Intestinal perforation management using T-tube drainage

Abstract

In cases of small bowel perforation with gross contamination, enterostomy has traditionally been the treatment of choice. An 86-year-old woman was diagnosed with perforative peritonitis. Emergency laparotomy revealed a small bowel perforation with gross contamination, and a T-tube enterostomy was performed. The T-tube was used for intestinal decompression for the first few days and was then accompanied by enteral feeding. When oral intake was sufficient, the T-tube was removed. The abdominal wall's fistula healed within 2 days of removal. Except for wound infection, the patient developed no postoperative complications. Under specific circumstances, a T-tube enterostomy can be an effective alternative for a traditional enterostomy. Its advantages include less or no anastomotic leakage, easier management of fluid and electrolyte levels, postoperative enteral feeding from the tube, a shorter operative time and no need for a second operation to close the stoma.

Figure 1:

(a) Perforation on the edematous and damaged small intestine wall. (b) A rubber T-tube was inserted through the perforation and tightened in place with several stitches. (c) The T-tube was brought out through the abdominal wall, and the bowel was sutured to the abdominal wall at the exit site.

Figure 2:

The fistula closed spontaneously within 2 days.