RESUMEN
To find out the outcome of ileostomy in cases of small bowel perforation.Prospective, descriptive study carried out over a period of two years.Civil Hospital,Karachi.All patients presenting with small gut perforations except children and duodenal ulcer perforation cases. The patients were evaluated clinically and investigations including CP and ESR, RBS, Urea, Creatinine and Electrolytes, Widal Test, X-ray Chest and Abdomen [erect] done. All patients were operated in emergency OT via a right paramedian incision and findings noted. Ileostomy, either loop or end, was performed in all cases after primary closure of the perforation or resection of the gut. Out of the 40 patients seen during the study period, there were 33 [82.5%] males and 7 [17.5%] females. The age of the patients ranged from 15 to 75 years. The causes of small gut perforation were typhoid perforation 135%], followed by trauma [30%], non-specific inflammation [30%] and tubercluosis [5%]. Abdominal pain, vomiting constipation and high grade fever were common symptoms, while generalized tenderness, rigidity and obliteration of liver dullness were the main clinical findings. Wide differences were observed in haemoglobin levels,:total leukocyte counts, urea, creatinine and electolytes. In most patients the perforation was single and at the anti-mesenteric border 'with minimal to moderate peritoneal soilage. Multiple perforations and gross peritoneal soilage was present inpatients who presented late. Common complications seen during hospitalization and in the follow-up period were -ound sepsis, peristomal skin excoriation, chest infection and prolonged ileus. Other complications included deostomy retraction, faecal fistula, intra-abdominal abscesses and burst abdomen. Inspite of late presentation in same cases, the overall mortality was low [7.5%], major causes of mortality were septicaemia and uncontrolled faecal fistula. Hospital stay varied between seven to twenty eight days.Creation of a stoma [ileostomy], especially in-patients with typhoid and tuberculous perforations, reduced mortality and morbidity dramatically. Such immuno-compromised patients instead of having primary Pewction and anastomosis had an alternative approach of faecal diversion, which has altered the outlook completely