Nonspecific Ulcers Research Articles

Cryptogenic Multifocal Ulcerating Stenosing Enteropathy(CMUSE) and/or Chronic Non-specific Multiple Ulcers of the Small Intestine(CNSU) and Non-granulomatous Ulcerating Jejunoileitis (NGUJI).

The purpose is to make aware of the existence of the rare and exclusive small intestine (SI) diseases, namely cryptogenic multifocal ulcerating stenosing enteropathy (CMUSE) or chronic non-specific multiple ulcers of the small intestine (CNSU) and non-granulomatous ulcerating jejunoileitis (NGUJI). The article will elucidate their epidemiology, pathogenesis, clinical features, diagnosis, differentiating features and management. Recent papers have published the clinical features and diagnostic criteria of CMUSE/CNSU and NGUJI. CNSU/CMUSE is caused by gene mutations involved in the prostaglandin pathways. Although capsule endoscopy can detect these lesions, it carries a risk of retention. TNF antagonists and azathioprine have shown response in few cases. CMUSE/CNSU and NGUJI are uncommon diseases that cause relapsing SI obstruction and bleed due to short-segment strictures and multiple shallow ulcers. This article focuses on current knowledge and novel insights regarding their pathogenesis, genetics, clinical features, diagnostic criteria and management. Multicentric clinical and genetic studies are the need of the hour.

ATYPICAL DISSEMINATED NECROTIZING AND EXTENSIVE ORAL ULCERATIVE LESIONS IN PATIENT WITH DERMATOMYOSITIS

Objectives Oral ulcerative stomatitis may be seen in patients with autoimmunity in treatment with methotrexate, demonstrating a wide clinical and histopathologic spectrum that ranges from non-specific ulceration to EBV (+/-) lymphoproliferative disorders, disseminated necrotizing and ulcerative lesions affecting the gingiva extensive to the tongue has not been previously reported, we present a rare oral manifestation of methotrexate and summarize the clinicopathologic features of previously published cases. Clinical presentation A 62-year-old female patient with a 5-year history of Hodgkin lymphoma in remission, and one year of dermatomyositis in treatment with prednisone, colchicine and methotrexate, presented with burning and pain in the gingiva, which lasted 10 days. Physical examination revealed that there was multiple necrotic ulcers located in the upper and lower marginal gingiva, including the interdental papillae that extend to the palate. The inserted gingiva shows edema and petechiae, there is radicular exposure without dental mobility or bone destruction. In the left lateral border of the tongue, a crater-like ulcer is detected, irregular and indurated edges. Intervention and outcome: It was decided to suspend methotrexate previous medical interconsultation and take a biopsy. The result of pathology reported B-cell diffuse lymphoma, the large-sizes lymphoid cells were positive for CD20, CD3, CD30, EBV, Ki67 and negative for CD2, CD56, Grandzima, CD15, CD1a, k and l. After 15 days of having stopped the methotrexate there is total remission of the lesions. Based on the clinical-histological correlation, lymphoproliferative lesion associated with methotrexate was established. Conclusion Oral necrotizing and disseminated ulcerative lesions are part of the wide clinical presentation of lymphoproliferative disorders associated to methotrexate. Clinical, histopathologic and immunohistochemical evaluation, may provide the correct diagnosis.

Idiopathic myointimal hyperplasia is a distinct cause of chronic colon ischaemia.

