Annals of PIMS-Editorial Board

Objective: To study the outcome of primary repair in spontaneous small bowel perforations
Study Design: Case series study.
Place and Duration: Surgical Unit, Hayatabad Medical Complex ( HMC ), Postgraduate Medical Institute, Peshawar, from January 1, 2007 to June 30, 2008.
Materials and Methods: Study included all patients presenting to and admitted in Surgical Unit HMC, with acute peritonitis due to small bowel perforation during the above mentioned period, in whom primary repair or resection and anastomosis was done. Patients in whom local and systemic factors favored primary repair, were included, while those with local and systemic factors unfavorable for gut repair were subjected to gut exteriorization and were not included in the study. Name, age, sex, other relevant data, history and examination findings and results of investigation were recorded.
Results: Out of 44 patients, there were 31 male and 16 female patients. Most common age group was 21-30 years. Primary repair of perforation was done in 35 cases while resection and primary anastomosis was done in 9 cases. Mean hospital stay was 8 days. Wound infection occurred in 16 cases, anastomotic leak occurred in one case, abdominal wound dehiscence in two cases, re-collection needing peritoneal wash occurred in 5 cases. There was no inhospital.
Conclusion: Primary repair and resection and primary anastomosis is a good treatment option in most cases of spontaneous small bowel perforations with acceptable outcome. Morbidity and mortality rates don’t differ with change in surgical options rather the interval of seeking treatment is more important.
Key Words: Small bowel perforation, Primary intestinal repair, Acute peritonitis

Spontaneous intestinal perforation may occur due to infectious diseases of intestine like typhoid fever and tuberculosis. Typhoid fever remains endemic in tropical and subtropical countries. It is caused by salmonella typhi. The terminal ileum in the region of Peyer’s patches is the commonest site for intestinal infection with the formation of a longitudinal ulcer on the antimesenteric border situated within 45 cm of the ileocecal valve in the majority of patients. Diagnosis is based on identification of organism in the feces and urine. Blood culture and bone marrow culture may be positive in the first week of infection. Surgical treatment is indicated in those cases in which typhoid fever has given rise to intestinal perforation. It can be diagnosed on clinical examination and investigations like plain x-rays and abdominal ultrasound.^1,2
Tuberculosis of the intestine can be hypertrophic, ulcerative, fibrotic or ulcerofibrotic. Ulcerative type of tuberculosis gives rise to transverse ulcers on the mucosa in ileum which may lead to perforation. Intestinal perforation as a result of tuberculosis is an indication for surgical exploration and repair of gut. Rest of the treatment is medical i.e. antituberculous chemotherapy. ^2,3
Regardless of etiology, principles of surgical treatment for spontaneous perforations of intestine are similar. Different treatment methods used for intestinal perforations include primary repair, resection and primary anastomosis, and exteriorization of gut. Different methods are employed in different conditions. There is no consensus of which treatment modality is superior over others.
The purpose of the present study is to assess the feasibility and outcome of primary repair and resection and primary anastomosis in the treatment of spontaneous small bowel perforations.