Ileal Perforation Peritonitis Research Articles

Benefits of Early Enteral Feeding with a Locally Prepared Protein-Energy Ration after Surgery for Acute Generalised Peritonitis: A Randomised Trial in Two Hospitals in Bukavu, Eastern Democratic Republic of Congo.

Acute generalised peritonitis (AGP) is a common and serious digestive surgery pathology. Undernutrition exacerbates patient condition and compromises their postoperative prognosis. Early enteral nutrition is recommended to reduce postoperative complications, but its availability and cost are problematic in low-income countries. The objective of this study was to evaluate the impact of providing early enteral feeding (EEF) to postoperative patients with intestinal perforation AGP using a locally prepared protein-energy food ration in two hospitals in Bukavu, a city of South Kivu, in the eastern part of the Democratic Republic of Congo. A prospective, randomised controlled trial with two groups of patients was conducted to investigate the effects of EEF with a local mixture versus enteral feeding after peristalsis had returned (control group) in patients who underwent laparotomy for AGP caused by ileal perforation. The local mixture consisted of soybean, maize, white rice, and pineapple. The trial included 66 patients with ileal perforation peritonitis. The results comparing early enteral fed and nonfed patients showed significant differences in peristalsis recovery time (2.1 (0.6) days vs. 3.8 (1.2) days, p < 0.0001) and length of hospital stay (25.5 (14.9) days vs. 39.4 (25.3) days, p = 0.0046). Bivariate analyses indicated a significant early enteral feeding (EEF) reduced of 9.1% (vs. 36.4%, p = 0.0082) in parietal infections and 3.4% (28.1%, p = 0.009) in fistulas (p = 0.009) when EEF was included. In addition, EEF significantly reduced reintervention rates by 9.1% (p = 0.0003) and eliminated evisceration rates. EEF was also shown to reduce the incidence of malnutrition by 63.6% (p < 0.0001). Multivariate analysis showed that enteral nutrition significantly reduced the time to recovery of peristalsis (p = 0.0278) with an ORa of 0.3 and a 95% CI of 0.1-0.9. Moreover, EEF reduced malnutrition (p = 0.0039) with an ORa of 0.1 and a 95% CI of 0-0.4. EEF with locally sourced protein-energy rations can enhance a patient's nutritional status and facilitate postoperative recovery. This procedure is advantageous and involved early enteral nutrition using locally manufactured rations, especially for those operated on for acute generalised peritonitis in the Democratic Republic of Congo.

Right ileo-colic intubation at the University Hospital of Kamenge: Preliminary results. About 7 cases.

Objective: To describe the advantages of the right ileo colic intubation technique Patients and methods: This is a prospective descriptive study of right ileo colic intubation at the Kamenge University Hospital (CHUK) in the visceral surgery department over a period of 12 months from 1 January to 31 December 2021. The study focused on patients who underwent the right ileocolic intubation technique at CHUK during this period. Results: Out of two hundred and sixty-four emergency surgical procedures performed in the visceral surgery department during the study period, we recorded seven cases of right ileocolic intubation, i.e. a frequency of 2.6%. The average age of the patients was 22 years. The sex ratio was 1.3. Transfer for suspected acute abdomen was the most frequent reason for consultation (57.1%). Intraoperative diagnoses were: ileal perforation peritonitis (42.8%), ileal strangulation peritonitis with Ladd's flange (14.2%), strangulated umbilical hernia with ileal perforation (14.2%), Richter's hernia (14.2%) and small bowel obstruction (14.2%). In these patients, right ileo-colic intubation was performed and the postoperative course was simple without complications. The average hospital stay was 41 days. The postoperative follow-up was one month. Conclusion: Right ileocolic intubation is a simple technique, easy to learn and associated with low morbidity.

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

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.

