A CLINICAL STUDY OF GASTRODUODENAL PERFORATIONS
*Dr. C. Thiruppathy and Dr. Selvan Ramamoorthy
Introduction: Duodenal perforation is one of the most common surgical emergencies. An acute perforation is estimated to occur in 2% to 10% of patients with duodenal ulcer. Perforation is one of the important complications of duodenal ulcer. Duodenal perforation currently accounts for approximately 75% of peptic ulcer perforation. Of note, the mortality rate for perforated ulcer is high in elderly and after gastric than after duodenal perforation. Based on this aim of our study is to study the incidence, age and sex distribution of gastro duodenal perforation, also to study the etiology and clinical features of gastro duodenal perforations, different surgical techniques in the management and factors influencing the outcome of the patients. Materials and Methods: This study was conducted in the Department of General Surgery, Tirunelveli Government Medical College Hospital, Tirunelveli, 91 cases of Gastro intestinal perforations were studied during our study period. The diagnosis was established by the Emergency Surgeon provisionally, based on the clinical presentation and supporting radiological evidence, in the ward, and definitive diagnosis established at the time of operation. Based on the time interval between the hospital admission and surgery, the surgery was categorized into, Immediate, Same day, Delayed. Operative details were noted. Tissue biopsies for histologic confirmation were taken in appropriate case. Mortality was defined as death following surgery. Patients with traumatic perforations, Oesophageal perforation/rupture, and other perforation were excluded. Results and Conclusion: Duodenal ulcer perforation was the commonest cause of gastrointestinal perforation with a male preponderance. Smoking and alcohol were aggravating factors. Simple closure with omental patch with thorough peritoneal toileting was very much effective. Definitive ulcer surgery was not warranted in the emergency and treatment with H2 blockers and H. pylori eradication achieved good control over the disease in the follow up period. The prognostic indicates were early hospitalization, adequate fluid replacement and no co-existing medical illness. Closure of recent advances in closing duodenal peroration by laparoscopy and by other means, still simple closure with omental patch is widely practiced in the study group. The most common post-operative complication was wound infection. Deaths were due to septicemia and cardiac arrest.
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