Colon ischaemia (CI) is most commonly an acute and reversible manifestation of a transient, non-occlusive decrease of blood flow in the colonic microvasculature. Irreversible complications are uncommon and the progression to chronic CI remains controversial. Our objective was to identify cases of chronic CI and assess for distinct clinicopathological features. A retrospective review was performed of CI patients having symptom chronicity of ≥1month and ischaemic histology at our institution from 1994 to 2015. Demographic, clinical, endoscopic, radiological, pathological and outcome variables were abstracted. Histological evaluation was performed by two gastrointestinal pathologists. Fifteen patients (n=9; 67% men) with a median age of 65years (range 22-88) were identified. The most common presenting symptoms were diarrhoea and abdominal pain (n=6, 86%; n=5, 71%, respectively). The typical endoscopic appearance was segmental ulceration of the sigmoid colon (n=6, 75%). Vascular imaging showed patent mesenteric vessels in all patients. Histopathological evaluation revealed venous intimal hyperplasia consistent with idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) in eight patients; the remainder showed non-specific ulceration and fibrosis. Surgical resection was performed in seven IMHMV patients, resulting in symptom resolution. On re-review of pre-resection biopsies, all IMHMV patients had characteristic changes of hyperplastic, thick-walled, hyalinized vessels in the lamina propria. IMHMV is a unique histopathological entity causing chronic CI. The small vessel histological changes in IMHMV are distinctive in colonic resections and undetectable by routine vascular imaging. Preoperative diagnosis of IMHMV is possible with endoscopic biopsy and segmental colon resection is curative.

Cutaneous Manifestations of Extra pulmonary Tuberculosis

Background: Ulcers and surgical wounds not healing well and expectedly are common problems among patients in countries like us. Ulcers may develop spontaneously or following a penetrating injury. wounds not healing well are common among poor, lower middle class and middle class people. Postsurgical non-healing wound or chronic discharging sinuses at the scar site are also common in that class of people. Suspecting malignancy or tuberculosis in these types of wounds we have sent wedge or excision biopsy for these ulcers in about 500 cases and found tuberculosis in 65 cases. In rest of the cases histopathology reports found as non- specific ulcers, Malignant melanoma, squamous or basal cell carcinoma, Verruca vulgaris.
 Objectives: To find out the relationship of tuberculosis with chronic or nonhealing ulcers.
 Methods: This is a prospective observational study conducted for patients coming to our chambers, OPD of a district general hospital and Shaheed Suhrawardy Medical College Hospital, Dhaka from July 2012 to June 2018.
 Results: Mean age of the study subjects were 28±2. Among the study subjects nonspecific ulcer or sinus tracts were found in 418 (83.6%), tuberculosis in 65 (13%), Malignant melanoma 7 (1.4%), Verruca vulgaris 5(1%), squamous cell carcinoma 3(0.6), basal cell carcinoma 2 (0.4%). Biopsy done only for very suspicious ulcers or wounds.
 Conclusion: With this very small sample size it is difficult to conclude regarding incidence of cutaneous involvement of extra pulmonary tuberculosis , but every clinician should think of it in case of suspicious non healing wounds, ulcers and prolonged discharge from a surgical incision site.
 J Shaheed Suhrawardy Med Coll, December 2018, Vol.10(2); 86-90

Genome wide analysis for mouth ulcers identifies associations at immune regulatory loci

Mouth ulcers are the most common ulcerative condition and encompass several clinical diagnoses, including recurrent aphthous stomatitis (RAS). Despite previous evidence for heritability, it is not clear which specific genetic loci are implicated in RAS. In this genome-wide association study (n = 461,106) heritability is estimated at 8.2% (95% CI: 6.4%, 9.9%). This study finds 97 variants which alter the odds of developing non-specific mouth ulcers and replicate these in an independent cohort (n = 355,744) (lead variant after meta-analysis: rs76830965, near IL12A, OR 0.72 (95% CI: 0.71, 0.73); P = 4.4e−483). Additional effect estimates from three independent cohorts with more specific phenotyping and specific study characteristics support many of these findings. In silico functional analyses provide evidence for a role of T cell regulation in the aetiology of mouth ulcers. These results provide novel insight into the pathogenesis of a common, important condition.

Distinction between Chronic Enteropathy Associated with the SLCO2A1 Gene and Crohn's Disease.

