefny AF, Joshi S, Abu-Zidan FM. Non-traumatic perforation of the small bowel. Afr Health Sci 2008;8:36-39.
• Chaikof EL. Nontraumatic perforation of the small bowel. Am J Surg 1987;153:355-358.
• Jain BK, Arora H, Srivastava UK, et al. Insight into the management of non-traumatic perforation of the small intestine. J Infect Dev Ctries 2010;28;4:650-654.
• Akyildiz HY, Akcan AC, Sözüer E, et al. Unusual causes of intestinal perforation and their surgical treatment. Ulus Travma Acil Cerrahi Derg 2009;15:579-583.
• Freeman HJ. Spontaneous free perforation of the small intestine in adults. World J Gastroenterol 2014;7:20:9990-9997.
• Stagnitti F, Coletti M, Corona F, et al. Small intestine tumors: our experience in emergencies. G Chir 2003;24:34-38.
• Aamer Naseer A, Ahmad S, Naeem M. Primary Repair in Spontaneous Small Bowel Perforations. Ann Pak Inst Med Sci 2009;5:170-173.
• Ara C, Sogutlu G, Yildiz R, et al. Spontaneous small bowel perforations due to intestinal tuberculosis should not be repaired by simple closure. J Gastrointest Surg 2005;9:514-517.
• Orringer RD, Coller JA, Veidenheimer MC. Spontaneous free perforation of the small intestine. Dis Colon Rectum 1983;26:323-326.
• Ara C, Coban S, Kayaalp C, et al. Spontaneous intestinal perforation due to Non-Hodgkin’s lymphoma: Evaluation of eight cases. Dig Dis Sci 2007;52:1752-1756.