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終末廻腸穿孔의 臨床的 考察

A Clinical Study on Patients with Terminal Ileal Perforation

대한외과학회지 1968년 10권 6호 p.369 ~ 375
李鍾遠, 金子勳,
소속 상세정보
李鍾遠 (  ) - 서울대학교 醫科大學 外科學敎室
金子勳 (  ) - 서울대학교 醫科大學 外科學敎室

Abstract


The present report is a study of 89 cases of the terminal ileal perforation which were treated at the Dept. of General Surgery of S.N.U. Hospital from Jan. 1960 to Aug. 1966.
Cases associated with tumors and other mechanical causes were not included. Among the cases, 79 wellstudied cases which were strongly suggestive of salmonellosis were evaluated.
The reults obtained are as follows:
1) Of 89 patients with acute diffuse peritonitis due to perforation of terminal ileum, 79 cases(88.7%) were due to salmonellosis, 6 cases(6.8%) due to tuberculosis and 4 (4.5%) were due to Crohn´s disease.
2) The sex distribution assumend a ratio of 2.4 to 1 with 56 males and 23 females. The age in the majority of the patients was between second and third decade of life (50.6%).
3) In seasonal incidence 53(67.0%) of the cases occured in June and November.
4) In 41 cases(50.6%) perforation occurred at the 2nd to 3rd week of the febrile duration and in 19 cases(24.0%) at the 1st to 2nd week.
5) The most diagnostic signs encountered were sudden generalized abdominal pain with or without nausea and vomiting, abdominal distention, tenderness and muscular rigidity mostly after an irregular febrile episode.
6) The hematologic findings included: leucopenia in 57 cases (72.2%) and leucocytosis in 22 cases(27.8%).
7) Positive Widal test was observed in 21 cases (37.5%) out of 56 cases.
8) X-Ray findings revealed subdiaphragmatic free gas in 40 cases (63.5%) and with signs of paralytic ileus in 14 cases(22.2%).
9) The susceptibility of the bacteria isolated from the abdominal pus or exudate to antibiotics was in order of kanamycin, albamycin and chloramphenical.
10) In operative findings the site of perforation of all cases was within one meter from the terminal end of the ileum, the number was single in 48 cases (60.7), the size less than 0.6 cm in diameter was in 58(out of 128 perforations) and the shape was mostly round or ovoid.
11) The operative procedures were simple closure for 60 cases (76.0%), segmental resection with end-to-end anastomosis for 13 cases (16.4%), ileostomy for 4 cases (5.0%), abdominal drainage only for 2 cases (2.5%).
12) The most frequent complications were 31 cases (51.7%), of wound infection and disruption.
13) The deaths during hospitalization were 9 cases with an overall mortality of 11.4%, which inclnares and 7.6% of ileal resections.

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