Small-bowel perforations. A study of 32 cases.

We studied 32 consecutive cases of small-bowel perforations treated in a single surgical unit during the last three years. Clinical features are typical and diagnosis is not difficult. Suprapubic peritoneal paracentesis in head-high position is the most accurate diagnostic investigation. Ultimate results are not related to cause, but are directly proportional to the degree of contamination of the peritoneal cavity, delay in manifestation, antibiotic resistance of the contaminating organism, and the method of treatment of the perforation. There were two deaths in the 16 patients who had exteriorization of the suture line (12.5%), compared with seven deaths in the group of 16 patients who did not have exteriorization (43.75%). Exteriorization of the suture line (16 cases) is a superior method of treatment and significantly lowers the mortality.