Perforation Of Terminal Ileum Research Articles

Cecum Necrosis with Terminal Ileum Perforation Due to Invasive Fungal Infection in a Patient with Diabetes Mellitus and Acute Myeloid Leukemia: A Case Report

Introduction: Immunosuppression conditions are the leading risk factors for opportunistic fungal infections. The clinical manifestation is related to the site of infection. Gastrointestinal (GI) mucormycosis is a rare form of this disease, even in immunosuppressed patients. Case Presentation: We report rare cecum necrosis with terminal ileum perforation resulting from infiltration of mucormycosis in the cecum wall and terminal ileum mesentery in a patient with diabetes mellitus and acute myeloid leukemia (AML). During chemotherapy for AML, the patient presented diarrhea followed by constipation, severe progressive abdominal pain, and fecaloid peritonitis. Perforation of the terminal ileum was observed during the surgery. Ileostomy, right hemicolectomy, and resection of necrotic tissue were performed, and bowel mucormycosis was confirmed on histologic examination. Unfortunately, the patient expired five days after surgery. Conclusions: Gastrointestinal mucormycosis is an uncommon infection with symptoms like abdominal pain, nausea, vomiting, and melena. The mortality of GI involvement is due to perforation, peritonitis, and GI bleeding.

Gastrointestinal perforations by ingested foreign bodies: A preoperative diagnostic flowchart-based experience. A case series report.

BackgroundGastrointestinal tract perforation is the most harmful complication of Foreign Body (FB) ingestion, besides diagnostic delay adversely affects the outcome. This paper aims to present our preoperative diagnostic flowchart and describe the surgical management in a Tunisian center.MethodsA retrospective review of 48 patients with gastrointestinal perforation by ingested FB treated in the surgery department of Jendouba Hospital. January 2010–December 2020.Results48 patients were treated for gastrointestinal tract perforation induced by FB ingestion. The mean age was 56.6 years. The sex ratio was 2/1. Acute abdominal pain was reported in all the patients. 35 patients had abdominal X-ray that showed a FB in 12 cases. CT scan was performed in 38 patients and identified the FB in 28 cases. Postoperative proofreading has identified a preoperative missed diagnosis of FB perforation in 5 cases, all before applying the diagnostic flowchart. All patients underwent open surgery after a median time of 7.12 h. This duration decreased after applying the flowchart (8.21 h versus 5.6 h). 33 patients had a terminal ileum perforation. Enterectomy was performed in 33 patients. Postoperatively, there was one abdominal abscess, one pulmonary embolism, one refractory septic choc, and one wound abscess. The median hospital stay was 6.35 days. The mortality rate was 6.25%. All patients managed with enterostomy had their stoma closed after 3–5 months.ConclusionsThe challenge of gastrointestinal perforation due to FB ingestion is accurate diagnosis and early management. A standardized initial assessment based on a diagnostic flowchart is helpful to achieve this goal and improve outcomes.

A Rare Case of Pneumoperitoneum in Pregnancy: Perforation of Tubercular ileal Ulcer

The incidence of tuberculosis (TB) is rising worldwide, despite the efficacy of the BCG vaccination. Populations at greatest risk of contracting TB are migrant communities, as well as immunocompromised individuals. The diagnosis of intestinal tuberculosis can often present as a diagnostic conundrum, due to its nonspecific and varied presentation, often mimicking inflammatory bowel disease or malignancy. Free perforation is one of the most feared complications of the intestinal tuberculosis. The terminal ileum is the most common site of perforation, while the majority of (90%) perforations are solitary. We present a 25 year old 17 weeks primi presented with peritonitis with solitary perforation of terminal ileum with miscarriage of fetus and subsequent surgical wedge resection of ileum and ileo-ileal anastomosis. Histology revealed presence of Langerhan’s cell with caseating granulomatous inflammation. There was no radiological evidence of pulmonary tuberculosis. Patient was started on anti-tubercular therapy and responded well. This present case underscores the importance of biopsy specimens taken from the margins of patients with ileal perforation to avoid the misdiagnosis of such condition.

