Retrospective Cohort Study of Non-Traumatic Jejunum and Ileum Perforation: A Multi-center Study

• Published in: Turkish journal of colorectal disease Vol. 33; no. 1; pp. 1 - 6
• Main Authors: Muniandy, Jothinathan, Palaniappan, Selva Raja N., Muthusamy, Santhia, Bujang, Mohamad Adam, Huei, Tan Jih, Goh, Yew Yip, Long, Kenny Tee Tang, Thevendran, Sanjay Deva, Sivalingam, Sharvin S.
• Format: Journal Article
• Language: English; Turkish
• Published: Mersin Galenos Publishing House 01.03.2023
• Subjects: Cohort analysis; Etiology; Mortality; Radiation; Small intestine; Surgical anastomosis
• ISSN: 2536-4898; 2536-4901
• DOI: 10.4274/tjcd.galenos.2022.2021-12-16

Aim: Non-traumatic jejunum and ileum perforation (NTJIP) is a rare clinical entity. Contrary to infective causes occurring in Eastern countries, immune-mediated pathologies are predominant in the West. The studies on NTJIP in Southeast Asia are lacking. This study is designed to describe the involved patients incidences, etiological patterns, and outcomes. This study analyzed the predictors of mortality in these patients. Method: This retrospective cohort study involved patients with NTJIP who underwent surgery over 4 years from 2016 to 2019. Data were sourced from operative databases of five tertiary public hospitals in Sarawak, Malaysia. Small bowel perforation data were screened, and patients with adhesive obstruction from previous surgeries, trauma, and duodenal perforation were excluded. Patients' socio-demographic characteristics, surgical characteristics, and outcomes were stated in the prepared pro forma. Results: From 2016 to 2019, a total of 42 patients with NTJIP were included in this study. The mean [standard deviation (SD)] age of incidence was 55.7 (19.3) years old. Twenty-nine presented within 3 days of symptoms. Their etiologies were attributed mainly to non-specific causes (29%), followed by radiation-associated perforation (17%). The mean (SD) hospital stay was 10 (3) days, with the post-operative complication rate of ileus at 21%, surgical site infection at 23%, and anastomotic leak at 23%. The mortality rate was 36%, and the Mannheim peritonitis index was a reliable predictor of mortality. Conclusion: This study observed that radiation and vascular etiologies were the most common identifiable causes of NTJIP in the current series. Further research would prove beneficial to analyze inconclusive cases, as the dilemma surrounding etiologies for NTJIP remains.