Nontraumatic perforations of the small intestine.

The etiology of nontraumatic small bowel perforations in 24 operated patients was as follows: strangulation in five, diverticulum in four, foreign bodies in four, idiopathic in three, Crogn's disease in two, malignant atrophic papulosis of Degos (MAP) in two, and tuberculosis, carcinoid tumor, radiotherapy, and iatrogenic in one. The high mortality rate in these patients appeared to be a funciton of the disease process rather than of the means of treatment. In favorable circumstances, as in strictly localized lesions with well known etiology and otherwise normal bowel, a simple closure of perforation is warranted. In more far advanced cases operated upon early enough, we still consider bowel resection and primary anastomosis as the best method of treatment, though it yielded poor results in procedures are advisable to protect the anastomosis.