Effect on outcome of delay in surgical management of hollow viscus perforation peritonitis: an experience at Dhulikhel Hospital, Kathmandu University Hospital
Abstract
Background: Hollow viscus perforation is a common surgical problem worldwide. Early diagnosis and prompt surgical management is essential for good outcome. However, in our context, in cases of hollow viscus perforations, onset of symptoms and laparotomy interval is prolonged due to delayed presentation to hospital. The main objective of this study was to compare patients with the anatomical site of hollow viscus perforation and to see whether delayed laparotomy effected on outcome.Patients and methods: Fifty one hollow viscus perforation peritonitis cases were obtained from medical records between Jan 2005 and October 2009. Patients were divided into four groups on the basis of duration of delaying in hospital visit. Time of onset of symptoms to operation, site of perforation, and outcome were studied.Results:Among 51 cases male were 39 (76.47%) and female were 12 (23.52%). Majority (60.78%) of hollow viscus perforations were seen in productive age group (15-45 years). Most common site of perforation was small bowel (ileum and jejunum) perforation (35.29%), followed by duodenal ulcer perforation (25.49%). Patients with delayed surgery after >5 days of onset of symptoms of perforation showed prolonged hospital stay (3-4 and more weeks) and occurrence of more wound complications (infection, burst abdomen and fecal fistula). Gastric and duodenal perforation have less number of hospital stay (1-2 weeks) without any serious complications whereas small bowel (55.55%) and appendicular (60.00%) perforations have more hospital stay (3-4 weeks) with wound complications.Conclusion: Even with prompt surgery delayed hospital visit with high extent of peritoneal soiling, there is significantly higher risk of wound complications and prolong hospital stay. In contrast to appendicular, ileal and jejunal perforations, duoneal ulcer and gastric perforations have fewer complications.References
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4. Holland AJA, Cass DT, Glasson MJ, Pitikin J: Small bowel injuries in children. J Paediatr Child Health 2000;36:265-69.
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10. Robbs JV, Moore SW, Pillay SP. Blunt abdominal trauma with jejunal injury a review. J Trauma. 1980;20(4): 308-11.
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Seventy cases of injuries of the small intestine caused by blunt abdominal trauma: a retrospective study from 1970-1994. J Trauma. 1999; 46 (1): 116-21.
13. Kemmeter PR, Senagore AJ, Smith D, Oostendrop L. Dilemmas in the diagnsois of blunt enteric trauma. Am Surg. 1998;64:750-4.
14. Fakhry SM, Brown Stein M, Watts DD, Baker CC,
Oller D. Relatively short diagnostic delays (< 8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience. J Trauma. 2000; 48 (3): 408-15.
Published
2015-03-20
How to Cite
LAMSAL, R; SHRESTHA, R KM.
Effect on outcome of delay in surgical management of hollow viscus perforation peritonitis: an experience at Dhulikhel Hospital, Kathmandu University Hospital.
J Soc Surg Nep, [S.l.], v. 14, n. 1, mar. 2015.
ISSN 2392-4772.
Available at: <https://www.jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=24>. Date accessed: 21 mar. 2025.
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