Outcome of ileostomy in the management of ileal perforation

OBJECTIVE: To evaluate the role of a defunctioning ileostomy in the prevention of morbidity and mortality in patients with small bowel perforation. DESIGN: A prospective randomized study. PLACE AND DURATION OF STUDY: Department of Surgery, Liaquat University of Medical & Health Sciences, Jamshoro / Hyderabad between October 2005 and September 2006. SUBJECTS AND METHODS: Total 108 patients who underwent laparotomy for ileal perforation were included. RESULTS: There were 67 males and 41 females. The age of patients ranged from 15 to 72 years with 80% of the patients being in age group of 17-70 years. Typhoid was the commonest cause for ileal perforation which was seen in 69 (63.8%) patients, followed by intestinal tuberculosis which was present in 23 (21.3%) patients. Out of a total of 108 patients, a proximal defunctioning ileostomy was constructed to protect the primary repair or the intestinal anastomosis in 57 patients (group I). In the remaining 51 patients, primary repair or intestinal anastomosis was done without a defunctioning ileostomy (group II). Two (3.5%) patients in group I and 7 (13.7%) patients in group II died postoperatively. Six of the 51 patients in group II who underwent primary closure of perforation or resection and end-to-end anastomosis without a defunctioning ileostomy developed postoperative faecal fistula. None of the patients with defunctioning ileostomy developed this complication. CONCLUSION: We conclude that construction of a temporary ileostomy to provide defunctioning for repair of ileostomy perforations reduce the incidence of fatal complications like faecal fistula. Ileostomy, however, is associated with a number of ileostomy-specific complications. We recommend that defunctioning ileostomy should be preferred over all other surgical options in cases of ileal perforations.