Non-traumatic Small Bowel Perforations Research Articles

Bowel perforation and peritonitis caused by a jejunal leiomyoma. A rare complication of jejunal leiomyoma

Small-bowel leiomyomas are rare, usually indolent, benign neoplasms, sporadically associated with complications, mainly including bleeding and obstruction. Herein we report a case of a 78-year-old female patient under high-dose corticosteroid treatment for systemic disease, presenting with clinical signs suggestive of peritonitis. Urgent exploratory laparotomy revealed an intraluminal jejunal mass complicated by bowel perforation and multiple enlarged mesenteric lymph nodes. Microscopic examination of the surgical specimen suggested the presence of a jejunal leiomyoma as the cause of perforation and lymph nodes’ infiltration by Hodgkin lymphoma. The patient died on the 15th post-operative day due to pulmonary complications. To our knowledge, this is the first reported case of a jejunal leiomyoma complicated by bowel perforation and peritonitis. A high index of suspicion for the presence of underlying neoplastic disease should be maintained in cases of non-traumatic small-bowel perforation. Additionally, the potentially detrimental effect of comorbidities on a patient’s outcome should be considered even in the context of successful management of primary disease.

A STUDY OF NON TRAUMATIC SMALL BOWEL PERFORATION

Objective: Non-traumatic small bowel perforation is a rare but potentially life-threatening condition. It is important to understand the causes, clinical features, surgical procedures, complications, and outcomes associated with this condition. This study aims to investigate these aspects within a specific hospital setting.
 Methods: A retrospective analysis of medical records was conducted to identify cases of non-traumatic small bowel perforation. Data on patient demographics, etiological factors, clinical presentations, surgical procedures, complications, and outcomes were collected and analyzed. Statistical methods were employed to examine the relationships between variables.
 Results: Small bowel perforation causes vary based on development status, with typhoid and tuberculosis more common in developing countries, and Crohn's disease and malignancies prevalent in developed countries. Patients present with symptoms like abdominal pain, vomiting, and fever. Diagnosis is challenging, with laparotomy being the primary method, and mortality rates remain high, reaching up to 42%.
 Conclusion: Non-traumatic small bowel perforation is a serious condition with potentially life-threatening complications. Prompt diagnosis and aggressive surgical intervention are crucial for improving patient outcomes. Understanding the causes, clinical features, and surgical management of this condition can guide effective treatment strategies and reduce morbidity and mortality rates.

Study of management of non-traumatic small intestinal perforation

Background: Perforation of the small bowel from a wide variety of causes is a significant entity in surgical emergencies. Surgery is the cornerstone in the management of perforation peritonitis. The most common etiology is of infective origin. This study was undertaken to find out the demographic characteristics, etiological factors, clinical presentations and various surgical procedures for small intestinal perforation, it’s complications in our setup. Materials and methods: This was a prospective observational study conducted in the department of general surgery at SCB Medical College, Cuttack from January 2017 to January 2020. A total of 50 cases of non-traumatic small bowel perforation were included in this study. Results: Most common age group was 21-30 years (40%). Ileum was the most common site accounting for 80%. Sixty per cent of cases were enteric infections due to typhoid followed by tuberculosis (20%). Conclusion: Diagnosis of non-traumatic small bowel perforation is a challenge even with the advent of newer technology. Younger populations are commonly affected compared to the western population. Infective aetiology is most common in our part of the world. Early surgical intervention along with treatment of the etiological factors may lead to a better outcome.

Spectrum of presentation and prognostic factors in non-traumatic small bowel perforations

Background: The small bowel perforation peritonitis is one of the main causes of generalized acute peritonitis in developing countries.The aim is to find out the prognostic factors affecting the mortality and morbidity of non-traumatic small bowel perforations.Methods: A total of 50 patients of any age and either gender of non-traumatic small bowel perforation peritonitis were included and studied prospectively. The prognostic evaluation was assessed by the impact of pre-operative prognostic factors and per operative findings on post-operative complications and mortality.Results: One third of the patients were of 20-30 years of age followed by 18% who belonged to 10-20 years age group. Operative findings revealed mean duration of surgery was 2 hours. Majority of patients (33) had bilio-purulent peritonitis. Post-operative pulmonary complication revealed 56% (28 out of 50) patients were having pulmonary complications. Post-operative wound complication showed surgical site infection as the most common complication noted and managed by sending wound culture and changing antibiotics. Second most common was burst abdomen managed initially by dressing and thereafter secondary wound closure. Delay in intervention (DII) had significant correlation with world society of emergency surgery (WSES) score and amount of peritoneal fluid.Conclusions: Most common cause of non-traumatic small bowel perforation was typhoid ileal perforation with most common presentation being pain abdomen. The significant factors defining the outcome of these patients were volume of intra-peritoneal fluid (purulent/fecal) >1000 ml, WSES score >6 and Mannheim’s peritonitis index (MPI)>18.

