Small bowel perforation

Abstract

Purpose: Perforations of the gastrointestinal organs are one of the most dangerous surgical emergencies with tremendous mortality, especially if proper assistance is not provided promptly.Purpose: To evaluate imaging results and determine specific perforation sites and causes in patients with small bowel perforation.Material and Methods: A retrospective study was performed in the Emergency Department from 2020 March to 2021 July. Twenty-one patients (20-90 years old) with clinically and radiologically confirmed small bowel perforation were enrolled.Results: Ulcers, trauma, organ wall necrosis were the typical perforation causes, affecting 14 patients (66.6%). There were 3 cases of perforated diverticula (14.3%). Other reasons (iatrogenic perforation, foreign body ingestion, abscess, and cancerous lesion) were noted 4 (19.1%). The abdominal x-ray was performed for 11 patients (52.4%). Intestinal obstruction was observed in 3 patients (27.3%), free air in 3 patients (27.3%), in one patient (9.0%), both features were seen. Fourteen patients (66.6%) underwent abdominal ultrasound: for 6 patients (42.9%) intraperitoneal fluid identified. Abdominal computed tomography (CT) was performed for all patients. In 62.0% (13 patients), CT revealed signs of pneumoperitoneum. The accurate perforation site was seen in 14 cases (66.6%). Nineteen patients (90.5%) underwent surgical treatment, 2 (9.5 %) - conservative or minimally invasive therapy. Eleven patients (52.4%) had died; 6 (54.5%) of them - during the first week after admission. On average, patients were hospitalized for 20 days.Conclusion: CT is the most helpful imaging method for small intestine perforations. Perforation is an acute condition that requires urgent diagnosis and usually surgical treatment. Ulcers, trauma, and necrosis were the main perforation reasons.