Free perforation in XXXX : I. A survey of 99 cases.

@entity1 @entity254 @entity397 @entity694 @entity30 @entity298
A review of more than 181 reported cases of free perforation in @entity30 yielded 84 cases that fulfilled rigorous criteria for classification as spontaneous free perforation with generalized @entity298 . An additional 15 cases from The Mount Sinai Hospital, derived from a population of 1010 @entity1 with @entity30 , bring the total number to 99. Separately tabulated are 116 other cases either occurring in bypassed segments, developing after surgery, presenting with @entity397 , or not definitively documented. Most reported perforations in the literature occurred in the distal small bowel. Among the @entity30 @entity1 in our hospital, however, the incidence of @entity694 were 1.6 and 0.7%, respectively, with the highest frequency actually occurring in diseased segments of jejunum (2/50 = 4%). Free perforation was the presenting manifestation of the disease in 25 of the 84 reported cases. In our 15 @entity1 , although perforation was never the presenting manifestation, it tended to occur early in the course of the disease (mean 3.5 years from onset of symptoms). Ninety-six of the 99 cases were operated on. The three @entity1 treated without surgery all died. Mortality was most frequent following simple suture in the earliest reported case (39%), but considerably less frequent after resection and @entity254 (3.7%). All 18 @entity1 treated by resection and diversion survived. Immediate surgery with resection and/or diversion therefore appears to be appropriate treatment for free perforation in @entity30 .
