Morbidity and mortality after ileostomy in small bowel perforations

Abstract

Background: The aim of the present study was to study the morbidity status of patients of small bowel perforations undergoing ileostomy. To study the intra operative findings determining the construction of type of ileostomy and the effectiveness of various ileostomy appliances in maintaining skin integrity after ileostomy.

Methods: The study population consisted of 60 patients of surgically verified ileal perforation in which ileostomy was made. Patients were studied for etiology, site, operative technique, appliance used and complications if any. All the data was presented in the observation tables, analysed and interpretation was done.

Results: In our series maximum number of perforations occurred in third decade of life. The youngest patient was 7 years old and oldest patient was 80 year old. Mean age is 29.75 years. The Male: Female ratio is 1.6:1.Abdominal pain was the most prominent symptoms and was found in all patients. Etiologically, typhoid accounts for 63.3% of all perforation cases, with tuberculosis and traumatic perforation sharing 10% and 6% cases each respectively. Out of 60 cases, in which ileostomy was made, 31 patients (51.6%) had solitary ileal perforation. Out of 30 patients in whom the Romson's bag was applied, skin excoriation was present in 23 patients (76.6%). Out of 30 patients in whom the Hollister's bag was applied, only 12 patients (40%) had skin excoriation.

Conclusion: There is a definite reduction in the mortality of the patients of small bowel perforation after ileostomy as compared to primary closure of perforations. Early diagnosis and meticulous surgical interventions of the cause of small bowel perforation and proper post op care is mandatory.