Small bowel perforations: Review of 33 cases

Abstract

Context: Small bowel perforation is one of the commonest surgical emergencies in our limited resource rural area. Aims: To review the common aetiologies, diagnostic dilemmas and challenges to treat small bowel perforations in the emergency. Settings and Design: This was a prospective study of 33 patients with small bowel perforation managed in a single surgical unit at Rohilkhand Medical College, Bareilly between August 2014 and July 2015. Materials and Methods: Demographic data, clinical presentation, radiological findings, laboratory reports, operative notes, surgical procedure performed, postoperative progress, complications, hospital stay, mortality notes of all the patients were meticulously entered in a previously prepared proforma for this purpose. Results: Twenty-seven (81.8%) patients were males and 6 (18.2%) were females with ages ranging from 10 to 80 years. Abdominal pain and distension was the commonest presenting symptom in all 33 (100%) patients. 17 (51.5%) patients had evidence of pneumoperitoneum on erect plain X-ray chest and abdomen. 23 (70%) patients were of duodenal perforation, 3 (9%) of jejunal whereas 7 (21%) had a single ileal perforation. Anterior wall perforation in the duodenum due to nonsteroidal anti-inflammatory drugs (NSAIDs)/steroid was the commonest etiology in 21 (63.6%) patients. The mean hospital stay was 22 days and there were two mortalities. Conclusions: Small bowel perforations in rural areas like ours have etiological factors very different from counterparts in the West. Unregulated and indiscriminate use of NSAIDs/steroids still accounts for the high rate of duodenal perforation in our rural area. Insanitary conditions lead to endemic typhoid infections and perforations causes which have been eliminated from developed countries.