A Rare case of pneumoperitoneum in pregnancy: Perforation of Tubercular ileal Ulcer

The incidence of Tuberculosis (TB) is rising worldwide, despite the efficacy of the BCG vaccination. Populations at greatest risk of contracting TB are migrant communities, as well as immunocompromised individuals. The diagnosis of intestinal tuberculosis can often present as a diagnostic conundrum, due to its nonspecific and varied presentation, often mimicking inflammatory bowel disease or malignancy. Free perforation is one of the most feared complications of the intestinal tuberculosis. The terminal ileum is the most common site of perforation, while the majority of (90%) perforations are solitary. We present a 25 year old 17 weeks primi presented with peritonitis with solitary perforation of terminal ileum with miscarriage of fetus and subsequent surgical wedge resection of ileum and ileo-ileal anastomosis. Histology revealed presence of Langerhan’s cell with caseating granulomatous inflammation. There was no radiological evidence of pulmonary tuberculosis. Patient was started on anti-tubercular therapy and responded well. This present case underscores the importance of biopsy specimens taken from the margins of patients with ileal perforation to avoid the misdiagnosis of such condition.

Terminal Ileum Perforation

Intestinal perforation is an uncommon complication and presentation of verocytotoxigenic Escherichia coli (VTEC) infection in individuals with Prader-Willi syndrome (PWS). The common site of perforation from VTEC infection is in the colon (and almost exclusively in the pediatric population), whereas PWS is in the stomach. Terminal ileum perforation is uncommon and is not reported in either these 2 conditions. We report a death from terminal ileum perforations in an adult who had PWS and was infected with VTEC. Potential reasons why the perforation occurred at this rare location, rather than in other more common location, in an adult are discussed.

A woman with abdominal pain while being treated with steroid

Introduction/Background Saccharomyces cerevisiae is a yeast of the phylum Ascomycota which can be used in food production. It has rarely been mentioned in the literature as a cause of human disease. Various types of infections have been reported, primarily bloodstream infections. Whether Saccharomyces is a cause of true infection in other sites as compared to a culture contaminant is controversial, as it is considered a normal part of the gastrointestinal (GI), vaginal, and respiratory mucosal flora. The main risk factors for infection with Saccharomyces are immunodeficiency including chemotherapy, history of a central venous catheter, gastroenterological surgery, and use of antibiotics or probiotics. We present the case of an 80-year-old woman who, after five days of dexamethasone treatment for COVID-19 pneumonia, presented with worsening abdominal pain. The patient was diagnosed with perforated diverticulitis, complicated by Saccharomyces cerevisiae fungemia. We will discuss the management of Saccharomyces cerevisiae fungemia and other infections to highlight the difficulty in management and high mortality risk associated with similar infections. Case Presentation An 80-year-old woman with no known medical history was admitted for COVID-19 pneumonia and hypoxia, for which she required four liters of oxygen. She was initially treated with dexamethasone, remdesivir, cefepime, and azithromycin. On the fifth day of hospitalization, she developed acute generalized abdominal pain. Computed tomography of the abdomen and pelvis (figure 2) showed pneumoperitoneum, sigmoid versus terminal ileum perforation, and two abscesses (measuring 5.5 cm and 8 cm in the largest diameters) in the pelvis. Surgical team recommended non-operative management. On days eight and ten of illness, blood cultures were obtained and grew Saccharomyces cerevisiae. Piperacillin-tazobactam was started for empiric GI coverage. Micafungin was started when yeast was identified in blood cultures and was subsequently switched to oral voriconazole once the yeast was identified as Saccharomyces. Blood cultures cleared four days after first positive. Due to persistently worsening leukocytosis, an exploratory laparotomy with sigmoidectomy and end colostomy was performed on day twelve of hospitalization. Intraoperative diagnosis of Hinchey stage IV diverticulitis (diverticulitis with generalized fecal peritonitis) was made. A drain was placed, and cultures from the abscess fluid grew Saccharomyces cerevisiae. In addition to the Saccharomyces isolate, a Mucor species grew in the abscess culture after four days, and the patient was transitioned to liposomal amphotericin B. Two days after amphotericin was started, the patient developed acute encephalopathy to the point where she was non-responsive to pain, believed to be secondary to amphotericin B neurotoxicity. She required transfer to a surgical intensive care unit. Liposomal amphotericin B was changed to intravenous posaconazole. Within 48 hours of stopping amphotericin, the patient's mental status showed moderate improvement and she was disoriented but conversive. She then developed refractory hypoxia and progressive kidney dysfunction, and ultimately required intubation and continuous renal replacement therapy. Surgical team questioned posaconazole as a cause for her worsening renal function, and she was subsequently switched to intravenous Isavuconazole. The patient continued to decline, requiring vasopressor support. She developed refractory metabolic acidosis and lactic acidosis, and hypoxia uncorrected with maximum ventilatory support. The patient's family requested to transition to comfort measures, and the patient expired on day 21 after initial COVID-19 admission. Discussion In one study, Saccharomyces cerevisiae was considered one of the nosocomially acquired infections. It has been reported to cause an average of 1.7% of all fungal cases. Our patient developed Saccharomyces cerevisiae after evidence of diverticulitis complicated by bowel perforation in the setting of being treated with broad-spectr m antibiotics and while not being known to use probiotics. Various types of GI infections have been reported in Saccharomyces cerevisiae, including esophagitis, peritonitis, liver abscess and a link to Crohn's disease, where antibodies to Saccharomyces cerevisiae are a sensitive and specific test. A key element in the management of Saccharomyces cerevisiae is the removal of the infected foreign bodies and the purification of the source. There are no guidelines for dealing with Saccharomyces cerevisiae infections, it is well known that it is susceptible to amphotericin B. Several different types of azole drugs have been investigated, resistance to itraconazole and fluconazole have been reported. Better susceptibility Results were observed with voriconazole and posaconazole. The mortality rate of Saccharomyces cerevisiae fungemia remains high and was reported in one study as 29.5%. Saccharomyces cerevisiae fungemia is a rare, lifethreatening disease with no clearly defined treatment guidelines. Further studies are needed to better understand the therapeutic antifungals options. (Table Presented).

