• enteric perforation
• ileal perforation
• ileostomy
• pyoperitoneum
• resection and anastomosis
• stoma related complications
• widal test

• ileal perforation
• impacted fecolith
• peritonitis
• stercoral ulcer
• transmural necrosis

Introduction

Peritonitis secondary to gastrointestinal perforation causes high morbidity and mortality rates in the emergency department with an immediate need for surgical intervention. Despite improved surgical management procedures, patients are still suffering from gastrointestinal leak causing peritonitis that demands surgical management by highly skilled surgeons in high-quality surgical units.

Material and methods

This paper presents one year of experience in the surgical treatment of gastrointestinal perforation-related peritonitis by surgeons in Lahore General Hospital, Lahore, Pakistan. Data was retrospectively collected from patient records and quantitatively analyzed. Involved patients developed peritonitis secondary to gastrointestinal perforation requiring surgical exploration and interventions in the emergency department between November 2020 and October 2021.

Results

One hundred and fifty-eight patients were involved; the mean age was 43.46 years. The number of males was 87 (55.06%). The patients mostly presented with generalized abdominal pain (57.6%). All the patients had perforation-related peritonitis, which was most prevalent in the ileum (62%). The most performed surgical intervention was loop ileostomy (36.71%). Compared to other published reports, the incidence rate of wound dehiscence in the hospital was relatively higher. Postoperatively, wound infection was low if the skin was left open (23.62%) compared to closed skin (38.7%). Patient outcomes were acceptable as the death rate was low (3.2%, 5/158).

Conclusion

Peritonitis caused by gastrointestinal perforation is associated with a high risk of morbidity that necessitates surgical exploration. Leaving skin wound open after the surgical intervention is recommended to decrease the incidence of wound infection and dehiscence.

• India
• cost of illness
• economic burden
• enteric fever
• health expenditure
• ileal perforation
• out of pocket expenditure
• typhoid

• Cost of Illness
• Hospitals
• Humans
• India/epidemiology
• Poverty Areas
• Typhoid Fever/epidemiology
• Typhoid Fever/prevention & control

• Bill and Melinda Gates Foundation
• National Surveillance System for Enteric Fever in India

Gastrointestinal (GI) tract perforation is a surgical emergency. The epidemiology and etiology of perforation vary considerably across geography. Lower GI tract perforations in the elderly predominate in the West compared to upper GI perforations in the younger population in the tropics. Fungi and viruses have been reported to cause GI perforations in immuno-compromised individuals but it is rare in immuno-competent individuals. We report a very rare case of gastric perforation secondary to fungal gastritis in an immuno-competent 35-year-old female who presented with features of peritonitis. At emergency laparotomy, gastric perforation was found which was repaired by the Cellan-Jones method. Perforation edge biopsy findings were consistent with fungal etiology. She responded well to Antifungal therapy. We conclude that fungal etiology can be considered in patients with gastric perforation without any history of peptic ulcer disease (PUD) or use of oral non-steroidal anti-inflammatory drugs.

• gastric pathology
• gastric perforation by fungal colonization
• invasive fungal infections
• mucormycosis induced gastric perforation

Ileal perforation is one of the most dreaded complications of abdominal tuberculosis. It is more common in immunodeficient patients, where ulcerative type of intestinal tuberculosis predominates. Various factors play role in the outcome of these patients, such as age and comorbid illness, though the lag period (advent of symptoms to time of admission to hospital) correlated directly to the mortality in these patients. Herein we present a 28-year-old male who had a coinfection of typhoid fever along with intestinal tuberculosis. The patient presented with abdominal pain and fever for one-week duration. On examination, he had diffuse tenderness of his abdomen with guarding. X-ray revealed free air under diaphragm. The patient underwent limited resection of terminal ileum and cecum with end ileostomy for ileal perforation. The patient’s serum Widal test was positive and blood culture grew Salmonella Typhi, and the patient was started on intravenous (IV) antibiotics based on culture and sensitivity. The patient’s general condition worsened after two weeks with bile leak from the surgical site. The patient succumbed to severe sepsis. Postoperative histopathology of the resected ileo-cecal segment showed features of ileo-cecal tuberculosis. As typhoid is a common cause of ileal perforation in the developing countries, the co-existence of typhoid fever in this patient lead to the delay in the diagnosis and appropriate management of tubercular ileal perforation. Knowledge about various causes of typhoid perforation is essential for treating surgeons. 

• anastomosis
• ileostomy
• lag period
• non-traumatic perforation
• resuscitation
• small bowel

• Bezoar
• Non-traumatic Perforation
• Perforation
• Small bowel perforation

Typhoid ileal perforation (TIP) is the most lethal complication of typhoid fever. Although TIP is a surgical emergency by consensus, there is still much controversy regarding the most appropriate surgical approach to be used. Bowel exteriorization and secondary closure are usually recommended for patients presenting late with multiple TIPs and heavy peritoneal soiling. We, however, discuss a unique case of an 86-year-old patient with 15 typhoid ileal perforations successfully treated with one-step surgery comprising bowel resection and ileotransverse anastomosis in a resource-constrained setting of Cameroon.