Background/AimsWe recently identified recessive mutations in the solute carrier organic anion transporter family member 2A1 gene (SLCO2A1) as causative variants of chronic nonspecific multiple ulcers of the small intestine (chronic enteropathy associated with SLCO2A1, CEAS). The aim of this study was to investigate the gastroduodenal expression of the SLCO2A1 protein in patients with CEAS and Crohn’s disease (CD).MethodsImmunohistochemical staining for SLCO2A1 was performed with a polyclonal antibody, HPA013742, on gastroduodenal tissues obtained by endoscopic biopsy from four patients with CEAS and 29 patients with CD.ResultsThe expression of SLCO2A1 was observed in one of four patients (25%) with CEAS and in all 29 patients (100%) with CD (p<0.001). The three patients with CEAS without SLCO2A1 expression had a homozygous splice-site mutation in SLCO2A1, c.1461+1G>C (exon 7) or c.940+1G>A (exon 10). The remaining one CEAS patient with positive expression of SLCO2A1 had compound heterozygous c.664G>A and c.1807C>T mutations.ConclusionsImmunohistochemical staining for SLCO2A1 in gastroduodenal tissues obtained by endoscopic biopsy is considered useful for the distinction of CEAS from CD.

A Case of a Non-specific Small Intestinal Ulcer Treated with Single-incision Laparoscopic Surgery after intestinal Endoscopic Marking

A Case of a Non-specific Small Intestinal Ulcer Treated with Single-incision Laparoscopic Surgery after intestinal Endoscopic Marking

Laparoscopic Surgery of Intestinal Obstruction due to Nonspecific Ulceration of the Small Intestine—A Case Report—

Laparoscopic Surgery of Intestinal Obstruction due to Nonspecific Ulceration of the Small Intestine—A Case Report—

Case of surgical treatment of the heavy nonspecific ulcer colitis complicated by massive bleeding

Complex treatment of patients with nonspecific ulcerative colitis is one of the most difficult problems of modern gastroenterology and is characterized by ulcerative-destructive changes of its mucous membrane. The main indications for surgical treatment of patients with nonspecific ulcer colitis are its complications, as well as the inefficiency of multi-component conservative therapy. The case of treatment of a young patient suffering from ulcerative colitis complicated by bleeding is considered. The possibility of performing radical surgical interventions for complications of ulcerative colitis is shown. One of the most dangerous, life-threatening complications of ulcerative colitis is bleeding. Most operations in patients with bleeding are performed urgently in extremely adverse conditions, due not only to the severity of bleeding, posthemorrhagic anemia and significant violations of hemostasis, but also the presence of concomitant complications of nonspecific ulcerative colitis, as well as associated multiple organ dysfunction. Thus, during the hospitalization of the patient, which amounted to 48 days, the patient underwent 11 open surgical interventions. For proper treatment it took more than 25 liters of blood products. Attention is paid to the favorable long-term result of treatment of patients with this pathology. In the treatment of this category of patients should be aware of the possibility of using minimally invasive technologies. The urgency of the problem under consideration is increased due to the steady increase in the incidence of nonspecific ulcerative colitis, which is naturally accompanied by an increase in the frequency of complications and disability of patients, a significant part of whom are the most efficient and socially active patients aged 20-40 years, with the causes and mechanisms of their development are not fully known.

Unusual perforation of the small bowel: A case report and literature review

Spontaneous, non-traumatic perforation of the small bowel is an uncommon surgical emergency. Although, duodenojejunal flexure is a common site for traumatic bowel perforation due to its relative fixation by the ligament of treitz, Hereby, we present case of a 75-year-old man who presented with spontaneous perforation of duodenojejunal flexure secondary to a non-specific ulcer. The patient underwent emergency laparotomy and resection of the affected part of small bowel. Postoperatively, he made a good recovery and was discharged home. Early recognition and radical surgical resection of the affected small bowel ulcer site is considered the best treatment, and has a favourable outcome.

