COMPARISON OF OUTCOMES OF ILEOSTOMY,PRIMARY REPAIR AND RESECTION ANASTOMOSIS FOR ILEAL PERFORATION IN TERTIARY CARE HOSPITAL

Abstract

ntroduction: Ileal perforation peritonitis is a commonly encountered surgical emergency in the Indian subcontinent and in tropical countries. Despite the availability of modern diagnostic facilities and advances in treatment regimes, this disease has an abrupt onset and a rapid downhill course with a high mortality if not treated [1,2]. Better antibiotics, aggressive surgery and the elimination of conservative treatment, better preoperative and postoperative management have all signicantly contributed to the improvement in patient outcome. The present studyMethods: includes 50 patients of ileal perforation with emphasis on typhoid, nonspecic and traumatic perforations, their preoperative and postoperative management and the factors inuencing outcome. This was an observational study of patients presented with ileal perforation managed with operative management like primary closure , resection- anastomosis and ileostomy Fever and abdominal pain were the most common. Result: clinical presentations. Ileostomy was performed in the majority of the cases after proper preoperative resuscitation , general condition of patient and intra-operative ndings. Nonspecic was the leading cause followed by typhoid. Abdominal pain, fever and vomiting were theDiscussion: most common symptoms of peritonitis. Most of the patients with ileal perforation have single perforation of size ranging 0.5-1 cm. Ileostomy as a treatment modality performed in 28 patients out of 50 Ileostomy may be given priority over other surgical options especially in those. Conclusion: moribund patients who present late in the course of their illness, have more than one perforation with massive fecal contamination of the abdominal cavity. Primary closure of perforation is a preferred technique in clinically stable patients with a single perforation with minimal soiling of the abdominal cavity. After adequate preoperative resuscitation , loop ileostomy holds the best result in terms of complications like postoperative leak, intra abdominal abscess, fecal stula, peritonitis, septicemia, paralytic ileus.