Subject(s)
Colonic Diseases/etiology , Ileal Diseases/etiology , Intussusception/etiology , Jejunal Diseases/etiology , Peutz-Jeghers Syndrome/complications , Adult , Anastomosis, Surgical/methods , Biopsy , Colon/surgery , Colonic Diseases/diagnosis , Colonic Diseases/therapy , Humans , Ileal Diseases/diagnosis , Ileal Diseases/surgery , Ileum/surgery , Intussusception/diagnosis , Intussusception/surgery , Jejunal Diseases/diagnosis , Jejunal Diseases/surgery , Jejunum/surgery , Male , Peutz-Jeghers Syndrome/diagnosisABSTRACT
BACKGROUND/AIM: In developing countries, enteric perforation due to typhoid continues to have very high morbidity and mortality rates irrespective of the type of operative procedure performed. The aim of the present study was to evaluate the effectiveness of a free omental sheet graft in perforated typhoid enteritis, in comparison to other methods of enteric perforation repair in terms of decreased morbidity, mortality and cost-effectiveness. METHOD: A non-randomized study of 114 patients with enteric perforations was carried out over a period of 4.5 years. The study was divided in two groups; group I includes 38 cases in which a free omental sheet graft was used in typhoid enteritis with perforation and group II includes 76 cases in which other surgical procedures for enteric perforation repair were used. The outcomes were measured in relation to postoperative complications and mortality. RESULTS: The incidence of complications including faecal fistula was 2.6% in group I (free omental sheet graft group) versus 32.89% in group II. The mortality rate of 2.6% was also lower in group I versus 19.7% in group II. CONCLUSION: This study concludes that the use of free omental sheet graft on typhoid enteric perforation site is effective in lowering the repair leak rate and thereby decreases the morbidity and mortality associated with these procedures. By lowering the complication rates, it also entails reduction in financial burden.
Subject(s)
Intestinal Fistula/etiology , Intestinal Perforation/surgery , Omentum/transplantation , Peritonitis/etiology , Postoperative Complications/etiology , Typhoid Fever/complications , Adolescent , Adult , Aged , Child , Female , Humans , India , Intestinal Perforation/microbiology , Intestinal Perforation/mortality , Male , Middle Aged , Respiratory Tract Diseases/etiology , Retrospective Studies , Sepsis/etiology , Surgical Wound Dehiscence/etiology , Surgical Wound Infection/etiology , Young AdultABSTRACT
A liver abscess formation is a rare complication of a gallbladder perforation, with a cholecystohepatic communication. Niemeier, in 1934, classified free gallbladder perforations and generalised biliary peritonitis as an acute or a Type I gallbladder perforation, a pericholecystic abscess and localised peritonitis as a subacute or a Type II gallbladder perforation, and cholecystoenteric fistulas as chronic or Type III gallbladder perforations. We are describing a 50-year-old male patient who presented with right upper quadrant pain and was found to have an intrahepatic perforation of the gallbladder. Our patient had a Type II perforation. We have discussed the diagnostic work-up and the management of this rare entity. Due to the high mortality that can be caused by a delay in making the correct diagnosis, a gallbladder perforation represents a special diagnostic and surgical challenge.
