[Unusual causes of intestinal perforation and their surgical treatment].

Background: Intestinal perforation is one of the major causes of obligatory surgical intervention. There can be many different causes of perforation. The aim of this study was to evaluate the unusual causes and the surgical treatment.

Methods: In our clinic, we operated 675 patients due to intestinal perforation over a period of six years. Perforation due to brid, trauma, colorectal tumor, mesenteric ischemia, hernias, and iatrogenic injuries were considered as usual causes and excluded from the study. The remaining 37 patients (22 male, 15 female; mean age 53.2; range 25 to 80 years) were analyzed. For statistical analysis, Mann-Whitney U and chi-square tests were used, and p < 0.05 was considered significant.

Results: A localized or generalized peritonitis was the most common symptom. Leukocytosis was found in 18 patients and free abdominal air was seen in 20 patients; bedside ultrasonographic examination was done in 17 patients. The most prevalent etiological factors were non-Hodgkin lymphoma, Crohn disease and internal herniation, respectively. Eight patients died; their time to laparotomy was significantly longer (8.7 days), and half of them had malignant small bowel tumor in perforation etiology.

Conclusion: Mortality and morbidity rates are high in intestinal perforations due to unusual causes. Delayed laparotomy and malignant etiology may be the main factors.