Non-traumatic perforation of the small bowel

HO Eid, AF Hefny, S Joshi, FM Abu-Zidan

Abstract
Background: Non-traumatic perforation of the small bowel is an uncommon serious complication associated with high morbidity and mortality. Diseases that cause small bowel perforation vary in different areas of the world.

Objective: To highlight difficulties in the diagnosis and management of non-traumatic perforation of small bowel. Material and methods: The medical records of four patients who have presented with non-traumatic perforation of the small bowel and were treated at Al-Ain Hospital during the last 5 years were studied retrospectively.

Results: The presenting symptoms of all patients were similar. Erect chest X-ray has shown free air under diaphragm in 3 patients. Leukocytosis was present in only one patient. HIV was confirmed in one patient. Patients were diagnosed to have typhoid, HIV, hook worms and tuberculosis. Only the HIV patient died while the others were discharged home in a good condition.

Conclusion: Clinical findings of small bowel perforation are usually non specific and diagnosis is usually reached after surgery. The
Histopathological examination of the small bowel ulcer were non conclusive in three patients. We have made our management plan according to the clinical findings. Non traumatic perforation in developing countries can be due to typhoid, HIV, tuberculosis and
possibly hook worms.