Our experience with enteric ileal perforation: a retrospective study at a tertiary care centre in northern India

Background: Typhoid fever is one of major causes of intestinal perforation in India and is one of the common surgical emergencies for which intervention is required. The study aims to evaluate the clinical presentation, operative findings, outcome of surgical procedures, postoperative complications and associated mortality among the patients managed for typhoid ileal perforation in a tertiary care hospital.Methods: This was a retrospective study evaluating the patients who were operated for typhoid ileal perforation peritonitis in FH Medical College, Agra, UP, India between April 2017 and September 2019. Diagnosis of typhoid ileal perforation was made with the combination of clinical presentation, laboratory investigations, radiological results and per-operative findings.Results: In the present study, 57 patients were managed for typhoid ileal perforation. Majority of the patients were young. In our study 40 patients (70.18%) were male and 17 patients (29.82%) were female. All patients presented with pain in abdomen and abdominal distension. However there was no history of fever in 19.3% of patients. Free gas under the right diaphragm was present in 60% of patients. Exploratory laparotomy was done in all the patients and multiple perforations were found in 59.65% of patients. Ileostomy was made in 75% of patients. Most common post-operative complication was wound infection (85.96%) and mortality was 12.28%.Conclusions: Perforation peritonitis is an alarming complication of typhoid fever which needs urgent and aggressive management. Mortality rate is high (12.28%) and may be attributed to delayed presentation.

Prognostic Factors of Non-Traumatic Small Bowel Perforation Peritonitis: A Multicenter Study in North Benin

Objective: Identify the factors affecting the non-traumatic intestinal perforations peritonitis outcome. Methods: This was a retrospective study over a period of 30 months (1st January 2014 – 30th June 2016), which took place in four hospitals in northern Benin, including three district hospitals and one teaching hospital. The study population consisted of patients operated for generalized acute peritonitis. The inclusion criteria were: peroperative confirmation of the non-traumatic ileal perforation and the existence of a complete medical record in relation to the variables studied. Results: We collected 121 cases of non-traumatic ileal perforation peritonitis with a total of 447 cases of generalized acute peritonitis; the non traumatic ileal perforation peritonitis frequency was 27.1%. Ninety-nine files met the inclusion criteria. The mean age was 17 ± 12 years with extremes of 2 and 60 years. The sex ratio was 2.4. The predictive factors were: age (p 0.00), consultation time (p 0.03), surgical time (p 0.02), amount of peritoneal fluid (p 0.001), perforation number (p 0.0009), surgical technique (p 0.0003) and postoperative complications such as digestive fistula (p 0.001) and postoperative peritonitis (p 0.04). Conclusions: At the end of our study, the factors of bad prognosis identified were the age, the time of consultation, the time of surgery, the quantity of peritoneal fluid. Some postoperative complications may cause death.

A rare presentation of ileal perforation due to local iron toxicity

Ileal perforation peritonitis is a frequently encountered surgical emergency in developing countries. In contrast to Western countries where lower gastrointestinal (GI) tract perforations predominate, upper GI tract perforations attribute to the majority of cases in India. Spontaneous ileal perforation remains a dreaded surgical condition in developing countries. Typhoid fever is the predominant cause of nontraumatic ileal perforation, while other causes include tuberculosis, nonspecific inflammation, obstruction, radiation enteritis, and Crohn's disease. Iron tablets, in case of toxicities, are notorious for causing erosions of the gastric mucosa due to their corrosive effect leading to perforations. The incidence of these, however, is few and far between. However, iron tablets causing erosions as a cause of ileal perforation is virtually unheard of. Literature suggests the possible perforations due to iron toxicity to be in the upper GI tract, namely stomach and duodenum, reflecting the sites of absorption. In this case report, we present a patient with an ileal perforation following acute ingestion of iron tablets. We suspect that this is probably either due to the sheer number of tablets, leading to a reduced absorption, or the fact that it may be enteric coated, which may explain the passage through the upper GI tract undigested. There are no studies to the authors' knowledge that explain such a finding. Thus, there is no consensus on the total amount of iron needed or the minimum time exposed to the toxic agent to produce such a finding.

Use of Acute Physiology and Chronic Health Evaluation II score to grade the severity and outcome in patients of typhoid ileal perforation peritonitis

Background: Typhoid ileal perforation peritonitis is a potentially life-threatening surgical emergency in developing nations. The severity assessment of a disease condition is useful to prioritize treatment and to reduce morbidity and mortality. Aims: The aim of this study was to use Acute Physiology and Chronic Health Evaluation (APACHE) II score to grade the severity and outcome in patients of typhoid ileal perforation peritonitis. Materials and Methods: A prospective analysis of data was done, which was collected over a period of 3 years for 100 cases of secondary peritonitis following typhoid ileal perforations, irrespective of age, sex, and duration of illness. APACHE II score was used to grade the severity and outcome in these patients. Results: Out of 100 patients included in this study, 87 were male and 13 were females. Age ranges between 14 and 65 years, maximum number of patients were in 2 nd and 3 rd decade of life. History of fever, abdominal pain, and abdominal distention were present in all cases. After onset of fever perforation occurred in 65% patients in 1 st week, there was an increase in mortality with increase in APACHE II score, age >50 years was associated with more mortality. The mean Intensive Care Unit stay in this study was 4.33 days, 5.81 days for survivors, and 3.47 days for nonsurvivors. Mortality in our study was 22%. Conclusion: APACHE II score is an easy and objective tool to grade severity of acute peritonitis and can be used for assessment of outcome. According to this study, patients with higher APACHE II score had highest rate of mortality and vice versa.

