Non Traumatic Gastrointestinal Perforations

Anandhi, A (2008) Non Traumatic Gastrointestinal Perforations. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: Perforation peritonitis is the most common surgical emergency in India. Despite advances in surgical techniques, antimicrobial therapy and intensive care support, management of peritonitis continues to be highly demanding, difficult and complex. The spectrum of etiology of perforation continues to be different from that of western countries and there is paucity of data from India regarding it's etiology, prognostic indicators, morbidity and mortality patterns. Our study was designed to highlight the spectrum of perforation peritonitis as encountered by us at Kilpauk Medical College and Hospital, Chennai. AIMS OF THE STUDY: 1. To study the epidemiology, seasonal trends, etiology and clinical presentation. 2. To study the incidence in perforation in different part of GIT. 3. To study the different management techniques used. 4. To study the factors influencing the outcome. 5. To study the morbidity and mortality. PATIENTS AND METHODS: An analysis of 125 patients of perforation peritonitis was done over a period of 27 months (from May2005 to July 2007) at Kilpauk Medical College, Chennai. All cases were studied in term of clinical presentation, radiological investigations done, operative findings and postoperative course. Data was collected from indoor patient records, operation theatre records and outpatient department follow up of cases. All patients following a clinical diagnosis of perforation peritonitis and adequate resuscitation, underwent exploratory laparotomy in emergency setting. At surgery the source of contamination was sought for and controlled. The peritoneal cavity was irrigated with 5–6 litres of warm normal saline and the decision to insert a drain was left to the discretion of the operating surgeon. Abdomen was closed with continuous, number one non-absorbable suture material. Although all patients received appropriate perioperative broad spectrum antibiotics, the drug regimen was not uniform. Inclusion Criteria: All cases found to have peritonitis as a result of perforation of any part of gastrointestinal tract at the time of surgery were included in the study. Exclusion Criteria: 1. cases of primary peritonitis 2. esophageal rupture or perforation. 3. perforation of hepatobiliary system. 4. iatrogenic perforations. 5. traumatic perforations. 6. peritonitis due to anastomotic leak. CONCLUSION: 1. duodenal ulcer perforation was the commonest cause of GIT perforation with male preponderance. 2. More common in third decade. 3. More common in lower socioeconomic class. 4. More common in winter season. 5. Smoking and alcohol were aggravating factors. 6. Most of the patients presents with pain abdomen, fever and vomiting. 7. Simple closure with omental patch was very effective in the management. 8. Next to duodenum gastric perforation was more common. 9. Gastric perforation was more common in fourth decade. 10. Ileal perforation was more common in third decade. 11. Commonest causes being typhoid and tuberculosis. 12. Single ileal perforation was more common than multiple perforation. 13. Closure in two layers was very much effective in small bowel perforation. 14. Prognostic determinant in perforation were delay in presentation to the hospital and degree of contamination. 15. Conservative management increases the number of hospital stay. 16. Incidence of colonic perforation was 2.4% (3 cases) in this study. 17. Most common post operative complication was wound infection. 18. Deaths were due to septicemia, cardiac arrest and respiratory complication. 19. In spite of the recent advances in closing the D.U. perforation by laparoscopy and by other means, still simple closure with omental patch is widely practiced.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Non Traumatic ; Gastrointestinal Perforations.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 05 Jun 2018 17:40
Last Modified: 06 Jun 2018 02:47

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