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Category: Volume 07 Issue 02 February 2019
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Title: Study of morbidity and mortality after ileostomy in gangrenous small bowel perforations

Authors: Singh S, Chandel H, Dutt C

 DOI: https://dx.doi.org/10.18535/jmscr/v7i2.116

Abstract

Aims & Objective

i)To study the morbidity status, complication and outcome of patients of small bowel perforations after ileostomy.

ii)To study the effectiveness of various ileostomy appliances in maintaining skin integrity after ileostomy.

iii) To study the intra operative findings determining the construction of type of ileostomy.

Methods: We conducted prospective observational study on 60 patients admitted in government hospital. Each patient of perforation, preoperative counselling and psychological preparation of the patients for stoma was done. After opening of abdomen, peritoneal lavage was done and exploration of the gut was done and intraoperative findings were recorded. Ileostomy appliance was applied in the post-operative period randomly in 30 patients each. Complications were divided into local and systemic. Follow up of patients was done at regular intervals. Local & systemic complication recorded and the management was done accordingly.

Results: i) Midline wound dehiscence and skin excoriation (58.8%) was the most common local complication. Parastomal hernia was seen in 3.3% patients. 23.3% patient presented with burst abdomen. ii) 76.6% patient shows skin excoriation in which Romson bag applied & 40% with Hollister bag iii) Electrolyte imbalance and pulmonary infection were the systemic complication seen in most of the patients. All the patients having septicaemia were expired. iv)13.3% patients died inspite of all resuscitative measures.

Conclusion i) The increase in the perforation-operation interval increases the morbidity and mortality of the patients of ileal perforationii) Skin excoriation was found to be much less in Hollister bag's application as compared to Romson's bag in ileostomyiii)There was a definite reduction in the mortality of the patients of small bowel perforation after ileostomy as compared to primary closure of perforationsiv)However the morbidity rate following the ileostomy was not much affected but early diagnosis and meticulous surgical interventions of the cause of small bowel perforation and proper post op care is mandatory.

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Corresponding Author

Dr Himanshu Chandel

Associates Professor, Department of Surgery, Gajra Raja Medical College, Gwalior, (M.P.) India -474001

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