Sajid Mahmood, Syed Asghar Naqi, Muhammad Nadeem Aslam, Khalid Masood Gondal.
Morbidity and mortality due to delay in surgery of jejunoileal perforation.
Pak J Med Health Sci Jan ;4(4):568-71.

Objectives: Objectives of this study were to correlate the outcome of surgery with delay in treatment after small intestinal perforation and assess the pattern of morbidities and mortality among cases with ileal perforation. Study Design: Cross sectional comparative type of study was conducted. Setting and Duration: South Surgical Ward Mayo Hospital Lahore from May 2005 to January 2006 and November 2006 to March 2007 Material and Methods: Patients who underwent exploratory laparotomy in emergency following spontaneous small intestinal perforation were studied. History was taken prior to surgical intervention. Start of abdominal pain from a localized area to the entire abdomen was taken as the lead point to divide the patient into 2 groups. Groups A were those who presented within 24 hours and Group B were those who presented after 24 hours. The variables studied included healing of the gut and start of the oral feeding, persistence of fever, presence or absence of the wound infection. Surgical procedure carried out was described. Creation of a small intestinal stoma with mucus fistula was treated as morbidity. Other surgical options include resection and anastomosis or primary repair of the perforation. Follow-up information of the post surgical procedure was gathered up to 2 weeks after having discharged the patient. All this information was collected on a specially designed proforma. The statistical system used was SPSS version 10. Results: 62 patients were studied. They were divided into 2 groups, before 24 hour presentation, after 24 hour presentation. 70% were male patients. Age ranged from 13-65 (mean 26.5Y) Ileal Perforation was found in 49 patients (79%) 7 of these patients expired. Jejunal perforation was found in 13(21%) patients. 2 expired. 9 out of a total of 62 expired (14%).1 expired in Group (A). 8 expired in Group (B). Most common site of ileal perforation is 45 cm from ileocecal junction. Ileal perforation is much more common. Ratio is 4:1 with Jejunal perforation. 5 out of 8 expired in Group (B) presented after 100 hours of perforation. Ileostomy was made in 22 patients. 6 of these expired. As the time interval increased, morbidity and mortality increased quite significantly. Incidence of wound infection and persistence of fever in the post operative period increased as the time interval increased. Start of oral feeding is delayed. Requirement for ileostomy is increased. Conclusion: Duration between small intestinal perforation and surgical intervention is the most important factor in these patients. As the duration increases, various morbidities and mortality indices are directly increased.

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