Outcomes of Rurally Treated Small-Bowel Perforations Compared to a Tertiary Centre

Abstract

Introduction: Small-bowel perforation is a rare event but outcomes can be significantly influenced by treatment delay and mechanism of perforation. The aim of this study was to investigate the causative factors and outcomes of patients with a small- bowel perforation treated at a rural hospital. Distance from treating hospital and stabilisation by a remote hospital were correlated with outcomes. Methods: A retrospective analysis of all patients diagnosed with a small-bowel perforation between September 2004 and September 2009 was performed. Severity of abdominal sepsis and the grade of complications were assessed by established validated scoring systems. Outcomes were compared against those from a large tertiary hospital. Results: Thirty-two patients, with median age 44.5 (8-92) were treated for small-bowel perforation. Six patients were treated conservatively with twenty-six requiring surgical intervention. Eleven (34.3%) had presented to an outlying hospital for treatment prior to transfer. There was no significant difference in outcomes for those living within one hundred kilometres and those who did not. The overall mortality rate was 8.33% (n=2), one was treated conservatively and one surgically. In patients with a spontaneous small-bowel perforation, there was no significant difference in outcomes between those treated at a small rural hospital when compared to those treated at a tertiary centre. Causative mechanisms for spontaneous small-bowel perforations included, foreign body ingestion, adhesions, trauma, and Crohns disease. Conclusion: The outcomes are comparative between patients treated in rural and non-tertiary hospitals when compared to large tertiary referral centres in this two-centre analysis.