A Comparative study of Traumatic and Non Traumatic Gastrointestinal Perforation in Patients Admitted In General Surgery Department, Government Rajaji Hospital, Madurai

Kaliammal, E (2019) A Comparative study of Traumatic and Non Traumatic Gastrointestinal Perforation in Patients Admitted In General Surgery Department, Government Rajaji Hospital, Madurai. Masters thesis, Madurai Medical College, Madurai.

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Abstract

INTRODUCTION: Upper-bowel perforation can be described as either free or contained. Free perforation occurs when bowel contents spill freely into the abdominal cavity, causing diffuse peritonitis (e.g., duodenal or gastric perforation). Contained perforation occurs when a fullthickness hole is created by an ulcer, but free spillage is prevented because contiguous organs wall off the area (as occurs, for example, when a duodenal ulcer penetrates into the pancreas). Lower-bowel perforation (e.g., in patients with acute diverticulitis or acute appendicitis) results in free intra peritoneal contamination. Lau and Leow have indicated that perforated peptic ulcer was clinically recognized by 1799, but the first successful surgical management of gastric ulcer was by Ludwig Heusner in Germany in 1892. In 1894, Henry Percy Dean from London was the first surgeon to report successful repair of a perforated duodenal ulcer. The physiologic effects of truncal vagotomy on acid secretion had been known since the early 19th century, and this approach was introduced to the treatment of chronic duodenal ulcer in the 1940s. The next development in the management of peptic ulcer disease was the introduction of high selective vagotomy in the late 1960s. However, neither of these approaches proved to be useful, and several postoperative complications, including high rates of ulcer recurrence, have limited their use. Currently, in patients with gastric perforation, simple closure of perforated ulcers is more commonly performed than is gastric resection. During World War I, the mortality following isolated injuries of the small intestine and colon was approximately 66% and 59%, respectively. The possible reasons for the high mortality and morbidity rates at that time may have been related to the following factors: • Knowledge in the area of bowel injuries and the pathophysiologic changes triggered by such injuries was inadequate. • Clinical skills and diagnostic techniques that allow early detection of such injuries were lacking. • Intravenous saline solutions or blood transfusions were not used in the management of hypovolemia and hemodynamic changes of these patients. • No antibiotics were available. • Laparotomy was not recommended in abdominal injuries. • The technical maneuvers to assess bowel injuries and to mobilize ascending and descending colon were generally not recommended. During the early years of World War II, Ogilvie, a leading surgeon in the British Army, recommended colostomy for management of all colonic injuries. He reported a mortality rate of 53% for colonic injuries treated with colostomy, a rate similar to that observed during World War I. Several reports clearly indicated that surgeons used colostomy during the Korean and Vietnam wars, particularly in the management of left colonic injuries. However, in civilian injuries, it has been reported that primary repair can be successfully used. By the end of 1980s, primary repair was considered to the management strategy of choice, and it has replaced the use of colostomies in the treatment of civilian patients in most hospitals. The present study deals with the etiology, clinical features, treatment Modalities and factors influencing the prognosis of Gastro intestinal perforations at Government Rajaji Hospital, Madurai Medical College, Madurai. AIMS AND OBJECTIVES: AIMOF THE STUDY: To study the prognosis of traumatic and non traumatic gastrointestinal perforation in GRH, Madurai. OBJECTIVES: 1. To derive conclusion about incidence, age and sex distribution, various etiology, clinical characteristics, different surgical techniques in the management. 2. To study the factors influencing the outcome the patient. 3. To study the mortality and morbidity of gastro intestinal perforation. 4. To analyze the efficacy of scoring systems in predicting morbidity indicators such as SSIs, Return of bowel functions, Duration of ventilator support, Duration of hospital stay. MATERIALS AND METHODS: Study Design: It is a prospective comparative study. All patients who admitted in GRH with Traumatic and Non Traumatic Gastro Intestinal Perforative Peritonitis were subjected to this study. Period of Study: 1 Year (September 2017 – September 2018). Place of Study: Government Rajaji Hospital, Madurai. Selection of Study Subjects: All patients diagnosed with gastro intestinal perforation with peritonitis due to traumatic and non traumatic causes. SAMPLE SIZE: 100patients. DATA COLLECTION: Data regarding demographic data, history, clinical examination, laboratory values. METHODS: Prospective comparative study. ETHICAL CLEARANCE: Approved by the Institute of Ethical Committee, Madurai Medical College. CONSENT: Informed and written consent from all patients. ANALYSIS: USING CHI SQUARE TEST: P value. ELIGIBILITY CRITERIA: INCLUSION CRITERIA: 1. All patients admitted to General surgery department with hollow viscus perforative peritonitis. 2. Both traumatic (blunt and penetrating injury) and non traumatic causes. 3. Patients willing for definitive surgery, giving consent for study. EXCLUSION CRITERIA: 1. Patient who expired before definitive surgery. 2. Not willing for definitive surgery 3. Not willing for the study. CONCLUSION: Gastro intestinal perforation more common in younger age group. Appendicular and meckel’s diverticular perforations are more common in elderly age. Male predominance in gastro intestinal perforation. Smoker / alcoholic / NSAID are predisposing factor. Peptic ulcer disease complicated perforation more common in low socio economic status. Stab injury abdomen is the most common cause for traumatic gastro intestinal perforation. Duodenum and appendix is the most common site for non traumatic gastro intestinal perforation. Ileum and jejunum is the most common site for traumatic gastro intestinal perforation. Clinical examination and early diagnosis and management is the most important factor for Morbidity and mortality of the patient. Computated tomography and diagnostic peritoneal lavage is the gold standard for diagnosis of gastro intestinal perforation. Diagnostic laparoscopy decreases the incidence of negative laparotomy. Co morbidities increase the incidence of post operative wound complication. Simple with omental patch closure in the gastro intestinal perforation increases the patient outcome. Two layer closures in small bowel perforation is better outcome. Laparoscopic closure of the gastro intestinal perforation increases the patient outcome. Most common complication septicemia and wound infection. Cause of death septicemia and cardiac arrest.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Traumatic and Non Traumatic Gastrointestinal Perforation, General Surgery Department, Government Rajaji Hospital, Madurai.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 03 Sep 2019 23:43
Last Modified: 06 Sep 2019 08:31
URI: http://repository-tnmgrmu.ac.in/id/eprint/11439

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