Introduction. Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. It is reported to constitute the fifth common cause of abdominal emergencies due to high incidence of enteric fever and tuberculosis in these regions. Methods. Sixty proven cases of ileal perforation patients admitted to Surgical Emergency were taken up for emergency surgery. Randomisation was done by senior surgeons by picking up card from both the groups. The surgical management was done as primary repair (group A) and loop ileostomy (group B). Results. An increased rate of postoperative complications was seen in group A when compared with group B with 6 (20%) patients landed up in peritonitis secondary to leakage from primary repair requiring reoperation as compared to 2 (6.67%) in ileostomy closure. A ratio of 1？:？1.51 days was observed between hospital stay of group A to group B. Conclusion. In cases of ileal perforation temporary defunctioning loop ileostomy plays an important role. We recommend that defunctioning ileostomy should be preferred over other surgical options in cases of ileal perforations. It should be recommended that ileostomy in these cases is only temporary and the extra cost and cost of management are not more than the price of life. 1. Introduction Gastrointestinal perforations have been surgical problem since the time immortal. Scientists have found evidence of gastrointestinal perforations in Egyptian mummies. Perforation is said to occur once a pathology which extends through the full thickness of the hollow viscus leading to peritoneal contamination with intraluminal contents. Perforation can occur anywhere in the gastrointestinal tract starting from oesophagus to the rectum [1]. Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. It is reported to constitute the fifth common cause of abdominal emergencies due to high incidence of enteric fever and tuberculosis in these regions. Despite the availability of modern diagnostic facilities and advances in treatment regimes, this disease has an abrupt onset and a rapid downhill course with a high mortality if not treated [2, 3]. Various causes of nontraumatic ileal perforation include bacterial infections (salmonella, yersinia, and tuberculosis), viral infections (cytomegalovirus, human immunodeficiency virus), fungal infection (histoplasma), parasitic infections (A. lumbricoides, E. vermicularis, and E. histolytica), and others (Wagener’s granulomatous and drugs (Nonsteroidal
References
[1]
F. M. Nadkarni, S. D. Shetly, and R. S. Kagzi, “Small-bowel perforation. A study of 32 cases,” Archives Surgery, vol. 116, pp. 53–57, 1981.
[2]
S. Siddiqui, “Epidemiologic patterns and control strategies in typhoid fever,” Journal of the Pakistan Medical Association, vol. 41, no. 6, pp. 143–146, 1991.
[3]
D. K. Pal, “Evaluation of best surgical procedures in typhoid perforation—an experience of 60 cases,” Tropical Doctor, vol. 28, no. 1, pp. 16–18, 1998.
[4]
A. H. Rathore, I. A. Khan, and W. Saghir, “Prognostic indices of typhoid perforation,” Annals of Tropical Medicine and Parasitology, vol. 81, no. 3, pp. 283–289, 1987.
[5]
S. K. Bhansali, “Gastrointestinal perforations. A clinical study of 96 cases,” Journal of Postgraduate Medicine, vol. 13, no. 1, pp. 1–12, 1967.
[6]
P. B. Prasad, D. K. Choudhury, and O. Prakash, “Typhoid perforation treated by closure and proximal side-to-side ileo-transverse colostomy,” Journal of the Indian Medical Association, vol. 65, no. 11, pp. 297–299, 1975.
[7]
B. K. Kaul, “Operative management of typhoid perforation in children,” International Surgery, vol. 60, no. 8, pp. 407–410, 1975.
[8]
K. P. Singh, K. Singh, and J. S. Kohli, “Choice of surgical procedure in typhoid perforation: experience in 42 cases,” Journal of the Indian Medical Association, vol. 89, no. 9, pp. 255–256, 1991.
[9]
P. G. Purohit, “Surgical treatment of typhoid perforation. Experience of 1976 Sangli epidemic,” Indian Journal of Surgery, vol. 40, no. 5, pp. 227–238, 1978.
[10]
C. G. Athie, C. B. Guizar, A. V. Alcantara, G. H. Alcaraz, and E. J. Montalvo, “Twenty-five years of experience in the surgical treatment of perforation of the ileum caused by Salmonella typhi at the General Hospital of Mexico City, Mexico,” Surgery, vol. 123, no. 6, pp. 632–636, 1998.
[11]
A. M. Malik, A. A. Laghari, Q. Mallah, et al., “Different surgical options and ileostomy in typhoid perforation,” World Journal of Medical Sciences, vol. 1, pp. 112–116, 2006.
[12]
R. A. Wani, F. Q. Parray, N. A. Bhat, M. A. Wani, T. H. Bhat, and F. Farzana, “Nontraumatic terminal ileal perforation,” World Journal of Emergency Surgery, vol. 24, no. 1, article 7, 2006.
[13]
A. R. K. Adesunkanmi, T. A. Badmus, F. O. Fadiora, and E. A. Agbakwuru, “Generalized peritonitis secondary to typhoid ileal perforation: assessment of severity using modified APACHE II score,” Indian Journal of Surgery, vol. 67, no. 1, pp. 29–33, 2005.
[14]
S. Talwar, R. K. Sharma, D. K. Mittal, and P. Prasad, “Typhoid enteric perforation,” Australian and New Zealand Journal of Surgery, vol. 67, no. 6, pp. 351–353, 1997.
[15]
U. Beniwal, D. Jindal, J. Sharma, S. Jain, and G. Shyam, “Comparative study of operative procedures in typhoid perforation,” Indian Journal of Surgery, vol. 65, no. 2, pp. 172–177, 2003.
[16]
R. Bakx, O. R. C. Busch, W. A. Bemelman, G. J. Veldink, J. F. M. Slors, and J. J. B. van Lanschot, “Morbidity of temporary loop ileostomies,” Digestive Surgery, vol. 21, no. 4, pp. 277–281, 2004.
[17]
R. O. Perez, A. Habr-Gama, V. E. Seid et al., “Loop ileostomy morbidity: timing of closure matters,” Diseases of the Colon and Rectum, vol. 49, no. 10, pp. 1539–1545, 2006.