• Delayed primary skin closure
• Ileal perforation
• Primary skin closure
• Wound dehiscence
• Wound infection

• Cytomegalovirus
• IRIS
• Intestinal perforation
• Non-traumatic perforation
• Small bowel

Intestinal tuberculosis (TB) is an uncommon lesion for which differential diagnosis can be difficult. We present a case of a 53-year-old male and a systematic review of the literature, from clinical symptoms to differential diagnosis, unusual complications and therapy. The patient was admitted to the hospital with signs of acute abdomen as a result of a perforated terminal ileitis. Based on the skip lesions of the terminal ileum and cecum, Crohn’s disease (CD) was clinically suspected. An emergency laparotomy and right colectomy with terminal ileum resection was performed and systematic antibiotherapy was prescribed. The patient’s status deteriorated and he died 4 d after the surgical intervention. At the autopsy, TB ileotyphlitis was discovered. The clinical criteria of the differential diagnosis between intestinal TB and CD are not very well established. Despite the large amount of published articles on this subject, only 50 papers present new data regarding intestinal TB. Based on these studies and our experience, we present an update focused on the differential diagnosis and therapy of intestinal TB. We highlight the importance of considering intestinal TB as a differential diagnosis for inflammatory bowel disease. Despite the modern techniques of diagnosis and therapy, the fulminant evolution of TB can still lead to a patient’s death.

• Ileitis
• Autopsy
• Ileotyphlitis
• Crohn’s disease
• Tuberculosis
• Inflammatory bowel disease
• Ischemic colitis

• Acute Physiological and Chronic Health Evaluation II
• Acute abdomen
• ileostomy
• intestinal perforation
• peritonitis

• Emergency laparotomy
• Enteric fever
• Peritonitis

• Candida
• Intra-abdominal flora
• Prognosis
• Significance

Introduction. Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. It is reported to constitute the fifth common cause of abdominal emergencies due to high incidence of enteric fever and tuberculosis in these regions. Methods. Sixty proven cases of ileal perforation patients admitted to Surgical Emergency were taken up for emergency surgery. Randomisation was done by senior surgeons by picking up card from both the groups. The surgical management was done as primary repair (group A) and loop ileostomy (group B). Results. An increased rate of postoperative complications was seen in group A when compared with group B with 6 (20%) patients landed up in peritonitis secondary to leakage from primary repair requiring reoperation as compared to 2 (6.67%) in ileostomy closure. A ratio of 1 : 1.51 days was observed between hospital stay of group A to group B. Conclusion. In cases of ileal perforation temporary defunctioning loop ileostomy plays an important role. We recommend that defunctioning ileostomy should be preferred over other surgical options in cases of ileal perforations. It should be recommended that ileostomy in these cases is only temporary and the extra cost and cost of management are not more than the price of life.

To determine clinical features, operative findings and post-operative complications in patients operated for non-traumatic ileal perforation and to discuss the role of typhoid vaccination.

A retrospective study was carried out from 2009-2010. Seven patients were admitted through casualty as cases of acute abdomen. Underlying conditions were typhoid ulcers (4 patients) and non-specific etiology (3 patients). Diagnosis was made on clinical grounds, laboratory investigations, radiology and operative findings. Exploratory laporotomy was done. Different variables studied post-operatively were wound infection, residual abscess, recurrence and delayed post-operative complications.

Tenderness, distension and rigidity were found in maximum patients. Gases under diaphragm and air fluid levels were common radiological findings. However, widal test and blood culture for S. typhi was positive in four patients. Six patients had single perforation and one patient had two perforations, all being on antimesentric border of ileum. Maximum patients had peritoneal collection of less than 1000 ml. In five patients simple closure of perforation was done and in remaining two resection with end to side ileotransverse anatomosis was required. Wound infection and residual intraabdominal abscess were found in one patient each.

Management criteria remain same in typhoid and non-specific perforations. Commonest cause of ileal perforation is typhoid fever in our country, so immunization against typhoid beyond 18 years of age is recommended.

• Ileal perforation
• typhoid ulcer
• typhoid vaccination

• Colon
• Intestine
• Large bowel
• Perforation
• Peritonitis
• Pneumoperitoneum
• Small bowel

• Colon/blood supply
• Colon/radiation effects
• Colonic Diseases/etiology
• Diverticulitis, Colonic/complications
• Foreign Bodies/complications
• Humans
• Ileum/radiation effects
• Infections/complications
• Inflammatory Bowel Diseases/complications
• Intestinal Obstruction/etiology
• Intestinal Perforation/etiology
• Intestine, Small
• Ischemia/complications
• Radiation Injuries/complications

• Etiology
• Morbidity
• Mortality
• Perforation
• Peritonitis
• Presentation

• Intestinal perforation
• Mortality
• Typhoid fever

• AIDS
• Ileal perforation
• tuberculosis

Peritonitis is the most common life threatening surgical emergency, which requires urgent surgical intervention and is a significant cause of morbidity and mortality. The objective of this study was to highlight the frequency of secondary peritonitis and to analyze the site and causes of perforation, in our tertiary care setup.

