Pattern of ileal perforation in our experience; a tertiary care centre in Eastern India

Pawan Kumar Jha, Rajnish Chandran, Pradeep Jaiswal, Anurag Kumar, Kumari Seema, Digbijay Kumar Singh, Ashwini Kumar, Mukesh Kumar


Background: Perforation peritonitis is one of the common acute abdomen admitted in emergency department for emergency laparotomy. Pattern and aetiology of ileal perforation varies from developed and developing countries where infectious diseases are still highly prevalent.

Methods: This was a prospective study conducted over 3 years period in Indira Gandhi Institute of Medical Sciences, Patna. Total 118 patients were enrolled for this study after confirmation of ileal perforation on exploratory laparotomy.

Results: Out of total 118 patients 52 cases (44%) were in traumatic, typhoid causes perforation in 86% (57 cases) tuberculosis in 14% (9 cases) and 66 cases (56%) were in non-traumatic group, penetrating injury is more common than blunt trauma abdomen. Males are more commonly affected than females in among all cases of ileal perforation. Patients with traumatic ileal perforation seek early medical attention as most of the patients (44%) admitted within 12 hours after accident where as in case of non-traumatic cases 53% patients admitted after 2 days. Most common operative procedure performed is Loop ileostomy in case of non-traumatic perforation (49%) and Resection and anastomosis preferred in traumatic perforation (63%). Mortality rate is about 20% in all types of perforation.

Conclusions: In developing countries like India typhoid perforation is still most common cause of ileal perforation. Loop ileostomy is more preferred procedure in infectious cases but resection and anastomosis in case of traumatic perforation in our institute.


Ileal Perforation, Non-traumatic perforation, Typhoid, Tuberculosis

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John J, Van Aart CJC, Grassly NC. The Burden of Typhoid and Paratyphoid in India: Systematic Review and Meta-analysis. PLoS Negl Trop Dis. 2016;10(4):e0004616.

Singh G, Dogra BB, Jindal N, Rejintal S. Non-traumatic ileal perforation: A retrospective study. J Family Med Prim Care. 2014;3:132-5.

Chichom-Mefire A, Fon TA, Ngowe-Ngowe M. Which cause of diffuse peritonitis is the deadliest in the tropics? A retrospective analysis of 305 cases from the South-West Region of Cameroon. World J Emerg Surg. 2016;11:14.

Khalid S, Burhanulhuq, Bhatti AA. Non-traumatic spontaneous ileal perforation: experience with 125 cases. J Ayub Med Coll Abbottabad. 2014;26(4):526-9.

Debi U, Ravisankar V, Prasad KK, Sinha SK, Sharma AK. Abdominal tuberculosis of the gastrointestinal tract: Revisited. World J Gastroenterol. 2014; 20(40):14831-40.

Fraga GP, Souza e Silva FHB, Almeida NA, Curi CM, Mantovani M. Blunt abdominal trauma with small bowel injury: are isolated lesions riskier than associated lesions? Acta Cir Bras. [serial on the Internet] 2008 March-Apr;23(2).

Frick EJ, Pasquale MD, Cipolle MD. Small-bowel and mesentery injuries in blunt trauma. J Trauma. 1999;46(5):920-6.

Wani RA, Parray FQ, Bhat NA, Wani MA, Bhat TH, Farzana F. Non-traumatic terminal Ileal perforation. World J Emerge Surg. 2006;1:7.

Hussain T, Alam SN, Salim M. Outcome of ileostomy in cases of small bowel perforation. Pak J Surg. 2005;21:65-71.

Watts DD, Fakhry SM. EAST Multi-Institutional Hollow Viscus Injury Research Group. Incidence of hollow viscus injury in blunt trauma: an analysis from 275,557 trauma admissions from the east multi-institutional trial. J Trauma. 2003 Feb;54(2):289-94.

Yunus M, Karim HM, Hajong R, Singh VS. Polytrauma patient with through and through penetrating rod in abdomen: Timing and team is of utmost importance in emergency management. J Emerg Trauma Shock. 2015 Jul-Sep;8(3):176-7.

Jhobta RS, Attri AK, Kaushik R, Sharma R, Jhobta A. Spectrum of perforation peritonitis in India-review of 504 consecutive cases. World J Emerg Surg. 2006 Dec;1(1):26.

Faria GR, Almeida AB, Moreira H, Barbosa E, Correia-da-Silva P, Costa-Maia J. Prognostic factors for traumatic bowel injuries: killing time. World J Surg. 2012 Apr;36(4):807-12.

Mukhopadhyay M. Intestinal injury from blunt abdominal trauma: a study of 47 cases. OMJ. 2009;24:256-9.

Patil V, Vijayakumar A, Ajitha MB, Kumar L S. Comparison between tube ileostomy and loop ileostomy as a diversion procedure. ISRN Surg. 2012 Dec 18;2012.

Khan AA, Khan IR, Najeeb U, Sheikh AJ. Comparison between primary repair and exteriorization in cases of typhoid perforation. Annals of King Edward Medical University. 2016 Apr 11;11(3):226-7.

Mock CN, Amaral J, Visser LE. Improvement in survival from typhoid ileal perforation. Results of 221 operative cases. Annals of surgery. 1992 Mar;215(3):244-9.