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

摘要

Objective: The aim of this study was to report our management and outcomes of patients who underwent surgery with the diagnosis of non-traumatic small bowel perforation. Methods: The records of 30 patients who underwent surgery for non-traumatic small bowel perforation between 2005 and 2013 were examined. Age, gender, complaints, duration of symptoms, comorbid disease(s), perforation location, length of stay in hospital, etiology, surgical treatment, morbidity, and mortality data were recorded. Patients were divided into two groups, survivors and non-survivors, and their features were compared. Results: The mean age of the patients was 51.3±19.9 years. Signs of peritoneal irritation were present in 22(73.3%) patients. In surgical exploration, generalized purulent peritonitis was observed in 14(46.6%) patients, while localized peritonitis was observed in the others. Bowel resection was performed in 27(90%) patients, while primary suture was performed in only 3(10%) patients. A diverting ileostomy was performed in 18(60%) patients. Mortality was observed in 9 (30%) patients. Duration of the symptoms and multiple perforations were significantly higher in non-survivors. Conclusion: A delay in diagnosis and presence of multiple perforations are the most important causes of mortality. Every effort should be made to avoid delay in diagnosis; however, once the diagnosis is delayed, especially in patients with multiple perforations, extensive surgery such as bowel resection and ileostomy should not be avoided.