Granulomatous Esophagitis: Crohnʼs Disease in Rare Form

Introduction: Esophageal Crohn's disease (CD) is rare but must be recognized and distinguished from other esophageal diseases and treated accordingly. Case Report: A 35-year-old Caucasian man with CD presented with solid food dysphagia with associated odynophagia, heartburn and weight loss. He had a 20-year history of severe ileocolonic and perianal CD requiring subtotal colectomy and end ileostomy, subsequent ileal resection and ileostomy revision and multiple perianal drainage procedures. There was no history of upper gastrointestinal involvement. He previously lost response to infliximab and certolizumab and was then maintained successfully on adalimumab. An upper endoscopy revealed multiple deep, longitudinal ulcers coursing the length of the esophagus (Figure 1) with biopsies showing severe, non-specific inflammation and ulceration. A 12-week trial of twice daily proton pump inhibitor (PPI) resulted in partial relief of symptoms. A subsequent endoscopy showed no mucosal healing, and biopsies revealed dense inflammation and multiple small, non-caseating granulomas (Figure 2). Adalimumab and twice daily PPI were continued, and a prednisone taper followed by twice daily swallowed viscous budesonide resulted in significant improvement in symptoms as well as in endoscopic and histologic healing on follow-up endoscopy (Figure 3). Discussion: CD of the esophagus was first described in 1950 and is the least common location of disease in the GI tract. The prevalence among those with CD is estimated to be between 0.2-6.8% in adults with slightly higher prevalence reported in children, possibly because routine upper endoscopy is recommended in pediatric but not adult CD guidelines. Approximately 80% of patients have localizing symptoms including dysphagia and odynophagia. Non-specific inflammatory changes and ulcers are common on endoscopy and histology, but approximately 20% have detectable non-caseating granulomas. Care must be taken to rule out acid reflux, herpetic or tuberculous infection, pill esophagitis and infiltrative disease. PPI's, systemic and topical steroids and biologic therapies are the mainstays of management, while stricturing or fistulizing disease may require endoscopic dilation or surgery.1747_A Figure 1 No Caption available.1747_B Figure 2 No Caption available.1747_C Figure 3 No Caption available.

Capsule Endoscopy for Obscure Gastrointestinal Bleeding: A Single‑Center Experience

ABSTRACT Background: Capsule endoscopy (CE) has an established role in evaluating obscure gastrointestinal bleeding (OGIB). The aim was to know the diagnostic yield of CE and spectrum of OGIB. Materials and Methods: In this retrospective study, we evaluated all the patients with obscure gastrointestinal bleed using MiroCam capsule endoscope (IntroMedic, Seoul, Korea) between February 2014 and March 2018. Clinical data, ancillary investigations, and response to specific treatment were considered to confirm CE findings. Results: Out of 102 patients included in the study (mean age 54.5 ± 16.1 years, male: female ratio = 1.83:1) OGIB‑overt and OGIB‑occult was present in 46 and 56 patients, respectively. Diagnostic yield of CE was similar in both the groups (overt‑37/46, 80.4% versus occult‑37/56, 66.5%) (P ≥ 0.05), although there was trend to find more lesions in overt group. Overall positive diagnostic yield was 72.5%. Lesions detected were vascular malformations in 21 (20.5%), nonsteroidal anti‑inflammatory drug enteropathy in 13 (12.7%), small bowel ulcerations in 27 (26.4%), which were further divided into three subgroups (a) nonspecific ulcerations 11 (10.7%), (b) tubercular ulcer with/without stricture in 7 (6.8%) and (c) serpiginous ulcers and fissuring with cobble‑stone appearance suggestive of Crohn’s disease in 9 (8.8%), portal hypertensive enteropathy in 5 (4.9%), worm infestation (hookworms in 3, roundworms 1) in 4 (3.9%), and small bowel tumour in 1 (0.98%) patient. Overall, 56.7% patients were having definitive (P2) lesions (Saurin classification). Two patients had retention of capsule, but none developed intestinal obstruction. Capsule was removed with surgical intervention. Conclusion: CE has high diagnostic yield, relative safety and tolerability, and it is an important diagnostic tool for OGIB. Small bowel tuberculosis, Crohn’s disease and Worm infestation continue to be commonly recognized causes of OGIB in developing countries like India.

