Observational study of small bowel perforation in a tertiary care hospital

Background:  Perforation of the small intestine causing peritonitis is the most common abdominal surgical emergency encountered in study region. Late presentations with sepsis and septic shock makes evaluation and management of these patients a formidable surgical challenge. The aim of this study was to identify the etiologies, clinical presentation, diagnostic dilemmas and modalities of treatment of the small bowel perforation of diverse etiology in this study region. Objective was to study the demography, etiology, pathology, clinical presentation and various surgical procedures in treatment of small bowel perforation in hospital. Methods: This study was a prospective observational study conducted in the department of general surgery Rohilkhand medical college Bareilly, Uttar Pradesh, India from November 2015 to December 2016. 90 patients admitted in the emergency of this hospital who eventually turned out to be those of small bowel perforation were included in this study and an analysis of the demographic data, clinical presentations, radiological findings, site of perforation, surgical procedure performed, surgical complications and duration of hospital stay was done. Results:  Duodenal perforation was the commonest cause of small bowel perforation, contributing to 51 (56.66%) patients. Peptic ulcer disease accounted for 49 (96.07%) patients and blunt trauma abdomen for 2 (3.9%) of these patients.  Jejunal perforations accounted for 9 (10%) patients and ileal perforations for 30 (33.34%) patients. Typhoid fever was the commonest cause of ileal perforation in 24 (80%) patients Blunt trauma abdomen was the commonest cause in 5 (55.55%) patients of jejunal perforations. Conclusions:  Indiscriminate use of NSAIDS/Steroids accounted for most of the peptic ulcer perforation in our region. The other additive factors include alcohol consumption and smoking.