Clinicopathological study of ileal perforation in tertiary centre

Background: Perforation of terminal ileum is a cause for obscure peritonitis with severe toxic state, there may be obscured clinical features with resultant delays in diagnosis and adequate surgical intervention. The objective of this study was to evaluate the clinicopathological characteristics in Ileal perforations because of confusion and controversy over the diagnosis and optimal surgical treatment of terminal Ileal perforation -a cause of obscure peritonitis. Materials and methods: Patients underwent emergency explorative laparotomy for hollow viscus perforation surgery in general surgery department was included in present study. Edge biopsy specimen was sent to histopathological examination. All patients were tested for widal positivity and were started on anti- salmonella treatment if it was positive. Based on intra- operative finding and histopathological reports, ATT was started for those who are positive for tuberculosis. All patients were monitored in the post-operative period for complications. All patients were followed up for a period of six months. Results: A total of 60 patients with Ileal perforation were included in the study of which 50 were males and 10 were females accounting for 83.33% and 16.67 % respectively. The most common symptom was pain abdomen which was present in all the patients (100%). The next common symptom was vomiting seen in 44 out of 60 patients (73.33%) followed by fever seen in 38 out of 60 patients (63.33%). Absent bowel sounds was found in 36 out of 60 patients (60%). Air under diaphragm on erect X-ray abdomen was found in 56 patients (93.33%). Conclusion: Bacterial culture and tissue histopathology though confirmatory are time consuming, and immunological tests are expensive. And administration of ATT helped to treat the patients successfully. A high index of suspicion for intestinal tuberculosis is needed in patients who are on immunosuppression.