Nonspecific Oral Ulcerations in A Patient with HIV Infection: A Case Report

Oral ulcerations in HIV infection pose challenges to diagnosis because of the associated diversity of pathologic alterations and etiologic agents. The final diagnosis of nonspecific oral ulcerations is achieved by excluding infections or neoplastic processes. A 48-year old man with HIV infection refractory to highly active antiretroviral therapy presented with a CD4 count of 13 cells/mm3 and complaints of epigastric pain, weakness, and weight loss. Endoscopic examination showed deep ulcers in the esophagus and stomach. Intraoral examination revealed painful ulcerative metachronous lesions in the mouth floor and soft palate. The differential diagnosis included viral or fungal infection, lymphoma, and squamous cell carcinoma; incisional biopsy and histopathologic analysis were not conclusive. Serology, polymerase chain reaction, and immunohistochemistry were also negative for cytomegalovirus, Epstein-Barr virus, and herpes simplex virus 1 and 2. Thalidomide treatment resulted in resolution of oral lesions. This case shows the importance of the dental team in the diagnosis of oral lesions in patients with HIV infection.

Prolonged Intubation Injuries of the Larynx: Endoscopic Diagnosis, Classification, And Treatment.

Laryngeal trauma from prolonged endotracheal intubation occurs in patients of all ages. Most changes are superficial and heal quickly. Injuries that are found consistently during intubation include nonspecific changes, edema, granulation tissue, ulceration, and othermiscellaneous injuries. In thispapersignificant, severe, and lasting trauma of the larynx has been classified on thebasis of theknown factors in pathogenesis, observations made atendoscopy, and photographic documentation. This classification has required introduction of new descriptive terminology: "tongues of granulation tissue," "ulcerated troughs," "healed furrows," and "healed fibrous nodule." During intubation the degree of injury can be precisely assessed under general anesthesia by using telescopes for image magnification, thus assisting adecision whether to continue intubation orperform tracheotomy to minimize long-term morbidity. Changes that are found after extubation result from granulation tissue, ulceration, ora combination of both and have been illustrated on flow charts; a knowledge and understanding of these sequelae allows them to be identified by both indirect and direct laryngoscopy so that treatment can be planned.

Nicorandil ulcer: a frequent diagnosis, a rare etiology

Oral ulcers are a relatively frequent diagnosis in otolaryngology practice. They may have a vast etiology, the iatrogenic medication one of them nicorandil is an anti-ischemic drug used in coronary artery disease and is frequently used in combination with other anti-anginal drugs. There are reports of the association between nicorandil and the appearance of painful oral ulcers, with repercussion on patients' quality of life. The authors describe a case of a 76-year-old man man with ischemic heart disease past that presented to the emergency department complaining of ulcers on the tongue with 1 week of evolution. He had been medicated with long-standing nicorandil, however he had increased the dose one month before the urge of lesions. He was treated with topical corticosteroid and anti-fungal, with no response. The objective examination showed three ulcerated lesions in the tongue. Given the characteristics of the lesions and absence of response to therapy previously instituted, biopsies were performed. The histopathological results showed nonspecific ulceration aspects. Discussed the case with his Cardiologist and, given the temporal association between increased nicorandil dose and the appearance of the lesions, we decided for the drug suspension. In the revaluation after two weeks, there was favorable evolution, and 45 days after, the lesions had completely disappeared. For the diagnosis of oral ulcers, being of extremely importance to exclude neoplastic causes, it is relevant not to forget also the rarest etiologies, which although difficult to identify, may lead to a better quality of life and less use of medical care. &lt;p&gt; &lt;/p&gt;

