Clinical profile in cases of intestinal perforation

Abstract

INTRODUCTIONIntestinal perforation is one of the most serious and frequently encountered surgical emergencies. It presents as acute abdomen and requires urgent exploratory laparotomy and corrective surgery. Out of all emergency surgical hospital admissions due to acute abdomen, the prevalence of intestinal perforation could be up to 20-40%. 1 The diagnosis is clinically obvious in many cases, though radiological confirmation is invariably sought before surgical intervention. The morbidity and mortality is adversely affected by several factors pertaining to delay in seeking treatment, poor clinical condition at admission, type of perforation and complicating features. A wide range of pathologies can damage both small and large intestines. Clinically, such patients may present with features of acute intestinal obstruction or perforation. Intestinal obstruction often but not necessarily precedes perforation. Gastrointestinal tract perforations can occur for various causes such as infective etiology, peptic ulcer, inflammatory disease, blunt or penetrating trauma, iatrogenic factors, foreign body or a neoplasm, requiring an early recognition and, often, urgent surgical intervention. The underlying etiological factors of intestinal perforation vary between developed and developing countries. Infectious diseases like typhoid, tuberculosis and HIV infection are the common causes in the developing countries whereas non-infectious conditions like malignancy and diverticulitis are more common in developed nations. 2 The site of intestinal perforation depends on the underlying pathology. Perforation in the duodenum or stomach is a serious complication of peptic Results: The site of perforation was gastric 27.5%, duodenum 20%, jejunum 5%, ileum 35%, appendix 10% and colon 2.5%. Main causes included peptic ulcer 42.5%, typhoid 25% and few cases of trauma, tuberculosis, appendicitis and malignancy. Peritonitis was universal. Primary repair, resection with anastomosis, appendectomy and stoma were the operative procedures. Morbidity rate was 60.0% and mortality rate was 12.5%. Conclusions: Commonest site of perforation was gastro-duodenal while commonest cause was peptic ulcer disease. Morbidity and mortality was comparable with other studies.

An Audit on Gastrointestinal Perforation in a Tertiary Care Teaching Hospital Based in Northern Part of India: A Study of 100 Cases

“…(Singla S et al Ersumo T et al and Utaal M et al). [6,7] Present study showed male predominance, similar results were reported by Utaal M et al and Ersumo T et al [6,7] The male preponderance can be explained by excessive intake of alcohol, smoking, tobacco chewing which is more common in males than females. Also the incidence of acid peptic diseases is more in males as compared to the females.…”

“…Our results were in concordance with the result obtained by Singla S et al and Utaal MS et al who also reported Peptic ulcer was the most common cause for gastrointestinal perforations in their respective studies. [5,7] The results of our study are in congruence with the studies Gupta et al and Vagholkar. [8,13] In their studies, Peptic perforation was the most common etiology followed by Typhoid perforations.…”

“…A subset of patients exhibits delayed symptoms, abscess formation that mimics an abdominal mass, or with sepsis. [7] The most common age group for perforations was 21-40 years followed by 41-60 years with Mean age of 37.91 + 13.15 years in our study. The results were in concordance with the result obtained by previous authors who also reported similar findings.…”

“…Mortality outcome Utaal et al, [7] 12.5% Noguiera et al, [19] 10% Ciftci AO et al, [16] 5.7% Arslan S et al, [18] 5% Shah PH et al, [9] 2.04% Chalya PL et al, [11] 10.7% Nuhu A et al, [20] Nasio NA et al, [21] 2-25% Bhamre et al, [6] 6.67% Singla et al, [5] 5% Present study 5%…”

“…Utaal et al, [7] (%) Singla S et al, [5] (%) In Gastric perforations, Peptic ulcer was the most common cause of perforation followed by Trauma. In Ileal perforations, Typhoid was the most common cause of perforation followed by Tuberculosis and non-specific infection.…”