Presentation of Peptic Perforation Patients among Non Traumatic Perforation Patients
Journal Title: Journal of Medical Science And clinical Research - Year 2016, Vol 4, Issue 10
Abstract
Background: Gastrointestinal perforation constitutes one of the most common causes of surgical emergency. The main objective was to study incidence of peptic perforation peritonitis and there sign, symptoms and various factors affecting morbidity and mortality. Method: It was prospective 1 year study conducted in surgical ward of Department of surgery SGMH Rewa (M.P.) during the period August 2014-July 2015.A 162 cases of peptic perforation peritonitis were studied, out of 277 of all no traumatic perforation cases. Patients are selected on the basis of symptom, sign at the time of admission and operative finding. All patients have been studied and results are analysed. Result: in study, maximum number of cases were of Peptic perforation ( 58.48%), peptic perforation cases were reported throughout the year with higher incidence in month of October 2014 and January 2015, incidence of peptic perforation was recorded in the age group of 41-60 years(22.74%), followed by 21-40 years of age (22.38%), Peptic perforation found to be predominant in rural population accounting for 83.95% of total nontraumaic perforation cases, pain abdomen was present in all cases of peptic perforation. Next common symptom in peptic perforation was distension (95.67%) and constipation (82.71%), Tenderness and distension was present in all cases of peptic perforation, In peptic perforation there was Guarding in 98.8% cases and absent Bowel sounds in 96.3%, that escape of gas (92.59%) and fluid (91.35%) were found in peptic perforation during laparotomy, Adhesion was present in 51.85%. Gastric perforation was found in 72.22% of cases and duodenal perforation 27.77% cases, Respiratory infection was most common systemic complication (17.28%), followed by Toxaemia (10.49%). Wound infection was most common local complication (25.30%) mortality in peptic Perforation was 12.96%. Operative interval was taken as the time from the onset of first symptom till the patient was treated surgically. In case of peptic perforations which were operated before 72 hours mortality was 5.35%, which was less than those operated after 72 hours (16.98%),Mortality in case of Intra-peritoneal drainage followed by operation was 12.06%, which was less than patient that operated without intra-peritoneal drainage (13.46%).,Peptic Perforation operated by Simple closure + Omentopexy had mortality 11.53% which was lower than that patients operated by Omentopexy only (13.63%), average hospital stay in case of Peptic Perforation was 12 days. Conclusion: Peptic perforation is a serious emergency. Patient presentation mainly decided the mortality and morbidity of patients. Young age and early presentation associated with favourable prognosis and old age and late presentation associated with higher mortality. operative procedure like omentopexy is sufficient. Proper resuscitation at presentation and better post operative care can decrease the harmful and worse sequence of this condition.
Authors and Affiliations
Neelesh Shrivastava
Keywords
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