Acute Physiology and Chronic Health Evaluation II score as a tool to guide management strategies in ileal perforation

Background: Perforation peritonitis is the common surgical emergency. Despite advances in surgical techniques, antimicrobial therapy, and intensive care support, management of peritonitis continues to be highly demanding due to associated morbidity and mortality. Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system is the best available method for risk stratification in critically ill patients. Materials and Methods : This study was conducted in the 60 patients, who were admitted from causality and surgical outpatient department with a proven diagnosis of ileal perforation peritonitis. The patients were scored using by APACHE II into either of the two groups, Group A: <10 score. Group B: ≥10 score. Patients were operated for primary closure or ileostomy formation and were divided into two groups of 30 each depending on the surgical management. Group I (n = 30): These patients were managed by primary repair of the perforation with or without resection-anastomosis. Group II (n = 30): These patients were managed by ileostomy formation with closure/resection of the perforation. The outcome was assessed by postoperative complications and duration of hospital stay as related to APACHE II score. Results : Typhoid accounted for 38.3% of ileal perforations, Tuberculosis 15%, trauma 5% and nonspecific 41.6%. The majority of the perforations were single (90%), of size <1 cm (81.66%), and located within 60 cm of terminal ileum (95%). Simple closure of perforation with or without resection anastomosis was statistically significantly (P < 0.005) more done in patients with APACHE II score <10 whereas frequency of ileostomy was statistically significantly (P < 0.005) more done in patients with APACHE II score ≥10. As the APACHE II score increases the percentage of complication rate and hence hospital stay also increases, 12.97 ± 3.50 days in patients with APACHE II <10 score and 20.96 ± 5.09 days in patients with APACHE II ≥10 score (P < 0.001). Conclusion: Enteric fever is the most common cause of perforation peritonitis. Higher APACHE II scores in secondary peritonitis correlated significantly with the higher mortality and morbidity of the patients.

Acute Physiological and Chronic Health Evaluation II Score and its Correlation with Three Surgical Strategies for Management of Ileal Perforations.

Introduction:Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. It is reported to constitute the fifth common cause of abdominal emergencies due to high incidence of enteric fever and tuberculosis in these management based on Acute Physiological and Chronic Health Evaluation II (APACHE II) score.Methods:The following study was conducted in the Department of General Surgery, Government Medical College, Patiala. A total of 57 patients were studied and divided in to Group I, II, and III. APACHE II score accessed and score between 10 and 19 were blindly randomized into three procedures primary closure, resection-anastomosis, and ileostomy. The outcome was compared.Results:Ileal perforations were most commonly observed in the third and fourth decade of life with male dominance. APACHE II score was accessed and out of total 57 patients, 6 patients had APACHE II score of 0–9, 48 patients had APACHE II score of 10–19, and 3 patients had APACHE II score of ≥20. In APACHE II score 10–19, 15 patients underwent primary closure, 16 patients underwent resection-anastomosis, and 17 patients underwent ileostomy.Discussion and Conclusion:Primary closure of perforation is advocated in patients with single, small perforation (<1 cm) with APACHE II score 10–19 irrespective of duration of perforation. Ileostomy is advocated in APACHE II score 10–19, where the terminal ileum is grossly inflamed with multiple perforations, large perforations (>1 cm), fecal peritonitis, matted bowel loops, intraoperative evidence of caseating lymph nodes, strictures, and an unhealthy gut due to edema.

Surgical Audit of Patients with Ileal Perforations Requiring Ileostomy in a Tertiary Care Hospital in India.

