Our experience in gastrointestinal perforations: a retrospective study

Abstract

Background: Peritonitis secondary to gastrointestinal perforation is still one of the commonest surgical emergencies in India and is associated with high morbidity and mortality. The present study examines the incidence of various types of gastrointestinal perforations, their complications and the management of patients with postoperative leaks in our surgical unit and compares our findings with those of previous studies performed between 1984 and 2014.

Methods: Retrospective study analyzing the case files of all the operated cases of gastrointestinal perforations in a single unit over the last 10 years from September 2005 to August 2015 by open procedure. A total number of 381 cases were studied. All cases with perforative peritonitis, whether spontaneous, infective, traumatic or of neoplastic pathology, were included in the study.

Results: Gastrointestinal perforations were common between the ages of 30-50 years; 82% were males. From July to October (rainy seasons) every year a higher number of perforations were noticed; 40% of patients had duodenal, 34% had ileal, 11% appendicular, 6% gastric, 6% jejunal and 3% had colonic perforations. Abdominal pain (100%) and vomiting (81%) were the most common symptoms while tachycardia (50%) and tachypnea (42%) were common signs; 15-20% presented late with features of shock.

Conclusions: Gastrointestinal perforations are one of the most common surgical emergencies. Duodenal perforations are most common. Ileal perforations secondary to enteric fever (typhoid) have highest morbidity and mortality. Most of the anastomotic leaks can be treated conservatively. Mortality depends on the general condition of the patient and associated pre-operative comorbidities.