Extra-luminal air fluid level on abdominal X-ray of a patient with isolated jejunal blow out case report

Patients with trivial blunt abdominal trauma may present with isolated jejunal blow out [IJBO]. A high index of suspicion is required as delayed presentation or delayed diagnosis may increase morbidity. Presentation with frank perforation peritonitis can be diagnosed by abdominal X-rays. We report the case of a patient who presented with features of peritonitis 10 days after being injured by a knee kick trauma. An erect abdominal X-ray showed extraluminal air-fluid levels, suggesting a hollow viscous injury which on exploration was found to be IJBO

Transperitoneal drainage versus non drainage in advanced secondary peritonitis due to enteric fever

Background: Whether or not to utilize peritoneal drainage in patients with diffuse peritonitis has been a subject of controversy for years

Objective: This study was designed to compare the incidence of various postoperative complications after ileostomy in secondary advanced peritonitis due to enteric perforation with or without drains

Patients and Methods: This prospective interventional study was conducted in Surgical UnitI, Sheikh Zayed hospital, Rahim Yar Khan, from 1[st] January 2010 to 30 September 2010. All patients having history of secondary peritonitis for more than 48 hours were included in the study. Ileostomy was performed in patients showing features of systemic toxicity. Patients were randomized into two groups; Group A, in whom transperitoneal drainage was employed and Group B, without drainage. Patients with primary repair were excluded from the study

Results: A total of 50 patients with secondary peritonitis due to typhoid perforation [with evidence of systemic toxicity] requiring ileostomy, with or without gut resection, were included in this study. Mean age of patients was 24.75 +/- 10 years. 56% was males with M:F ratio of 1.27:1 Twenty six patients were without drainage and twenty four patients had drainage [group A and B]. Mean post operative hospital stay for group A and B were 9.5 +/- 0.5 and 6.5 +/- 0.51 respectively. 5 patients in group A, developed wound infection as compared to 3 patients in group B. In group A one patient got burst abdomen, two patients got intra abdominal collection, one chest infection compared to none in group B

Conclusion: The study has shown no benefit of drainage of peritoneal cavity in secondary advanced peritonitis, infact there was a slightly higher rate of complications like burst abdomen, intra abdominal collection and pulmonary infections among patients in whom drain was placed