Synchronic Pulmonary and Intestinal Tuberculosis in an Elderly Patient

We present the case of an elderly woman who presented to the ER with acute abdomen. During surgery, a free perforation in terminal ileum was found so ileostomy and resection were made. Pathology examination reported intestinal tuberculosis, and plain thorax radiography showed a classic Ghon complex. We present a brief report of this uncommon entity. Keywords: Gastrointestinal Tuberculosis; Mycobacterium tuberculosis Infections; Ileostomy

S2275 All at Once: Dual Novel Diagnosis of Crohn’s Disease and Colonic Adenocarcinoma in a 22-Year-Old Man

INTRODUCTION: Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the United States. Mucinous adenocarcinoma makes up 10-15% of all CRC and disproportionately affects younger adults. One study found that those aged 25 and younger who developed CRC present acutely and when compared to older adults, were diagnosed at a more advanced stage and carried a poorer prognosis.[1] Crohn’s disease frequently presents in ages 20-29 and can increase risk of CRC. CASE DESCRIPTION/METHODS: A 22 year old male with no significant past medical history presented to ED with intermittent abdominal pain, diarrhea and weight loss. Initial labs revealed leukocytosis, elevated CRP/ESR and positive fecal occult blood test. CT imaging revealed hepatic flexure stricture with dilation of the ascending colon and distal ileum with enlarged ileocolic lymph nodes (Figure 1). Colonoscopy revealed moderate stenosis at the hepatic flexure with significant inflammation and ulceration which prevented a pediatric colonscopy from traversing. Descending colon had scattered moderate inflammation. Two days following the colonoscopy, the patient developed a bowel perforation which required emergent exploratory laparotomy with open right hemicolectomy and diverting loop ileostomy. Surgical findings included terminal ileum perforation, dense stricture at the hepatic flexure with adherence to the underlying duodenum without fistula. Pathology report revealed adenocarcinoma in the ascending colon invading into the visceral peritoneal surface, with extensive lymphovascular invasion. The cancer was staged at G3pT4aN2a. The uninvolved terminal ileum revealed active inflammation consistent with Crohn’s disease. Genetic testing was only positive for polysomy of chromosome 17. He was ultimately diagnosed with mucinous adenocarcinoma with signet ring cell features in the setting of newly diagnosed Crohn’s disease (Figure 2). DISCUSSION: This is a rare case of advanced mucinous adenocarcinoma with signet ring features of the ascending colon in a 22-year-old with previously undiagnosed Crohn’s disease. This demonstrates the importance and difficulty of considering CRC in the differential when working up a young adult for GI symptoms as the newly diagnosed Crohn’s disease seemed to fit our patient’s presentation perfectly.Figure 1.: Stricture at the hepatic flexure with dilation of the ascending colon and distal ileum.Figure 2.: Signet ring cells.

