EVALUATION OF SPECTRUM OF SMALL BOWEL PERFORATION AND IT'S MANAGEMENT

Dr.M.Venkateswarulu; Dr.A.Sai Datta; Dr.P.Renuka; Dr.Rajitha; Dr.Anand; Dr.Ravindra; Dr.Deepak

Volume : IX, Issue : XII, December - 2019

EVALUATION OF SPECTRUM OF SMALL BOWEL PERFORATION AND IT'S MANAGEMENT

Dr. M. Venkateswarulu, Dr. A. Sai Datta, Dr. P. Renuka, Dr. Rajitha, Dr. Anand, Dr. Ravindra, Dr. Deepak

Abstract :

BACKGROUND:Perforation of small bowel is commonly observed problem in surgical practice. The different modes of clinical presentation of cases may be misleading in the diagnosis of its origin. It is required to know about current surgical practices for different types of perforations to manage such a case. A small effort has been done here, to know about the different modes of clinical presentation, diagnosis and types of management modalities for small bowel perforations. MATERIALS AND METHODS: A prospective study of 50 patients presenting to KMCH Hospital who has been diagnosed clinically with small bowel perforation between October 2016 and October 2018 is done.The clinical data, the investigations done and the surgical procedure undertaken are recorded. RESULTS: Pain abdomen was the chief symptom of all the patients, followed by Vomiting (76%), Fever (46%), and Distension (44%). Most of the patients had guarding and rigidity(84% cases) and liver dullness wasobliterated(42% cases) based on which a clinical diagnosis of perforation was made. Erect abdomen X–ray showed air under diaphragm in 64% cases. Midline incision was employed in 90% of cases. Ileal perforation was found to be the most common site. Typhoid disease was found to be the most commonly encountered cause of ileal perforation. The most frequently done surgical procedure was Resection and Anastamoses in two layers. Postoperative follow up all patients was done to know about the frequently encountered postoperative complications,time of recovery, morbidity rate and mortality rate. The most commonly encountered complication in this series was found to be Wound infection which accounted for 17 cases (34%) and 3 cases has shown Wound dehiscence. CONCLUSION: Pain abdomen(100%) is the most common presenting complaint in Small bowel perforation followed by vomiting,fever, abdominal distension and constipation. The investigations which are useful for diagnosing a perforation were found to beerect abdomen X–ray and USG abdomen. The most common surgical procedure employed here was Resection and anastomosis.The most common complication in this series was found to be wound infection. A Mortality rate of 10% was observed in our study.