Chatterjee H, Pai D, Jagdish S, Satish N, Jayadev D, Srikanthreddy P
Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry.
Trop Gastroenterol. 2003 Jul-Sep;24(3):144-7.
Two hundred and twelve cases of ileal perforation due to different causes (excluding typhoid) were treated in 3 phases in the Department of Surgery, JIPMER Hospital, Pondicherry, during the periods 1966-78 (phase I), 1981-88 (phase II) and 1990-1998 (Phase III). Forty per cent of the patients were in the second and third decades of life. Male-to-female ratio was 2.2:1. The majority of the perforations (52.8%) were due to non-specific causes. Trauma (19.3%) and mechanical factors (12.7%) were the other principal aetiologies. Pain abdomen (92.3%), constipation (63.6%) and fever (44.3%) were the principal presenting features. Abdominal guarding and rigidity (89%) were the main physical signs. Pneumoperitoneum was present in 66.8% of cases on plain X-ray abdomen. Widal and blood culture for Salmonella typhi were negative in all. Laparotomy was done in most of the cases after adequate resuscitation. Simple closure of the perforation, wedge resection and resection anastomosis were the different procedures of management. Histology of the margin of perforation/excised gut gave added evidence of a non-typhoid etiology. Broad-spectrum antibiotics in different combinations with metronidazole were administered postoperatively. Mortality was 28.2% in Phase I, and 9.4% and 11.9% in phases II and III respectively. The lag period (advent of symptoms and hospitalization) showed definite relationship with mortality and morbidity. Wound infection, wound dehiscence, enterocutaneous fistula and septicaemia were the principal postoperative complications.
1966年至1978年（第一阶段）、1981年至1988年（第二阶段）以及1990年至1998年（第三阶段）期间，位于本地治里的JIPMER医院外科对212例因不同病因（不包括伤寒）导致的回肠穿孔患者进行了三个阶段的治疗。40%的患者年龄在第二个和第三个十年。男女比例为2.2:1。大多数穿孔（52.8%）是由非特异性病因引起的。外伤（19.3%）和机械因素（12.7%）是其他主要病因。主要临床表现为腹痛（92.3%）、便秘（63.6%）和发热（44.3%）。腹部压痛和肌紧张（89%）是主要体征。66.8%的病例腹部平片显示有气腹。所有患者的伤寒肥达试验和血培养均为阴性。大多数病例在充分复苏后进行了剖腹手术。穿孔单纯缝合、楔形切除和切除吻合是不同的治疗方法。穿孔边缘/切除肠段的组织学检查进一步证实了非伤寒病因。术后给予不同组合的广谱抗生素联合甲硝唑。第一阶段的死亡率为28.2%，第二阶段和第三阶段分别为9.4%和11.9%。症状出现至住院的间隔时间与死亡率和发病率有明确关系。伤口感染、伤口裂开、肠皮肤瘘和败血症是主要的术后并发症。