Bacteremia by Leuconostoc mesenteroides in an immunocompetent patient with chronic Chagas disease: a case report

BackgroundThe Leuconostoc mesenteroides are members of the Streptococcae family and currently has been recognized as potential pathogens. This case describes a bacteremia caused by L. mesenteroides in an immunocompetent patient affected by Chagas disease.Case presentationA 67-year-old female patient with chagasic megaesophagus and megacolon was submitted to a Heller myotomy for achalasia in 2000 and endoscopic dilatation in 2015. Patient was admitted to the Nutrology Ward in May 2016 with protein-calorie malnutrition associated with achalasia and receiving enteral nutrition. In July 2016, the patient underwent a Serra-Doria surgery. In the third postoperative day she presented an important abdominal distension. She was submitted to a new surgical intervention, and then a terminal ileum perforation was detected, leading the surgeon to perform an enterectomy with side-to-side anastomosis. The next day after the surgery (4th postoperative day) the patient presented a decreased level of consciousness (Glasgow coma scale = 8), hypotension and hypoxemia. In two samples of blood cultures there was growth of Leuconostoc mesenteroides. Susceptibility pattern was evaluated by the diffusion disk method. The microorganism was susceptible to penicillin, ampicillin, chloramphenicol, erythromycin, and fluoroquinolones, but resistant to rifampin, tetracycline, vancomycin and teicoplanin.ConclusionWe concluded that infections caused by L. mesenteroides is serious and should be considered not only in settings of immunosuppression and prolonged antimicrobial use, but also in immunocompetent patients undergoing surgeries involving the gastrointestinal tract.

Modifiable risk factors for typhoid intestinal perforations during a large outbreak of typhoid fever, Kampala Uganda, 2015

BackgroundBetween January and June, 2015, a large typhoid fever outbreak occurred in Kampala, Uganda, with 10,230 suspected cases. During the outbreak, area surgeons reported a surge in cases of typhoid intestinal perforation (TIP), a complication of typhoid fever. We conducted an investigation to characterize TIP cases and identify modifiable risk factors for TIP.MethodsWe defined a TIP case as a physician-diagnosed typhoid patient with non-traumatic terminal ileum perforation. We identified cases by reviewing medical records at all five major hospitals in Kampala from 2013 to 2015. In a matched case-control study, we compared potential risk factors among TIP cases and controls; controls were typhoid patients diagnosed by TUBEX TF, culture, or physician but without TIP, identified from the outbreak line-list and matched to cases by age, sex and residence. Cases and controls were interviewed using a standard questionnaire from 1st -23rd December 2015. We used conditional logistic regression to assess risk factors for TIP and control for confounding.ResultsOf the 88 TIP cases identified during 2013–2015, 77% (68/88) occurred between January and June, 2015; TIPs sharply increased in January and peaked in March, coincident with the typhoid outbreak. The estimated risk of TIP was 6.6 per 1000 suspected typhoid infections (68/10,230). The case-fatality rate was 10% (7/68). Cases sought care later than controls; Compared with 29% (13/45) of TIP cases and 63% (86/137) of controls who sought treatment within 3 days of onset, 42% (19/45) of cases and 32% (44/137) of controls sought treatment 4–9 days after illness onset (ORadj = 2.2, 95%CI = 0.83–5.8), while 29% (13/45) of cases and 5.1% (7/137) of controls sought treatment ≥10 days after onset (ORadj = 11, 95%CI = 1.9–61). 68% (96/141) of cases and 23% (23/100) of controls had got treatment before being treated at the treatment centre (ORadj = 9.0, 95%CI = 1.1–78).ConclusionDelay in seeking treatment increased the risk of TIPs. For future outbreaks, we recommended aggressive community case-finding, and informational campaigns in affected communities and among local healthcare providers to increase awareness of the need for early and appropriate treatment.

