Is small intestinal perforation serious?

I believe that everyone has only heard of gastric perforation, but is not particularly clear about the disease of intestinal perforation. The human small intestine also has the disease problem of small intestinal perforation. Small intestinal perforation is mostly caused by small intestinal ulcers that are not treated in time. The main symptoms of small intestinal perforation in the human body are acute abdominal pain and bloody stools, so is the problem of small intestinal perforation serious?

The abdominal pain of acute intestinal perforation often occurs suddenly and is persistent and severe, often making it unbearable for patients and aggravated by deep breathing and coughing. The extent of the pain is related to how far the peritonitis has spread. The patient lies in supine position with both lower limbs flexed and unwilling to turn. Abdominal examination may reveal significantly weakened respiratory movements, hard abdominal muscles, weakened or disappeared bowel sounds, reduced or disappeared liver dullness boundaries, etc. X-ray examination may reveal free gas under the diaphragm.

Intestinal perforation requires the following identification.

Intestinal perforation is one of the serious complications of typhoid fever with a high mortality rate. The most obvious lesions of enteric typhoid fever are in the terminal ileum. The diseased lymph nodes undergo necrosis, and the mucosa sheds to form ulcers, which usually occur in the 2nd to 3rd week of the disease. Therefore, complications of intestinal perforation also often occur during this period. 80% of perforations occur within 50 cm of the ileocecal valve, most of which are single, and multiple perforations account for about 10% to 20%.

Ulcers of intestinal amebiasis are generally superficial, but when the infection is severe, deeper ulcers may occur and cause intestinal perforation; they often occur in patients with fulminant disease and have a high mortality rate. The perforation is often large, mostly located in the cecum, appendix and ascending colon, and less frequently at the rectosigmoid junction. Perforations may be single or multiple.

Once typhoid intestinal perforation is confirmed, surgical treatment should be carried out promptly. Generally, a right lower abdominal incision is used, and the principle is to perform perforation and suture. If the perforation is too large and the surrounding intestinal wall is severely edematous, a proximal ileal intubation can be performed to ensure healing of the perforation sutures. However, for other lesions where the intestinal wall is very thin and close to perforation, the seromuscular layer should also be sutured to prevent new perforation after surgery.

Typhoid fever and peritonitis should be treated actively after surgery with antibacterial drugs and enhanced supportive therapy.