Free Perforation of the Small Intestine

Abstract

Surgeons operating on patients with an obscure peritonitis should be aware of the diverse etiologies of small intestinal perforation and the general principles of management of each. A series of 16 adult patients with free perforation of the small intestine and spreading peritonitis in the absence of bowel obstruction, incarcerated hernia or traumas, is reviewed. Etiologies were as follows: Crohn''s disease, 4 patients; foreign body ingestion, 2 patients; jejunal diverticulosis, 1 patient; lymphoma, 2 patients; cancer chemotherapy, 1 patient, amyloidosis, 1 patient and idiopathic, 5 patients. Although all patients presented with diffuse peritonitis, the findings of fever and leukocytosis were inconstant. Free air was demonstrated on radiographs in only 8 of 16 patients and the correct preoperative diagnosis was not made except in the 4 patients with Crohn''s disease. Resection and primary anastomosis were utilized successfully in 10 patients, the remainder of the patients undergoing oversewing the perforation. Four patients (25%) died.