Small-bowel perforation complicating the open treatment of generalized peritonitis.

Fourteen patients were found to have developed 53 small-bowel perforations in the absence of pathogenic factors during "open abdominal treatment" for generalized peritonitis. They occurred after three to 17 laparotomies, on average at the eighth postoperative day (one to 120 days). Forty-nine lesions were located superficially. A relation with organ system failure, routine blood tests, type of nutrition, or microorganisms could not be demonstrated. The etiology of the lesions remains uncertain, but the open abdominal treatment must play some important role in its pathophysiology. Five patients survived. The therapy of choice appears to be mobilization of the bowel with resection of the affected part and primary anastomosis.