Abstract
Objectives:Although non-traumatic Small Bowel Perforations (SBPs) are rare, they have high rates of morbidity and mortality in case of late presentation. Aetiological factors vary across different geographical regions. In this paper, SBPs caused by anything other than trauma and other well-known causes are presented and the current literature is reviewed.Methods:The study was conducted at General Surgery Clinics of two different tertiary university hospitals between January 2008 and September 2016. The authors directly involved in managing the patients. This study was approved by the ethical institutional board and was performed at the Department of General Surgery, School of Medicine, Sakarya University. The medical records of patients retained in both hospitals are electronic. Medical records of subjects who had undergone emergency operations with a prediagnosis of acute abdomen in single center, and were determined to have SBPs due to unusual causes, were investigated retrospectively. Patients with aetiological factors such as trauma, mesenteric vascular disease, internal and external hernias, intra abdominal adhesions, inflammatory bowel diseases, and iatrogenic causes were excluded.Results:In total, 35 patients were evaluated, 20 (57.1%) males and 15 (42.9%) females. The mean age of the cases was 51.6 (18–88) years. Mean time until admission at the hospital was 1.4 days (range 0.25–7 days). The most frequent aetiological factors were various malignancies (10 cases, 28.5%) and perforation of Meckel’s diverticulum (8 cases, 22.8%). It was surprising to detect a considerable rate of perforation due to bezoars (6 patients, 17.1%).Conclusions:Post-operative consequences of SBPs due to unusual causes are similar with those related to common, known causes. Factors affecting the clinical course are presentation time and patients’ clinical status in admission, not aetiology.
Highlights
Small Bowel Perforations (SBPs) due to causes other than trauma and known common aetiological factors are called spontaneous or nontraumatic SBPs.[1,2] The most frequent causes include various malignancies, infections, and nonspecific inflammation.[3]
We aimed to present the unusual causes of small bowel perforations, treatment results and investigate whether the clinical course is different from other SBPs due to common, well known aetiologies
These are considered rare or unusual aetiological causes, and are sometimes classified in the surgical literature as non-traumatic or spontaneous SBPs. They occur at low rates, and SBPs resulting from these causes can be divided into two groups: those with defined and undefined aetiological factors.[4,5]
Summary
Small Bowel Perforations (SBPs) due to causes other than trauma and known common aetiological factors (mesenteric vascular disease, internal and external hernias, intraabdominal adhesions, inflammatory bowel diseases, and iatrogenic) are called spontaneous or nontraumatic SBPs.[1,2] The most frequent causes include various malignancies, infections, and nonspecific inflammation.[3]. This is why outcomes in the postoperative period are still poor despite developments in surgical-radiologic techniques and intensive care conditions.[1,5] The first-line choice for treatment of this disease is a surgical approach, and timing of the operation is a major factor determining success.[1]
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