Our Surgical Experience and Clinical Results in Nontraumatic Small Bowel Perforations

Our Surgical Experience and Clinical Results in Nontraumatic Small Bowel Perforations

Clinical profile and histopathological correlation of non-traumatic small bowel perforations

Non-traumatic perforation of small intestine is a common cause of peritonitis in developing countries requiring early surgical intervention. Various etiological factors have been proposed as the cause of small bowel perforation. It is difficult to diagnose cause of non-traumatic perforation of small bowel pre- operatively, so histopathology is a very important diagnostic tool. In this study consisting 40 patients, non-traumatic perforations were more common in males (72.5%) than females (27.5%) with maximum number of non-traumatic perforations (42.5%) occurring in the age group of 21-40 years and the minimum number (12.5%) occurring in the age group of ≤ 20years and >60 years, each. The most common etiology was nonspecific ileitis followed by tuberculosis, neoplasms and then, enteric fever.

Treatment results of small bowel perforations due to unusual causes.

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.

Non-traumatic intestinal perforation in the regional hospital Borgou of Benin: epidemiological and therapeutic characteristics

Background: Non-traumatic small bowel perforation is common condition in our income countries. This study aims to determine the pattern of non-traumatic intestinal perforation in our environment.Methods: The demographics, clinical features, relevant investigations, surgery performed and outcome of all the patients confirmed at surgery with intestinal perforation were collected for five years and the data analyzed using version 3.5.1 of Epi Info.Results: Out of the 69 cases involved in this study, there were 46 (66.7%) males and 23 (33.3%) females with a male/female ratio of 2; their mean age was 22.5±13.7 years (range 2 - 68 years). Young people in school constituted 23 (33,34%) of the cases and typhoid intestinal perforation was responsible for 64 (92.8%) cases while ischemic perforation as a result of postoperative flange, strangulated hernia and acute intussusception was responsible in 5 (7.2%) cases. The average duration before presentation in the hospital was 3 days while the average duration between presentation at the hospital and surgery was 2 days. The surgery offered was simple closure after freshening the edges in 35 (50.7%) cases, resection and anastomosis in 28 (40.5%) cases and resection with ileostomy in 6 (8.8 %) cases. The immediate postoperative course was uneventful in 64 (92.8%) case while the mortality was 10 (14.5%). The cause of death was not identified in 3 cases. The average hospital stay was 14.5±12.8 days with extremes of 7 and 55 days.Conclusions: NTIP is relatively common among the causes of widespread acute peritonitis in sub-Saharan Africa and its management remains difficult with high mortality.

Patient management and clinical outcomes in non-traumatic small bowel perforations

Amac: Bu calismanin amaci, travmatik olmayan ince barsak perforasyonu nedeniyle ameliyat edilen hasta yonetimimizi ve sonuclarini sunmaktir.Yontemler: Klinigimizde 2005 ve 2013 arasinda travmatik olmayan ince bagirsak perforasyonu nedeniyle ameliyat edilen 30 hastanin kayitlari incelendi. Hastalara ait yas, cinsiyet, sikayetler, belirtilerin suresi, eslik eden hastalik(lar), perforasyon yeri, hastanede kalis suresi, etyoloji, cerrahi tedavi, morbidite ve mortalite verileri kaydedildi. Hastalar yasayanlar ve olenler olmak uzere iki gruba ayrildi ve gruplarin cesitli ozellikleri karsilastirildi. Bulgular: Hastalarin yas ortalamasi 51,3±19,9 yil idi. Periton irritasyonu bulgulari 22 (% 73,3) hastada vardi. Eksplorasyonda 14 (% 46,6) hastada yaygin purulan peritonit gozlenirken, digerlerinde lokalize peritonit mevcuttu. Primer suturasyon sadece 3(%10) hastaya uygulanirken, barsak rezeksiyonu 27 (%90) hastaya uygulandi. Saptirici ileostomi 18 (%60) hastaya uygulandi. Mortalite 9 (%30) hastada gozlendi. Semptom suresi ve coklu perforasyon varligi mortalite gelisen hastalarda anlamli derecede yuksek bulundu.Sonuc: Tanida gecikme ve coklu perforasyon varligi mortalitenin en onemli nedenleridir. Tanida gecikmeyi onlemek icin her turlu caba harcanmalidir; ancak, eger tani gecikmisse, ozellikle coklu perforasyonu olan hastalarda bagirsak rezeksiyonu ve/veya ileostomi gibi genis cerrahi prosedurlerden kacinilmamalidir

