Management of post-traumatic intestinal perforations: practice and recommendations

Introduction: The management of post-traumatic intestinal perforations is sometimes limited in a low-income country such as Madagascar. Our objective is to evaluate the management of post-traumatic intestinal perforations.
Patients and method: Our case series was retrospective as part of a five-year observational, descriptive, monocentric study at the Joseph Ravoahangy Andrianavalona Antananarivo Hospital Center. The sampling was exhaustive and the parameters studied included the diagnostic and therapeutic means undertaken, as well as the characteristics of the lesions found and their evolution.
Results: Eighty-eight patients had bowel perforations due to abdominal contusion (29.54%) and a penetrating wound (70.45%). The presence of abdominal pain (100%), pneumoperitoneum (62.5%), and fluid effusion (68.18%) were diagnostic. Ileal lesions were found in 73.86%. Direct sutures were the most common surgical procedure performed for single punctures (76.92%) and hail punctures (73.84%). For colonic perforations, 56.52% had benefited from resection. The complication rate was 5.7% versus 7.9% for sutures versus resections (p=0.0005).
Conclusion: In the absence of diagnostic and therapeutic laparoscopy, the diagnosis of post-traumatic intestinal perforation is made by a careful clinical examination combined with an unprepared X-ray of the abdomen and ultrasound. Our therapeutic conduits followed the recommendations for obtaining good results.