Non-traumatic perforation of the small intestine. Report of 13 cases and review of the literature

Background/Aims: Non-traumatic perforation of the small intestine (NTPSI) is a rare entity. It is possible that nowadays, the etiology of NTPSI has changed and that mortality might be lower. The aim of this study was to compare a recent series with previous series published in the literature. Methodology: During 13 years (1984-1996), 13 patients were diagnosed by laparotomy and histology as cases of NTPSI. Results: The various etiologies of the perforations were: Crohn's disease in 6 (46%) patients, an ingested foreign body in 3 (23%) patients, primary intestinal malignancies (B-cell high-grade lymphoma and leiomyosarcoma) in 2, an internal hernia and an unclear etiology ("idiopathic") in 1 patient each. The symptoms were non-specific and an abdominal X-ray showed free-air in only 1 of 11 patients. Only one patient died postoperatively. Conclusions: NTPSI remains a rare entity with an incidence of 1 case/year/350000 population. Compared to seven previous series from industrialized countries, it seems that Crohn's disease has recently become the major etiology for NTPSI, probably due to the increasing prevalence of this disease. It is possible that many of the frequent "idiopathic" cases diagnosed in the past were due to non-steroidal antiinflammatory drugs. While in developing countries, typhoid fever remains a major cause of NTPSI, opportunistic infections are recently reported in industrialized countries. The diagnosis of NTPSI is usually made at laparotomy. In most cases, resection and primary anastomosis is appropriate. Mortality rates might be lower than in the past.