The Changes in Etiology and Clinical Features of Non-Traumatic Small Bowel Perforation

Background/Aims: We investigated the clinical features, and treatment outcomes in patients with non-traumatic small bowel perforations and compared these results to the previous study with patients who were diagnosed between 1997 and 2002. Methods: Patients who diagnosed non-traumatic small bowel perforation between January 2003 and December 2008 were reviewed retrospectively. Results: Of 38 patients of non-traumatic small bowel perforation, the most common etiologies were Crohn’s disease (CD) (36.8%), followed by intestinal tuberculosis (ITB) (28.9%) and primary malignancy (15.8%). In the study of 2002, however, the most common etiologies were idiopathic (39.3%), followed by mechanical obstruction (28.6%) and infectious enteritis (14.3%). Of 38 cases, 8 perforation sites were found in the jejunum and 30 in the ileum. The number of perforations was single in 20, two in 15, and over 2 in 3 cases. Twenty-five patients were treated with resection and anastomosis, nine patients with primary closure, and four patients with both procedures. The site and number of perforations, surgical methods, and post-operative complication rates were similar to those of 2002. The perforation patients with ITB had more frequent night sweats and pulmonary tuberculosis findings than those with CD. Conclusions: Although the clinical features and surgical outcomes in the 2009 study were similar to those of the previous study conducted in 2003, the etiologies of perforations were different; CD and ITB were two most common etiologies. In addition, clinical characteristics such as night sweats or pulmonary tuberculosis were suggestive findings for the diagnosis of ITB. (Intest Res 2012;10:189-195) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Limitations in the role of ulcer edge biopsy in establishing the aetiology of nontraumatic small bowel perforation

Spontaneous small intestinal perforations are common in India. Surgeons operating on patients with an obscure peritonitis should be aware of the diverse aetiologies of small intestinal perforations in order to be able to provide the appropriate management. We reviewed the pathology records of 165 patients operated on for nontraumatic perforations of the small intestines in our hospital between 2005 and 2007. Perforation edge biopsy was diagnostic in 53 cases, with typhoid being the most common aetiology, followed by TB. The majority of cases, however, revealed only a non-specific inflammatory granulation tissue. However, the sensitivity of biopsy diagnosis could be increased by taking additional biopsy material from the mesenteric lymph nodes, tubercles or omental nodules. We conclude that perforation edge biopsy is useful in a third of cases, but the diagnostic rate could be improved by taking additional biopsy material.

Intestinal Fistulas and the Open Management of the Septic Abdomen-Reply

<i>In Reply</i>.—Dr Schein disagrees with our supposition that the occurrence of nontraumatic small-bowel perforations during open treatment for intra-abdominal sepsis has not been described so far and states that it is a well-known and documented entity. Intestinal perforations and fistulizations are indeed common complications in patients treated for intra-abdominal sepsis, but there are obvious causes for fistulization in all cases reported in the literature, such as abdominal reentry damage, anastomotic breakdown, or abdominal-wall dehiscence. Dr Schein cites several references to support his argument but, again, all these cases had obvious causes. The article by Sitges-Serra et al deals with 87 fistulas, all secondary to either anastomotic breakdown, direct trauma to the small bowel, or small-bowel inflammation. In the article by Levy et al, causes for fistulization were anastomotic dehiscence (52%), small-bowel trauma (41%), abdominal-wall necrosis (1.7%), and a combination of these factors (5.3%). Schein's own group¹described a