Clinicopathological study of Ileal perforation: study in tertiary center

Abstract

Background: The objective of this study was to evaluate the clinicopathological characteristics in Ileal perforations because of confusion and controversy over the diagnosis and optimal surgical treatment of terminal Ileal perforation -a cause of obscure peritonitis. Perforation of terminal ileum is a cause for obscure peritonitis with severe toxic state, there may be obscured clinical features with resultant delays in diagnosis and adequate surgical intervention.Methods: A prospective study was conducted in Victoria Hospital and Bowring and Lady Curzon Hospital attached to Bangalore Medical College and Research Institute over a period of 5 years from June 2011 to May 2015. A total of 136 patients presented in this period with hollow viscus perforation and out of these 64 patients had Ileal perforation alone on exploratory laparotomy. Ileal perforations account for about 20 percent of all cases of hollow viscus perforation. Emergency exploratory laparotomy was done and perforation was identified, edge biopsy was taken in all cases and the perforation was closed in two layers and resection anastomosis was done in stricture with perforation. Histopathological report was reviewed following surgery.Results: A total of 64 patients with Ileal perforation were included in the study of which 52 were males and 12 were females accounting for 81.25 percent and 18.75 percent respectively. The causes for perforation were enteric fever (82.81%), nonspecific inflammation (9.38%), and tuberculosis (7.81%). Simple closure of the perforation (74.58%) and the remaining primary resection and anastomosis were the mainstay of the surgical management.Conclusions: The common pathology of Ileal perforation is Typhoid or Enteric fever, Non-specific ulcer, Tuberculosis and others. Intestinal complications of typhoid fever are quite common in developing countries. Nonspecific inflammation of the terminal ileum was other predominant cause operative findings were similar to that of typhoid fever but no laboratory evidence of the disease was found. Intestinal tuberculosis can mimic many conditions.