Gastrointestinal perforations: a tertiary care center experience

Parimala S. Devi; Ganesh Manikantan; Meer M. Chisthi

doi:10.18203/2349-2902.isj20170218

Authors

Parimala S. Devi Department of General Surgery, Government Medical College, Trivandrum, Kerala, India
Ganesh Manikantan Department of General Surgery, Government Medical College, Trivandrum, Kerala, India
Meer M. Chisthi Department of General Surgery, Government Medical College, Trivandrum, Kerala, India

DOI:

https://doi.org/10.18203/2349-2902.isj20170218

Keywords:

Blunt abdominal injuries, Bowel perforation, Hollow viscus injury, Penetrating abdominal injuries

Abstract

Background: In spite of the advances in surgical techniques and antimicrobial molecules, gastrointestinal perforations still remain highly fatal. Delay in diagnosis as well as referral is often attributed to be the cause behind the high mortality caused by this condition. The aim of the study was to elucidate the etiological factors of gastro intestinal perforation as well as postoperative outcome among patients undergoing treatment at a tertiary care centre.

Methods: This was a Descriptive study of patients admitted with gastro intestinal perforation in the General Surgical wards of Government Medical College, Trivandrum from March 2014 to February 2015. The demographic, clinical, operative and post-operative findings were entered into a structured performa and analyzed statistically.

Results: Atraumatic perforation was found to predominate over traumatic perforations. Most of the atraumatic perforations belong to the age groups between 21 and 30. Also, there is a high male predominance among these patients. Proximal gastrointestinal tract injuries predominate much more than distal ones. Increased morbidity is seen if there are associated co morbidities and risk factors including smoking and alcohol abuse. Mortality rate is highest in traumatic injuries involving colon and rectums.

Conclusions: Mortality due to perforation peritonitis is still a challenge to the surgeon and burden to the society. Early diagnosis and treatment will positively alter the outcome of a gastrointestinal perforation and can be ensured only by timely arrival of the patients to hospital and subsequently by early intervention. This in turn depends mostly on strengthening the primary care and referral services.

Metrics

Metrics Loading ...

References

Hugar BS, Harish S, Girishchandra YP, Jayanth SH. Study of sudden gastrointestinal deaths: an autopsy study. Med Sci Law. 2014;54(2):637.

Alastair CJ, Pierre JG. Abdominal trauma. In: John M, Graeme D, Kevin OM, editors. Surgical Emergencies, 1st edition. Italy: Blackwell Science Ltd. 1999:224-236.

Bege T, Brunet C, Berdah SV. Hollow viscus injury due to blunt trauma: a review. J Visc Surg. 2016;153(4):618.

Solomkin JS, Mazuski JE, Bradley JS. Diagnosis andmanagement of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect. 2010;11:79-109.

Mcfarlane M. Management of penetrating abdominal injuries. W Indian Med J. 1995;44:140-2.

Githaiga JW, Adwok JA. Diagnostic peritoneal lavage in the evaluation of abdominal trauma using the dipstick. East Afr Med J. 2002;79:457-60.

Kibosia JC. A study of some aspects of management of penetrating stab wounds (PASW) at KNH. Med Dissertation, University of Nairobi, 1990.

Exadaktylos A, Stettbacher A, Edul S. Successful management of abdominal stab wounds with clinical evaluation: experiences of a South-African trauma unit with 496 consecutive patients. Unfallchirurg. 2003;106:215-9.

Edino ST. Pattern of abdominal injuries in Amimu Kano Teaching Hospital, Kano. Niger Postgrad Med J. 2003;10:56-9.

Munns J, Richardson M, Hewett P. A review of intestinal injury from blunt abdominal trauma. Aust NZJ Surg. 1995;65:857-60.

Kane NM, Francis IR, Burney RE. Traumatic pneumoperitoneum. Implications of computed tomography diagnosis. Invest Radiol. 1991;26:574-8.

Grosfeld JL, Rescorla FJ, West KW, Vane DW. Gastrointestinal injuries in childhood: analysis of 53 patients. J Pediat Surg. 1989;24:580-3.

Bosworth BM. Perforation of the small intestine from non-penetrating abdominal trauma. Am J Surg. 1984;76:472-9.

Counseller VS, Mccormack CJ. Subcutaneous perforation of the jejunum. Ann Surg. 1935;102:365-74.

Dauterive AH, Flancbaum L, Cox EF. Blunt intestinal trauma. A modern day review. Ann Surg. 1985;201:198-203.

Sule AZ, Kidmas AT, Awani K, Uba F, Misauno M. Gastrointestinal perforation following blunt abdominal trauma. East Afr Med J. 2007;84:429-33.

Ameh EA, Nmadu PT. Gastrointestinal injuries from blunt abdominal trauma in children. East Afr Med J. 2004;81:194-7.

Dakubo JC, Naaeder SB, Lamptey JN. Gastro-duodenal peptic ulcer perforation. East Afr Med J. 2009;86(3):100-9.

Rodolfo L, Riquelme MC, Men C. Mannheim peritonitis index validation study at the hospital general de durango (Mexico). Cir Ciru. 2002;70:217-25.

Correia MM, Thuler LCS, Velasco E, Vidal EM, Schanaider A. Prediction of death using the mannheim peritonitis index in oncologic patients. Revista Brasileira Cancerologia. 2001;47(1):63-8.

Stewart BT, Lee V, Danne PD. Laparotomy for trauma in a regional centre: the effect of delay on outcome. Aust NZJ Surg. 1994;64:484-7.

Jhobta RS, Attri 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.

Lee JY, Lee SW, Jung MJ. Perioperative risk factors for in-hospital mortality after emergency gastrointestinal surgery. Medicine. 2016;95:35.