DOI: 10.36347/sjams.2016.v04i04.020

Pages: 1199-1207

Ileal perforation peritonitis is common surgical emergency in the Indian subcontinent, but the choice of procedure continues to be debated. Various strategies are being used to deal with ileal perforation. The aim of the study is to compare the results of two surgical modalities of treatment, as effective management of the disease to help in decreasing morbidity and mortality associated with disease. It is a prospective study from May 2013 –May 2015, involving 40 patients admitted from casualty and surgical OPD with diagnosis of ileal perforation peritonitis at Basaveshwara Teaching and General Hospital. Patients were divided into two equal groups. Patients in group 1 were managed by simple closure/ resection – anastomosis and in group 2 patients were managed by proximal defunctioning ileostomy to protect simple closure/ resection of the perforation. Severity of disease was assessed by using APACHE score. All patients were followed for post-operative complications. The most common cause of perforation was typhoid(45%), followed by non-specific (42.5%), tuberculosis(7.5%), traumatic(5%). Simple closure of perforation was done in 30% patients, resection – anastomosis was done in 20% and ileostomy proximal to simple closure/ resectionanastomosis was done in 50%. Postoperative complication rate in group 1 was 60% and 10% mortality. In group 2 complication rate was 85% and 20% mortality. Group2 patients had additive complication rate of 80% related to ileostomy. In patients with single perforation of upto 2cm with minimal contamination simple two layered closure of perforation is preferred. In patients with large perforations >2cm, multiple perforations, diseased unhealthy bowel, extensive peritoneal contamination, resection anastomosis is advocated instead of resection anastomosis with proximal temporary loop ileostomy due to its less morbidity related to ileostomy complications and need of second surgery for ileostomy closure.