Clinicopathological study of Ileal perforation: study in tertiary center

Background: The objective of this study was to evaluate the clinicopathological characteristics in Ileal perforations because of confusion and controversy over the diagnosis and optimal surgical treatment of terminal Ileal perforation -a cause of obscure peritonitis. Perforation of terminal ileum is a cause for obscure peritonitis with severe toxic state, there may be obscured clinical features with resultant delays in diagnosis and adequate surgical intervention.Methods: A prospective study was conducted in Victoria Hospital and Bowring and Lady Curzon Hospital attached to Bangalore Medical College and Research Institute over a period of 5 years from June 2011 to May 2015. A total of 136 patients presented in this period with hollow viscus perforation and out of these 64 patients had Ileal perforation alone on exploratory laparotomy. Ileal perforations account for about 20 percent of all cases of hollow viscus perforation. Emergency exploratory laparotomy was done and perforation was identified, edge biopsy was taken in all cases and the perforation was closed in two layers and resection anastomosis was done in stricture with perforation. Histopathological report was reviewed following surgery.Results: A total of 64 patients with Ileal perforation were included in the study of which 52 were males and 12 were females accounting for 81.25 percent and 18.75 percent respectively. The causes for perforation were enteric fever (82.81%), nonspecific inflammation (9.38%), and tuberculosis (7.81%). Simple closure of the perforation (74.58%) and the remaining primary resection and anastomosis were the mainstay of the surgical management.Conclusions: The common pathology of Ileal perforation is Typhoid or Enteric fever, Non-specific ulcer, Tuberculosis and others. Intestinal complications of typhoid fever are quite common in developing countries. Nonspecific inflammation of the terminal ileum was other predominant cause operative findings were similar to that of typhoid fever but no laboratory evidence of the disease was found. Intestinal tuberculosis can mimic many conditions.

Toothpick perforation of small intestine in an adult

The patient presented in Emergency with Pain right iliac fossa for last 24 hours. It was sudden in onset, mild in intensity, non-radiating to any site, and was associated with mild fever. About 5-6 episodes of vomiting occurred in that period. Her menstrual history was normal. She was taking medication for Rheumatoid Arthritis fort last three months. With Alvarado Score of 6 a clinical diagnosis of Acute Appendicitis was made. X-ray Abdomen did not reveal any abnormality, Blood C/E, Urine C/E, Blood sugar blood urea and serum electrolytes. After preparation, patient was taken to the theatre. Rutherford Morrison incision was made. Her appendix was difficult to locate but was normal. Strangely a toothpick was seen in the mesentery of appendix and there was a pinpoint perforation in terminal ileum about two inches proximal to ileocaecal junction Fig 1. Margins were fresh and it did not give a look of old perforation. There were adhesions between loops of small intestine, which were also adherent to under surface of liver. After adhesionolysis, margins of perforation were trimmed and it was repaired in two layers (Inner vicryl 2/0 continuous and outer with prolene 4/0 interrupted. Appendicectomy was also performed. After washing abdominal cavity with 0.9 normal saline wound was closed in layers. Patient was given postoperative antibiotics and an analgesic, kept NPO for 24 hours, and was discharged successfully after 3 days. Later on patient was asked and she admitted taking a burger three days earlier but she did not remember any toothpick.

Which cause of diffuse peritonitis is the deadliest in the tropics? A retrospective analysis of 305 cases from the South-West Region of Cameroon.