A retrospective analysis of 311 patients of secondary peritonitis was done from July 2008 to June 2010 at Liaquat University Hospital Jamshoro, Hyderabad, Sindh, Pakistan. All cases found to have peritonitis as a result of perforation of any part of gastrointestinal tract at the time of surgery were included in the study. All cases with either primary peritonitis or that due to anastomotic dehiscence were excluded.

A total of 311 patients were studied. Most of the patients were males (77%) and (89%) were in the third and fourth decades of life. Majority of the patients presented with pain (97%) associated with bowel symptoms. Most common site of perforation was small bowel (ileal 59%, jujenal 2%). In this series, most common risk factor of perforation was typhoid (43%). Ileostomy was the most commonly performed procedure. Overall morbidity was 48.5% and mortality was 17%.

Considering the relatively higher rate of typhoid perforation quoted in this study, it is vital that typhoid fever ought to be eliminated by improved sanitation and immunizing programmes, otherwise surgeons will be confronted with its complications.

• typhoid fever
• intestinal perforation
• surgical management
• prognostic factors
• tanzania

• AIDS
• Ileal perforation
• tuberculosis

The objective of the study was to present our last 5-years experience of peritonitis and validate POSSUM score in predicting mortality and morbidity in patients of enteric perforation (EP) peritonitis.

Data was collected prospectively for all peritonitis cases admitted in single surgical unit from January 2005 to December 2009. Parameters for calculating POSSUM were also retrieved; in these patients, O:E (Observed vs. Expected) ratio of mortality and morbidity were estimated after calculating predicted mortality and morbidity by exponential regression equations.

887 patients with peritonitis were admitted and treated in this unit during the 5 years of study period. Duodenal (n=431; 48%) followed by ileal (n=380; 42.8%) perforations were the commonest. Mean age of the patients was 34 years and 86% were males. Mean delay in presentation was 78.5 hrs. Mean duration of hospital and ICU stay was 13 and 7.2 days. Postoperative complications were seen in 481 (54%) patients, and 90 (10%) patients died. POSSUM scores and predicted mortality/morbidity were calculated in 380 patients of ileal perforation peritonitis; O:E ratio of mortality and morbidity were 0.47 and 0.85 in these patients.

POSSUM and P-POSSUM are accurate tools for predicting morbidity and mortality respectively in EP patients. Though they may sometime over or under predict morbidity as well as mortality.

• Enteric perforation
• P-POSSUM
• POSSUM
• Peritonitis

• Abdomen, Acute/mortality
• Abdomen, Acute/surgery
• Adolescent
• Adult
• Aged
• Delayed Diagnosis/statistics & numerical data
• Digestive System Surgical Procedures/mortality
• Emergency Medical Services/economics
• Emergency Medical Services/statistics & numerical data
• Emergency Treatment/economics
• Emergency Treatment/mortality
• Female
• Hospitals, Teaching
• Humans
• Male
• Middle Aged
• Morbidity
• Nigeria/epidemiology
• Postoperative Complications/mortality
• Pregnancy
• Prospective Studies
• Severity of Illness Index
• Socioeconomic Factors
• Time Factors
• Treatment Outcome
• Waiting Lists
• Young Adult

• hiv
• hook worms
• small bowel perforation
• tuberculosis
• typhoid

• Adult
• Aged
• Anti-Bacterial Agents/administration & dosage
• Anti-Bacterial Agents/therapeutic use
• Antinematodal Agents/administration & dosage
• Antinematodal Agents/therapeutic use
• Crohn Disease/complications
• Crohn Disease/diagnosis
• Cytomegalovirus Infections/complications
• Cytomegalovirus Infections/drug therapy
• Diagnosis, Differential
• Fatal Outcome
• Hookworm Infections/complications
• Hookworm Infections/drug therapy
• Humans
• Ileal Diseases/diagnosis
• Ileal Diseases/etiology
• Ileal Diseases/surgery
• Intestinal Perforation/diagnosis
• Intestinal Perforation/etiology
• Intestinal Perforation/surgery
• Laparotomy
• Male
• Mebendazole/administration & dosage
• Mebendazole/therapeutic use
• Middle Aged
• Retrospective Studies
• Time Factors
• Treatment Outcome
• Tuberculosis/complications
• Tuberculosis/diagnosis
• Tuberculosis, Gastrointestinal/complications
• Tuberculosis, Gastrointestinal/diagnosis
• Typhoid Fever/complications
• Typhoid Fever/drug therapy