Local and therapeutic intervention in the management of dushta vrana w.s.r. to tropic ulcer – a case study

An ulcer is a break in the continuity of the covering epithelium- skin or mucous membrane. Trophic ulcer is a kind of nonspecific ulcer. Wound healing is a mechanism where the body attempts to restore the integrity of the injured part. A clear wound heals earlier with a minimum scar as compared to contaminated wound. Several factors affect the normal process of wound healing such as the site of ulcer, vascular insufficiency, malnutrition, neurological deficit and drugs like corticosteroids. AcharyaSushruta mentioned 60 Upakramasfor the management of Vrana, Kashay Are among them. With NyagrodhadiKashaypatient was treated successfully and after the follow up ulcer was healed completely and the patient showed marked improvement. A case report of 26-year young male presented with an ulcer over the left foot which was painless, slough on the floor and loss of sensation over the distal 2/3rd of left foot has been presented here.

CONCOMITANT SEXUALLY TRANSMITTED DISEASES IN PATIENTS WITH DIAGNOSED HIV/AIDS: A RETROSPECTIVE STUDY.

Background:Human immunodeficiency virus (HIV) is a virus that causes Acquired Immunodeficiency Syndrome (AIDS) which weaken the human immune system and thus increasing the incidence of sexually transmitted infections (STIs) and vice versa.Materials and Methods:A retrospective study of STIs in HIV/AIDS patients in Unit Perawatan Intermediate Penyakit Infeksi (UPIPI) Dr. Soetomo General Hospital Surabaya was conducted from January 1st, 2013 to December 31st, 2014. We examined the number and type of STIs, age distribution, gender, occupation, number of CD4+, and antiretroviral treatment of patients with HIV/AIDS. The data were presented in a descriptive analysis.Results:The percentage of STIs patients was 4.2% (148 of 3.350) of all patients with HIV/AIDS in the UPIPI Outpatient Clinic of Dr. Soetomo General Hospital. Most patients were 25-44 years old (70.9%) including 54.7% were males, 8.0% were housewives, and 1.4% were students. The five highest prevalence of STIs were condylomata acuminate (43.9%), non-specific genital ulcers (11.5%), syphilis (10.7%), genital herpes (10.1%), and scabies (8.1%). The sexual predilections consisted of heterosexual (70.9%), homosexual (12.2%), bisexual (2.0%), and no data (14.9%). Patients with the number of CD4+ <200 mm3 was 52.0% and 79.1% of the patients received ARV therapy.Conclusion:STIs and HIV/AIDS were closely related. HIV/AIDS could increase the incidence of STIs and STIs could elevate HIV/AIDS.

Management of occult obscure gastrointestinal bleeding patients based on long-term outcomes.

Background:There is no consensus regarding the management of occult obscure gastrointestinal bleeding (OGIB) patients without a confirmed bleeding source. This study aimed to consider the management of occult OGIB patients based on their long-term outcomes.Methods:We retrospectively enrolled 357 consecutive occult OGIB patients (203 men; mean age: 59.7 years) who underwent capsule endoscopy (CE) at Hiroshima University Hospital, Japan and were followed up for more than 12 months (mean follow-up period; 50.2 months). Patients were divided into three groups as follows: Group A consisted of 98 of 157 patients who had positive findings and indication for treatment, Group B consisted of 59 of 157 patients who had positive findings but no indication for treatment, and Group C consisted of 200 patients who had negative small-bowel findings. We examined the rate of positive CE findings, detection rate and details of bleeding sources, overt bleeding rate, the rate of anemia exacerbation, 5-year anemia exacerbation rate, and overall survival rate.Results:The positive CE findings rate was 44% (157/357) and detection rate of bleeding source was 27% (98/357). The details of Group A were as follows: angioectasia (n = 61), nonspecific ulceration (n = 10), nonsteroidal anti-inflammatory drug-induced ulcer (n = 8), and others (n = 19). The details of Group B were as follows: erythema (n = 31), angioectasia (n = 25), and others (n = 3). There were no patients with overt bleeding in Group B. Although six patients had anemia exacerbation in Group B, they had angioectasia without a bleeding source.Conclusion:The long-term outcomes of occult OGIB patients were good. Occult OGIB patients without bleeding source lesions may not require follow-up CE.

