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Free perforation of small intestine in adults
D Ben-Baruch1, E Powsner, Y Wolloch
1Department of Surgery A, Beilinson Medical Center, Petah Tikva, Israel.
Abstract:
In a 14-year period 15 cases of free perforation of the small bowel in adults were treated in our department. In two patients perforation was caused by a foreign body and in six by each of the following: duplication of the small bowel, Hodgkin's lymphoma, vasculitis and steroid treatment, intussusception, adhesions, diverticulum. All patients presented with the signs of diffuse peritonitis. One patient died before surgery. Of the 14 patients operated upon, 10 underwent resection and primary anastomosis and four suturing of the perforation. In six cases the etiology remains unknown even after surgical intervention and pathological examination. The mortality rate of the 14 operated patients was 7.1%. 78.5% of the patients were operated on within 24 hours of onset of symptoms, and early surgery is considered to be the most important factor in the low mortality rate achieved in this series.
Insights
Free perforation of the small bowel in adults is rare, with diverse causes including foreign bodies and lymphomas. Early surgical intervention within 24 hours significantly improves patient outcomes and reduces mortality.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Free perforation of the small bowel is a rare surgical emergency.
- Understanding the diverse etiologies and optimal management is crucial for improving patient survival.
Observation:
- A 14-year study identified 15 adult cases of free small bowel perforation.
- Causes included foreign bodies, duplication, lymphoma, vasculitis, intussusception, adhesions, and diverticula; etiology remained unknown in 6 cases.
- All patients presented with diffuse peritonitis; one died pre-operatively.
Findings:
- Of 14 surgically treated patients, 10 had resection and anastomosis, and 4 had perforation suturing.
- The mortality rate for operated patients was 7.1%.
- 78.5% of patients underwent surgery within 24 hours of symptom onset.
Implications:
- Early surgical intervention is critical for reducing mortality in small bowel perforation.
- Timely diagnosis and treatment are paramount for favorable patient outcomes.
- Further research into unknown etiologies may refine diagnostic and therapeutic strategies.