Evaluation of Aetiology and clinical outcome of Nontraumatic free perforation of small bowel

Free small bowel perforation is frequently encountered in surgical practice with “trauma” being the most common cause. However, there are many non-traumatic causes too with a wide range of clinical presentation that can confuse the clinician. The resultant delay in diagnosis and treatment may then prove fatal for the patient. An effort has thus been made to find out the most frequent aetiologies, different clinical presentations with their treatment options and outcome. A prospective study of 30 patients admitted with a clinical diagnosis of non-traumatic small gut perforation was carried out over a period of 18 months. Pain abdomen was the presenting complaint in all patients (100%) followed by fever (68%) and vomiting (28%).On examination, 100% had abdominal tenderness,64% had distension,52% had obliteration of liver dullness and only 13% had rigidity. Straight X-ray abdomen in erect posture revealed free gas under diaphragm in 72% of patients only. Most common site of perforation was at the ileum.Most common aetiology was tubercular pathology followed by enteric fever and nonspecific inflammation. Ileostomy of the pathological site was the most commonly performed surgery followed by primary closure and resection anastomosis. Most common postoperative complication was wound infection and mortality was found to be 20%.