BackgroundAcute diffuse peritonitis is a common surgical emergency worldwide and a major contributor to non-trauma related death toll. Its causes vary widely and are correlated with mortality. Community acquired peritonitis seems to play a major role and is frequently related to hollow viscus perforation. Data on the outcome of peritonitis in the tropics are scarce. The aim of this study is to analyze the impact of tropic latitude causes of diffuse peritonitis on morbidity and mortality.MethodsWe retrospectively reviewed the records of 305 patients operated on for a diffuse peritonitis in two regional hospitals in the South-West Region of Cameroon over a 7 years period. The contributions of various causes of peritonitis to morbidity and mortality were analyzed.ResultsThe diagnosis of diffuse peritonitis was suggested on clinical ground only in more than 93 % of cases. The most common causes of diffuse peritonitis included peptic ulcer perforation (n = 69), complications of acute appendicitis (n = 53) and spontaneous perforations of the terminal ileum (n = 43). A total of 142 complications were recorded in 96 patients (31.5 % complication rate). The most common complications included wound dehiscence, sepsis, prolonged paralytic ileus and multi-organ failure. Patients with typhoid perforation of the terminal ileum carried a significantly higher risk of developing a complication (p = 0.002). The overall mortality rate was 15.1 %. The most common cause of death was septic shock. Differential analysis of mortality of various causes of peritonitis indicated that the highest contributors to death toll were typhoid perforation of terminal ileum (34.7 % of deaths), post-operative peritonitis (19.5 %) and peptic ulcer perforation (15.2 %).ConclusionThe diagnosis of diffuse peritonitis can still rely on clinical assessment alone in the absence of sophisticated imaging tools. Peptic ulcer and typhoid perforations are still major contributors to death toll. Patients presenting with these conditions require specific attention and prevention policies must be reinforced.

Perforation of Terminal Ileum as a Rare Complication of an Early Post- Transplant Course

Perforations of any part of the gastrointestinal tract can occur in transplant patients, although the colon may be the most common site. We analyze the case of a 39-year-old patient after kidney transplantation who suffered perforation of terminal ileum with peritonitis on the 7th day after transplantation. We histologically confirmed presence of a foreign body in the intestinal wall – a rare cause of intestinal perforation in a patient after kidney transplantation. We have not noticed a significant worsening of graft function or development of sepsis mainly because of quick evaluation of the patient’s clinical state, prompt surgical intervention and a combined antibiotic treatment. Gastrointestinal perforations have rarely been noted in large studies involving transplant recipients.

Free Perforation of Ileal Tubercular Ulcer- A Case Report and Literature Review

Primary intestinal tuberculosis is unusual in North American, European and Caribbean countries. Its diagnosis is often surprising and differentiation from inflammatory bowel diseases is difficult. Intestinal perforation is an uncommon but potentially fatal complication of intestinal tuberculosis. There is no reported case of ileal tubercular ulcer perforation from the Caribbean. We present a 59 year old HIV negative patient presented with peritonitis with solitary perforation of terminal ileum. Histology revealed presence of Langerhan’s cell with caseating granulomatous inflammation and culture grew acid fast bacilli. A subsequent Manteaux test was strongly positive. There was no radiological evidence of pulmonary tuberculosis. Patient was started on anti-tubercular therapy and it is now over one year, the symptoms have not recurs back again.

Ileal Perforation Caused by Typhoid Fever

Background: Typhoid fever is a systemic infectious disease specific to human beings which is caused by a gram-negative bacillus (Salmonella typhi). Its incidence demonstrates significant variations in different regions of the world. It is generally seen in children of the school age. In developing countries, its most widely seen, and serious complication is intestinal perforation (IP). IP is generally seen within the third week of the disease. In children, it can onset with necrotic ileal Peyer’s patches which progress to diffuse peritonitis if not treated with appropriate medical therapy or in cases of delayed diagnosis. In these conditions, it requires surgical treatment . Despite novel antibiotics, and improvements in surgical techniques, mortality rates still range between 9, and 22 percent. Conclusion: This case report aims to distract attention to the importance of appropriate, and timely surgical intervention in a 15-year-old boy who presented with terminal ileum perforation developed secondary to inappropriately treated typhoid fever.