Roles of Organic Anion Transporting Polypeptide 2A1 (OATP2A1/SLCO2A1) in Regulating the Pathophysiological Actions of Prostaglandins.

Solute carrier organic anion transporter family member 2A1 (OATP2A1, encoded by the SLCO2A1 gene), which was initially identified as prostaglandin transporter (PGT), is expressed ubiquitously in tissues and mediates the distribution of prostanoids, such as PGE2, PGF2α, PGD2 and TxB2. It is well known to play a key role in the metabolic clearance of prostaglandins, which are taken up into the cell by OATP2A1 and then oxidatively inactivated by 15-ketoprostaglandin dehydrogenase (encoded by HPGD); indeed, OATP2A1-mediated uptake is the rate-limiting step of PGE2 catabolism. Consequently, since OATP2A1 activity is required for termination of prostaglandin signaling via prostanoid receptors, its inhibition can enhance such signaling. On the other hand, OATP2A1 can also function as an organic anion exchanger, mediating efflux of prostaglandins in exchange for import of anions such as lactate, and in this context, it plays a role in the release of newly synthesized prostaglandins from cells. These different functions likely operate in different compartments within the cell. OATP2A1 is reported to function at cytoplasmic vesicle/organelle membranes. As a regulator of the levels of physiologically active prostaglandins, OATP2A1 is implicated in diverse physiological and pathophysiological processes in many organs. Recently, whole exome analysis has revealed that recessive mutations in SLCO2A1 cause refractory diseases in humans, including primary hypertrophic osteoarthropathy (PHO) and chronic non-specific ulcers in small intestine (CNSU). Here, we review and summarize recent information on the molecular functions of OATP2A1 and on its physiological and pathological significance.

Comparison between Outcome of Wedge Excision of Perforation Site and Trimming of Perforation Margin Followed by Primary Repair in the Management of Ileal Perforation

The aim of this study is to compare between the outcome of wedge excision of perforation site and trimming of perforation margin followed by primary repair in the management of ileal perforation in selected patients. This is an observational study with data from department of Surgery, Sir Salimullah Medical College and Mitford Hospital during February, 2007 to July, 2010. The study included 108 patients of ileal perforation of 15-67 years of age. All patients were treated by primary repair after either wedge excision of perforation site (Group I) or trimming of perforation margin (Group II). Perforation due to typhoid is common in both groups. Abdominal pain, fever, abdominal distention, constipation and vomiting were more frequent in both groups of patients. Signs of peritonitis were observed almost all the patients. Pneumoperitoneum was found 77.8% in group I and 66.7% in group II in X-ray. In ultrasonography ascitis and distended bowel loop was found 44.4% in group I and 66.7% in group II. Typhoid, tuberculosis, nonspecific ulcer and chronic nonspecific ulcer were found in histopathology. Post-operative complications were more in group II. Anastomotic leakage was found 18.5% in group I and 38.9% in group II. Prolonged ileus was observed 16.7% in group I and 33.3% in group II. Anastomotic leakage and Prolonged ileus difference were statistically significant (p&lt;0.05). The mean duration of hospital stay was significantly (p&lt;0.05) higher in group II, where the mean(±SD) duration of hospital stay was 14.2±7.2 days in group I and 18.1±8.9 days in group II. Mortality was observed 9.3% only in group II. So Wedge excision followed by primary repair is better in terms of post operative mortality and morbidity in the management of ileal perforation in selected patients.Medicine Today 2017 Vol.29(2): 17-20