Small-bowel perforation complicating the open treatment of generalized peritonitis
W. J. Mastboom, H. H. Kuypers, F. J. Schoots and T. Wobbes
Department of Surgery, St Radboud University Hospital, Nijmegen, The Netherlands.
Fourteen patients were found to have developed 53 small-bowel perforations
in the absence of pathogenic factors during "open abdominal treatment" for
generalized peritonitis. They occurred after three to 17 laparotomies, on
average at the eighth postoperative day (one to 120 days). Forty-nine
lesions were located superficially. A relation with organ system failure,
routine blood tests, type of nutrition, or microorganisms could not be
demonstrated. The etiology of the lesions remains uncertain, but the open
abdominal treatment must play some important role in its pathophysiology.
Five patients survived. The therapy of choice appears to be mobilization of
the bowel with resection of the affected part and primary anastomosis.
