Fifty patients with free perforation of the lower alimentary tract were evaluated with regard to etiology, diagnosis, treatment and prognosis.
They were classified according to etiology as follows: traumatic perforation 22 cases, secondary perforation 15, idiopathic perforation 7, and iatrogenic perforation 6. Traffic accidents were the most common cause of traumatic perforation, while in secondary perforation colorectal carcinoma and radiation enteritis were common.
Perforation of the alimentary tract was easily diagnosed by clinical examinaiton, but leukocytosis and free air were demonstrated in 43% and 61% of cases, respectively. Free air was demonstrated in 43% of cases of perforation of the small bowel and in 73% of cases of perforation of the large bowel. Free air was easily detected in cases of long duration from the onset of perforation.
For most of the cases, simple closure or bowel resection and primary anastomosis were carried out. Operative mortality rate was 18%, and the prognosis was poor in patients who had shock preoperatively.
It was concluded that earlier diagnosis and correct surgical procedure would decrease the mortality rate.