CLINICOPATHOLOGICAL STUDY AND MANAGEMENT OF NON-TRAUMATIC GASTROINTESTINAL PERFORATION- A HOSPITAL BASED STUDY
M. R. Attri, Ajaz Ahmad Shah*, Irfan Nazir Mir, Jubran Amain, Firdous Hamid, Mir Mujtaba Ahmad and Hilal Ahmad Wani
ABSTRACT
Introduction: Non-traumatic hollow viscus perforation is one of the most common surgical emergencies. Surgical interventions (laparotomy) is warranted in almost all cases. Objectives: (i) Evaluate the etiological factors of hollow viscus perforation commonly presenting in a tertiary hospitals. (ii) Evaluate the accuracy of history, clinical parameters, laboratory and radiological investigations in the diagnosis and further management. Methods: This hospital based prospective study was conducted in the Postgraduate Department of General Surgery, Government Medical College, Srinagar for two consecutive years from August 2015 to September 2017 in cases undergoing, laparotomy for non-traumatic hollow viscus perforations Result: Majority of our patients were in their 3rd and 4th decade of life. Out of a total of 272 patients, male contributed 238 (87.5%) while as females were only 34 (12.5%). A total of 171 (62.86%) cases of gastroduodenal perforations were encountered in the present study followed by 61 (22.42%) appendicular cases. 30 (11.02%) of patients had small gut perforations while as 10 (3.67%) patients had colorectal perforations. In duodenal perforation, duodenal ulcer was the commonest etiology, malignancy was the commonest etiology in gastric ulcer perforation. Typhoid fever was the commonest etiology in ileal perforation. In the present study free gas under right dome of diaphragm was present in 215 (79.05%) patients. Patients included in this study were managed according to the standard protocols, initial resuscitation was followed by definitive surgery. Conclusion: Gastrointestinal perforations have a good prognosis provided they are diagnosed and operated early because of its dramatic onset. Closure of the perforation is still thecommonest surgical procedure done in ileal perforations followed by thorough peritoneal toilet withnormal saline.
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