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Free perforation of the small intestine
Abstract:
Surgeons operating on patients with an obscure peritonitis should be aware of the diverse etiologies of small intestinal perforation and the general principles of management of each. A series of 16 adult patients with free perforation of the small intestine and spreading peritonitis in the absence of bowel obstruction, incarcerated hernia, or trauma is reviewed. Etiologies were as follows: Crohn's disease, four patients; foreign body ingestion, two patients; jejunal diverticulosis, one patient; lymphoma, two patients; cancer chemotherapy, one patient, amyloidosis, one patient; idiopathic, five patients. Although all patient presented with diffuse peritonitis, the findings of fever and leukocytosis were inconstant. Free air was demonstrated on radiographs in only eight of 16 patients, and the correct preoperative diagnosis was not made except in the four patients with Crohn's disease. Resection and primary anastomosis were utilized successfully in ten patients, the remainder of the patients undergoing oversewing the the perforation. Four patients (25%) died.
Insights
Diverse causes of small intestinal perforation can lead to peritonitis. Early diagnosis is challenging, but surgical intervention, including resection and anastomosis, can be successful, though mortality remains significant.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Abdominal Surgery
Background:
- Small intestinal perforation presents a diagnostic challenge, especially in the absence of common causes like obstruction or trauma.
- Peritonitis secondary to small bowel perforation requires prompt surgical management.
Purpose of the Study:
- To review the etiologies and management outcomes of small intestinal perforation presenting with diffuse peritonitis.
Main Methods:
- Retrospective review of 16 adult patients with free small intestinal perforation and peritonitis.
- Analysis of etiologies, clinical presentation, diagnostic methods, surgical interventions, and patient outcomes.
Main Results:
- Identified etiologies included Crohn's disease, foreign body ingestion, jejunal diverticulosis, lymphoma, chemotherapy, amyloidosis, and idiopathic causes.
- Preoperative diagnosis was often missed; fever and leukocytosis were inconsistent findings.
- Surgical management involved resection with primary anastomosis (10 patients) or oversewing the perforation (6 patients).
- Mortality rate was 25% (4 patients).
Conclusions:
- Small intestinal perforation has varied etiologies, necessitating broad surgical awareness.
- Timely surgical intervention is crucial for peritonitis management.
- Diagnostic challenges and significant mortality underscore the need for improved preoperative identification and management strategies.