A Retrospective Clinical Study of Gastroduodenal Perforation Peritonitis
Author(s): Narendra MC, Ramakrishna B*, Mutheeswaraiah Y, Rukmangadha N, Kadivella Aditya Sarma and Aggarapu Mallikarjuna Pavan
Abstract
Introduction: Perforated Gastroduodenal ulcer followed by generalized peritonitis is common surgical emergency. Perforation is associated with increased mortality, accounting for greater than 35% of all peptic ulcer-related deaths. There is significant correlation between delayed surgical interventions for more than 24 hours to postoperative complications. Materials and Methods: A Retrospective clinical study of Gastroduodenal perforation peritonitis on patients who underwent exploratory laparotomy in the department of General surgery at SVIMS, SPMC (W), TIRUPATI. All the required data is retrieved from the medical records department of the SVIMS, SPMC (W) hospital. The data like age, sex of patient, other demographic data, detailed history of acute abdomen, past history of gastroduodenal ulcer disease, smoking, alcohol intake, abuse of analgesics and steroids, general examination findings and details of vitals are collected from the medical records and are documented. The details of examination findings are in support of generalized peritonitis, resuscitative measures taken, findings of investigations, details of anesthesia, details of surgical procedure and intraoperative findings like site and size of perforation, quantity and quality of peritoneal fluid, type of repair done to perforation, post-operative management, biopsy details, details of morbidity and mortality, duration of hospital stay and treatment advice on discharge are also documented. Results: In this study, out of 44 patients considered, 33 patients (75%) are Male and 11 patients (25%) are Female with male to female ratio of 3:1. NSAID abuse is documented in 10 patients (22.7%), 10 patients (22.7%) had history of both alcohol abuse and smoking, 4 (9%) had only alcohol and 3 (6.8%) patients had only smoking history, 2 (4.5%) patients had history of chronic stress and one patient (2.27%) had history of steroid abuse. The incidence of site of gastroduodenal perforation is as follows, 21(47.72%) patients had perforation in prepyloric region, 18 (40.9%) patients had perforation in first part of duodenum, 3 (6.8%) patients had perforation in body of stomach and 2 (4.5%) patients had perforation in second part of duodenum. In this study, there is significant correlation between delayed presentations for more than 24 hours to post-operative complications (p- value 0.003). But there is no correlation of post-operative complications with size of perforation (P – value 0.065) and site of perforation (p-value 0.0517). Conclusion: NSAID abuse, smoking and alcoholism are important predisposing factors. Abdominal pain, tenderness, guarding and rigidity are documented in all the patients. There is increasing trend in gastric perforations with highest incidence in prepyloric region. There is significant correlation (0.003) between delayed surgical interventions for more than 24 hours and postoperative complications; but there is no correlation between size of perforation (0.065) and site of perforation (0.0517) to post-operative complications. Mortality is high in duodenal ulcers of size >1.5 cm with delayed presentation. None of them showed malignancy among all the specimens.