Spectrum of Gastrointestinal Perforations in a Tertiary Care Hospital of Central Nepal: An Analytical cross-sectional study.
Abstract
Introduction: Perforations of the gastrointestinal tract are frequently encountered surgical emergencies associated with high morbidity and mortality. This study was conducted to evaluate different spectrum of gastrointestinal tract perforations, their presentations, mode of surgery, complications and factors associated with mortality.Methods: This was an analytical cross-sectional study conducted in the Surgical Gastroenterology Department at College of Medical Sciences, Bharatpur, Chitwan, Nepal from October 1st 2021 to October 31st 2022. Patients undergoing emergency laparotomy for GI tract perforations were included in this study. Patients demographics, comorbidities, preoperative investigation, site and cause of perforation, type of surgery and postoperative complications were recorded.
Results: A total 100 patients with gastrointestinal perforations were analyzed. The mean age was 46.55 years. Male predominance with M:F=1.56:1 was seen. Almost 54% patients presented after 24 hrs of onset of pain. Peptic ulcer disease as a cause of perforation was seen in 26%, trauma in 23% cases, appendicular perforation in 20%, malignant perforation in 8%, tubercular perforation in 7% and foreign body perforation in 3% cases. Duodenal, appendicular and colorectal perforations were seen in 28%, 20% and 17% cases respectively. Total morbidity was 54% and mortality was 13%. Increasing age, delayed presentation, presence of comorbidities, systolic blood pressure less than 100 mm Hg, oliguria, presence of malignancy were significantly associated with high mortality.
Conclusion: Perforations of duodenum, appendix and colorectum are commonly encountered. Acid peptic disease, trauma and infections are the leading causes of perforations. Increasing age, delay in presentation, comorbidities, oliguria and hypotension are the factors associated with high mortality.
References
1. Ramakrishnan K, Salinas RC. Peptic Ulcer disease. Am Fam Physician. 2007;76(7):1005-12.
2. Pouli S, Kozana A, Papakitsou I, Daskalogiannaki M, and Raissaki M. Gastrointestinal perforation: clinical and MDCT clues for identification of aetiology. Insights Imaging. 2020; 11(1):31.
3. Langell JT, Mulvihill SJ. Gastrointestinal Perforation and the Acute Abdomen. Med Clin N Am. 2008;92(3): 599–625.
4. Kumar N, Singh R. Preoperative predictors of mortality in adult patients with perforation peritonitis: A review. J Med. College Chandigarh. 2017; 7(1):31-5.
5. Billing A, Frohlich D, Schildberg FW. Prediction of outcome using the Mannheim peritonitis index in 2003 patients. Br J Surg. 1994;81(2):209-13.
6. Thakur JK, Kumar R. Epidemiology of acute abdominal pain: a cross-sectional study in a tertiary care hospital of Eastern India. Int Surg J. 2019 Feb;6(2):345-48.
7. Shrestha K, Poudel BR, Shah LL, Mukhia R, Dahal P, Haque MA, et al. Spectrum of perforation peritonitis -260 cases experience. Postgrad Med J NAMS. 2010 Jul-Dec;10(2):29-32.
8. Chakma SM, Singh RL, Parmekar MV, Singh KH, Kapa B, Sharatchandra KH, et al. Spectrum of perforation peritonitis. J Clin Diagn Res. 2013 Nov;7(11):2518-20
9. Gupta V, Gill CS, Singla SK, Gupta M. Spectrum of perforation peritonitis at a tertiary care centre in Punjab. J Evolution Med Dent Sci. 2018;7(20):2433-36.
10. Bali RS, Verma S, Agarwal PN, Singh R, Talwar N. Perforation peritonitis and the developing world. ISRN Surg. 2014:105492.
11. Jhobta RS, Attari AK, Kaushik R, Sharma R, Jhobta A. Spectrum of perforation peritonitis in India-review of 504 consecutive cases. World J Emerg Surg. 2006;1(26):1-4.
12. Kabongo KMC, Erzingatsian K. Early postoperative complications associated with perforation peritonitis at a tertiary teaching hospital in Lusaka, Zambia: A prospective, observational study. East Cent Afr J Surg. 2021:1-15.
13. Poudel R, Shah S, Chandra K., Pradhan S and Joshi P. Spectrum of Perforation Peritonitis in Western Nepal. J Univers Coll Med Sci. 2018:6(1):11–13.
14. Meena LN, Jain S, Bajiya P. Gastrointestinal perforation peritonitis in India: A study of 442 cases. Saudi Surg J. 2017;5:116-21.
2. Pouli S, Kozana A, Papakitsou I, Daskalogiannaki M, and Raissaki M. Gastrointestinal perforation: clinical and MDCT clues for identification of aetiology. Insights Imaging. 2020; 11(1):31.
3. Langell JT, Mulvihill SJ. Gastrointestinal Perforation and the Acute Abdomen. Med Clin N Am. 2008;92(3): 599–625.
4. Kumar N, Singh R. Preoperative predictors of mortality in adult patients with perforation peritonitis: A review. J Med. College Chandigarh. 2017; 7(1):31-5.
5. Billing A, Frohlich D, Schildberg FW. Prediction of outcome using the Mannheim peritonitis index in 2003 patients. Br J Surg. 1994;81(2):209-13.
6. Thakur JK, Kumar R. Epidemiology of acute abdominal pain: a cross-sectional study in a tertiary care hospital of Eastern India. Int Surg J. 2019 Feb;6(2):345-48.
7. Shrestha K, Poudel BR, Shah LL, Mukhia R, Dahal P, Haque MA, et al. Spectrum of perforation peritonitis -260 cases experience. Postgrad Med J NAMS. 2010 Jul-Dec;10(2):29-32.
8. Chakma SM, Singh RL, Parmekar MV, Singh KH, Kapa B, Sharatchandra KH, et al. Spectrum of perforation peritonitis. J Clin Diagn Res. 2013 Nov;7(11):2518-20
9. Gupta V, Gill CS, Singla SK, Gupta M. Spectrum of perforation peritonitis at a tertiary care centre in Punjab. J Evolution Med Dent Sci. 2018;7(20):2433-36.
10. Bali RS, Verma S, Agarwal PN, Singh R, Talwar N. Perforation peritonitis and the developing world. ISRN Surg. 2014:105492.
11. Jhobta RS, Attari AK, Kaushik R, Sharma R, Jhobta A. Spectrum of perforation peritonitis in India-review of 504 consecutive cases. World J Emerg Surg. 2006;1(26):1-4.
12. Kabongo KMC, Erzingatsian K. Early postoperative complications associated with perforation peritonitis at a tertiary teaching hospital in Lusaka, Zambia: A prospective, observational study. East Cent Afr J Surg. 2021:1-15.
13. Poudel R, Shah S, Chandra K., Pradhan S and Joshi P. Spectrum of Perforation Peritonitis in Western Nepal. J Univers Coll Med Sci. 2018:6(1):11–13.
14. Meena LN, Jain S, Bajiya P. Gastrointestinal perforation peritonitis in India: A study of 442 cases. Saudi Surg J. 2017;5:116-21.
Published
2022-12-27
How to Cite
BELBASE, Narayan Prasad et al.
Spectrum of Gastrointestinal Perforations in a Tertiary Care Hospital of Central Nepal: An Analytical cross-sectional study..
J Soc Surg Nep, [S.l.], v. 25, n. 2, p. 58-62, dec. 2022.
ISSN 2392-4772.
Available at: <https://www.jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=528>. Date accessed: 03 june 2023.
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Original Article
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