Tubercular Perforation of the Small Bowel: Should All Patients Have an End Ileostomy?

Abstract

Background: Spontaneous ileal perforation is a common surgical emergency in developing countries due to high incidence of tuberculosis in these countries. Patients diagnosed to have intestinal perforation are universally treated surgically. The aim of this study was to compare the outcome and complication of two procedures usually performed for intestinal perforation i.e., primary repair and ileostomy.

Methods: The study is based on interventional quasi-experimental design with non-probability purposive sampling and was conducted for 6 months between April and October 2010 at a teaching hospital. Sixty patients with intestinal tubercular perforation participated in this study and were divided into two groups. Group A consisted of 30 patients who underwent primary repair and group B consisted of 30 patients who underwent ileostomy. Using Chi-square test, two groups were compared with respect to four outcome variables including duration of hospital stay, complications (peritonitis, wound infection, fever, and obstruction fistula formation) during hospital stay, and complications observed in second week and fourth week follow-ups.

Results: The mean age of presentation was 39.13 18.917 years (range 13 - 75). Sixty percent of patients were male and 40% were female. Size of perforation dictated operative decision; in group A, 100% of patients had a perforation less than 1 cm and in group B, 100% of patients had a perforation greater than 1 cm (P >=0.05). In both groups, 73.4% of patients had an admission of less than 7 days and 26.6% of patients stayed beyond this period (P >=0.05). The complication rate in group A during admission was 40%, compared to 30% in group B (P >=0.05). In the second postoperative week, complication rate was 16.6% in group A and 6.6% in group B (P >=0.05). Similarly in the fourth postoperative week, the complication rate was 13.4% in group A and 6.6% in group B (P >=0.05).

Conclusion: End ileostomy had fewer complications compared to primary closure in management of tubercular small bowel perforation. The choice of surgery was dependent on intra-operative judgement following assessment of the size of perforation and surrounding intra-abdominal contamination. Primary repair may still be a feasible option for perforations less than 1 cm without gross contamination given similar outcomes.




J Curr Surg. 2017;7(1-2):11-14
doi: https://doi.org/10.14740/jcs322w