Introduction. Ileal perforation peritonitis is a frequently encountered surgical emergency in the developing countries. The choice of a procedure for source control depends on the patient condition as well as the surgeon preference. Material and Methods. This was a prospective observational study including 41 patients presenting with perforation peritonitis due to ileal perforation and managed with ileostomy. Demographic profile and operative findings in terms of number of perforations, site, and size of perforation along with histopathological findings of all the cases were recorded. Results. The majority of patients were male. Pain abdomen and fever were the most common presenting complaints. Body mass index of the patients was in the range of 15.4–25.3 while comorbidities were present in 43% cases. Mean duration of preoperative resuscitation was 14.73 + 13.77 hours. Operative findings showed that 78% patients had a single perforation; most perforations were 0.6–1 cm in size and within 15 cm proximal to ileocecal junction. Mesenteric lymphadenopathy was seen in 29.2% patients. On histopathological examination, nonspecific perforations followed by typhoid and tubercular perforations respectively were the most common. Conclusion. Patients with ileal perforations are routinely seen in surgical emergencies and their demography, clinical profile, and intraoperative findings may guide the choice of procedure to be performed.

A comparative study between single layer versus double layer closure in ileostomy reversal

Background: Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. Formation of an intestinal stoma is frequently a component of surgical intervention for diseases of the small bowel. The technique for stoma reversal has remained controversial is the use of either one or two layers of sutures for anastomosis.Methods: Sixty patients with ileostomy were taken for study .These patients divided in two groups A and B, 30 each. These patients were taken up for ileostomy closure in single layer (group A) (n-30) &amp;double layer (group B) (n-30). Results: 60 Patients of ileostomy were studied, divided equally in 2 groups, A decreased intra operative time was seen in Group A when compared with Group B with no any significant comparative complication in these groups. Conclusion: Two-layer anastomosis for ileostomy closure offers no definite advantage over single layer anastomosis in terms of postoperative leak and other complications. Single layer ileostomy closure technique is safe, easy to perform and simply to taught. Considering duration of the anastomosis procedure and medical expenses single-layer intestinal anastomosis may prove the choice of procedure for most of the surgeons. DOI: http://dx.doi.org/10.3126/ajms.v6i2.10080Asian Journal of Medical Sciences Vol.6(2) 2015 44-47

A Comparative Study between the Outcome of Primary Repair versus Loop Ileostomy in Ileal Perforation.

Introduction. Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. It is reported to constitute the fifth common cause of abdominal emergencies due to high incidence of enteric fever and tuberculosis in these regions. Methods. Sixty proven cases of ileal perforation patients admitted to Surgical Emergency were taken up for emergency surgery. Randomisation was done by senior surgeons by picking up card from both the groups. The surgical management was done as primary repair (group A) and loop ileostomy (group B). Results. An increased rate of postoperative complications was seen in group A when compared with group B with 6 (20%) patients landed up in peritonitis secondary to leakage from primary repair requiring reoperation as compared to 2 (6.67%) in ileostomy closure. A ratio of 1 : 1.51 days was observed between hospital stay of group A to group B. Conclusion. In cases of ileal perforation temporary defunctioning loop ileostomy plays an important role. We recommend that defunctioning ileostomy should be preferred over other surgical options in cases of ileal perforations. It should be recommended that ileostomy in these cases is only temporary and the extra cost and cost of management are not more than the price of life.

Validation of the use of POSSUM score in enteric perforation peritonitis - results of a prospective study

The objective of the study was to present our last 5-years experience of peritonitis and validate POSSUM score in predicting mortality and morbidity in patients of enteric perforation (EP) peritonitis. Data was collected prospectively for all peritonitis cases admitted in single surgical unit from January 2005 to December 2009. Parameters for calculating POSSUM were also retrieved; in these patients, O:E (Observed vs. Expected) ratio of mortality and morbidity were estimated after calculating predicted mortality and morbidity by exponential regression equations. 887 patients with peritonitis were admitted and treated in this unit during the 5 years of study period. Duodenal (n=431; 48%) followed by ileal (n=380; 42.8%) perforations were the commonest. Mean age of the patients was 34 years and 86% were males. Mean delay in presentation was 78.5 hrs. Mean duration of hospital and ICU stay was 13 and 7.2 days. Postoperative complications were seen in 481 (54%) patients, and 90 (10%) patients died. POSSUM scores and predicted mortality/morbidity were calculated in 380 patients of ileal perforation peritonitis; O:E ratio of mortality and morbidity were 0.47 and 0.85 in these patients. POSSUM and P-POSSUM are accurate tools for predicting morbidity and mortality respectively in EP patients. Though they may sometime over or under predict morbidity as well as mortality.