A case of pseudohyperkalaemia secondary to thrombocytosis in a patient with grumbling abdominal sepsis

A case of pseudohyperkalaemia secondary to thrombocytosis in a patient with grumbling abdominal sepsis

Suprapubic catheter change resulting in terminal ileal perforation

Suprapubic cystostomy is commonly performed in patients with neurogenic bladder or bladder outlet obstruction. The most serious complication is bowel injury, which usually occurs during catheter insertion. Bowel perforation during suprapubic catheter exchange is rare. We herein report an extremely rare case of terminal ileal perforation resulting from a change of suprapubic catheter. After insertion of the suprapubic catheter, a feculent material was noted in the terminal ileum. A cystography revealed that the contrast medium passed directly into the terminal ileum and colon. A computed tomographic scan confirmed the presence of a balloon tip in the terminal ileum. Terminal ileum perforation was diagnosed. Emergent laparotomy and loop ileostomy were performed. The patient's recovery was uneventful.

Complications of Protective Ileostomy in Emergency Surgery- A Study of 50 Cases

The temporary proximal loop or end ileostomy is considered suitable to protect a distal anastomosis following surgery for gangrene or perforation of terminal ileum with faecal peritonitis and colorectal surgery. This technique is, however, associated with failure, complications and even mortality. The aim of this study was to quantify retrospectively the morbidity associated with an ileostomy and its subsequent closure. Fifty patients with a temporary ileostomy, created between July 2007 and December 2009 were retrospectively analyzed from a review of patient records. All operations of ileostomy closure were done after a median period of 106 days (interquartile range: 69–174 days). Stoma related morbidity occurred in 26(52%) patients. After ileostomy closure, 21 major complications were seen in 10(20%) patients and 28 minor complications occurred in 17(34%) patients. Sixteen (32%) patients had neither stoma-related morbidity or peri- or postoperative complications after stoma closure. Protective proximal ileostomy was found to be associated with a high morbidity. This raises the question of the mode of identifying the specific patients with an ileal perforation/gangrene or low anastomosis who should be provided an ileostomy for protection, set against the potential complications of the formation and closure of the ileostomy. DOI: http://dx.doi.org/10.3329/jbcps.v29i4.11325 J Bangladesh Coll Phys Surg 2011; 29: 196-200

A study of 82 patients of non-traumatic terminal ileal perforation in Al-Kindy teaching hospital.

Background typhoid fever is the commonest cause of non traumatic terminal ileal perforation in our study with a grave postoperative morbidity & mortality depending upon preoperative time delay &/or type of surgical intervention practiced. Objective to evaluate the frequency of non traumatic causes of terminal ileal perforation, their presentations,perforation-operation interval effect on complications, as well as different modalities of treatment and their complications.Methods the study is a prospective study of 82 patients with perforation of terminal ileum diagnosed by explorative laparatomy in Al Kindy teaching hospital ,Baghdad, Iraq from April 2008- December 2010, all of the patients were examined clinically & investigated by plain x-ray of abdomen, ultrasound, complete blood picture, laparatomy was done for them after resuscitation and intravenous antibiotic, tissue biopsy was taken for paraffin section histopathological examination, and patients were followed for complications.Results: the study of 82 patients revealed that their mean age 42 years (±14) ranging from16-75 years, with male to female ratio is 2, 28:1. The main cause of perforation is enteric fever 59 (71.95%) of patient, non specific inflammation 17(20.74%), Chronic granulomatous lesion 5(6.1%). The main presenting symptom in all patients was severe abdominal pain associated with fever, and abdominal distention in variable degree.The operative finding was single perforation in 61patients(74%) , two perforations in 8 patients(10%) and multiple in 13 patients(16%). The simple closure was done in 50 patients(60%), and other treated by resection and end to end anastomosis , Loop ileostomy,Resection and ileotransverse anastomosis, and follow up of patients revealed that 7(8%) died postoperatively , 3 patients(3.6%) developed wound dehiscence,6 patients(7%) developed enterocutanous fistula ,10 patients (12.1%) developed wound infection and 6 patients (7.3%) developed residual collection. Conclusion non-traumatic perforation of terminal ileum is not uncommon and the most common cause is typhoid fever, and carries high mortality and morbidity rates specially in delayed presentation & diagnosis group of patients.