A DESCRIPTIVE STUDY OF THE EMERGENCY LAPAROTOMIES AT A GOVERNMENT TEACHING HOSPITAL

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A DESCRIPTIVE STUDY OF THE EMERGENCY LAPAROTOMIES AT A GOVERNMENT TEACHING HOSPITAL

Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 10

Abstract

BACKGROUND Although, emergency laparotomy is a common surgical procedure performed routinely, yet outcome data and postoperative care data is very less documented. Therefore, we undertook this systematic study of emergency laparotomies performed in our Government Teaching Hospital. MATERIALS AND METHODS This is a Descriptive study of 137 consecutive emergency laparotomies, which were performed in our Government Teaching Hospital between 01 January 2015 and 31 December 2016. The clinical presentations, indications, intraoperative findings and complications after emergency laparotomies were properly documented and tabulated. RESULTS Patients who underwent emergency laparotomy presented with the symptoms of acute abdomen (78.9%) or with history of trauma. The majority of cases who presented with acute abdomen were having gastrointestinal perforation (74%). Next common aetiology was found to be intestinal obstruction (20%). 89% of the laparotomies due to trauma were of blunt trauma type and the rest were of penetrating type. On examination, the most common clinical features were found to be abdominal tenderness (89.7%), distension of abdomen (78.1%), tachycardia (77.4%), guarding (69.3%) and hypotension (9.5%). The age group of the majority of the patients was in the 20 - 50 years range. Nearly half (47.4%) of the patients were taken for surgery within the first 24 hours of their arrival into the hospital. About 56.2% of patients developed postoperative complications, of which the most common was wound infection (27%). After emergency laparotomies, 20 patients (14.6%) died in the postoperative period during the initial hospital stay. Mortality was maximum in the elderly age group and in patients with large bowel perforation and in patients having extensive bowel gangrene due to mesenteric ischaemia. In trauma group, severe haemorrhagic shock and major organ or multiple solid organ injuries and/or great vessel injury were the mortal causes. CONCLUSION ‘Acute Abdomen’ is the most common indication for emergency laparotomies. Among these cases of ‘Acute Abdomen,’ perforation peritonitis is the most common indication for a laparotomy. Although, the most common perforation in our study was duodenal perforation, the diagnosis-specific mortality in ‘Acute Abdomen’ cases was higher when the aetiology was large bowel perforation or mesenteric ischaemia. Time elapsed between presentation to the Emergency Room (ER) and surgical intervention had a bearing on the outcome.

Authors and Affiliations

Khalid Muqueem, Gowreesh Meti

Keywords

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EP ID EP411299
DOI 10.14260/jemds/2018/273
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