jsmc-10070

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NON TRAUMATIC GASTROINTESTINAL PERFORATION AS A CAUSE OF ACUTE ABDOMEN

Kamal Ahmed Saeed * and Kamal Aziz Abdulqadr **

* Department of Surgery, School of Medicine, Faculty of Medical Sciences, University of Sulaimani.

** Halbja General Hospital.

Submitted: 31/8/2014; Accepted: 25/1/2015; Published 1/6/2015

DOI Link: https://doi.org/10.17656/jsmc.10070

ABSTRACT

Background

Any part of the GI tract may become perforated, releasing gastric or intestinal contents into the peritoneal space. Causes vary. Symptoms develop suddenly, with severe pain and may be followed by signs of shock. Diagnosis is usually made by the presence of free air in the abdomen on imaging studies. Treatment is with fluid resuscitation, antibiotics, and surgery. Mortality varies with the underlying disorder and the patient’s general health.

Objectives

To study the clinical pattern of various gastrointestinal perforations in Surgical Emergency Department in Sulaimany.

Patients and Methods

This prospective study was done in Sulaimany Teaching Hospital, including all emergency, non-traumatic acute abdomen those were caused by gastrointestinal (GI) perforation from the 1^st of February 2011 to the 1^stof September 2012. A total of 100 patients were collected. Patient’s data were analyzed by history, examination

and various laboratory investigations and radiological studies.

Results

The commonest cause of perforation was peptic ulcer (70%), nineteen cases (19%) were infection, and the remaining (11%) were from other causes. Seventy-two patients (72%) were male and (28%) were female, fifty cases were of age between 15-45 years. Most of the patients presented with pain in the abdomen (93%), eighty

febrile, and (7%) had shock. Ninety-eight (98%) cases were surgically treated, of which 60 were recovered uneventfully, thirty-one cases developed complications and 8 died post-operatively.

Conclusion

To manage a case of perforated hollow viscus of any sort, a skilled surgical team which can handle these situations confidently is of prime importance.

KEYWORDS

Acute abdomen, GI perforation, NSAID, and Peptic ulcer.

References

1. Wakayama T, Ishizaki Y, Mitsusada M .Risk factors influencing the short-term results of gastroduodenal perforation. Surg Today 1994, 24:681-87.

2. Dorairajan LN, Gupta S, Deo SV, Chumber S, Sharma L. Peritonitis in India-a decade’s experience. Trop Gastroenterol. 1995; 16(1):33–38.

3. Ordonez CA, Puyana JC. Management of peritonitis in the critically ill patient. Surg Clin Nort Am. 2006; 86(6):13231349.doi:10.1016/j.suc.2006.09.006.

4. Chan WH, Wong WK, Khin LW, Soo KC: Adverse operative risk factors for perforated peptic ulcer. Ann Acad Med Singapore 2000, 29:164-67.

5. Koo J,Ngan YK, Lam SK: Trends in hospital admission, perforation and mortality of peptic ulcer in Hong Kong from 1970 to 1980.Gastroenterology 1983, 84:1558-62.

6. Alam MM: Incidence of duodenal ulcer and its surgical management in a teaching hospital in Bangladesh.Trop Doct 1995, 25:67-8.

7. Tripathi MD, Nagar AM, Srivastava RD, Partap VK: Peritonitis- study of factors contributing to mortality. Indian J Surg 1993, 55:342-49.

8. Wig JD, Malik AK, Chaudhary A, Gupta NM: Free perforations of tuberculous ulcers of the small bowel. Indian J Gastroenterol 1985, 4:259-61.

9. Butler J, Martin B. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Detection of pneumoperitoneum on erect chest radiograph. Emerg Med J. Jan 2002;19(1):46-7.

10. Jones R. Recognition of pneumoperitoneum using bedside ultrasound in critically ill patients presenting with acute abdominal pain. Am J Emerg Med. 2007; 25:838–41? [PubMed] 11. Grassi R, Romano S, Pinto A, Romano L. Gastro-duodenal perforations: Conventional plain film, US and CT findings in 166 consecutive patients. Eur J Radiol. 2004; 50:30–6.

12. Donovan AJ, Berne TV, Donovan JA. Perforated duodenal ulcer: an alternative therapeutic plan. Arch Surg. Nov 1998; 133(11):1166-71.

13. Bailey & love’s Short practice of surgery, 25th edition, p 994, summary box 58.5, p69.

14. Yadav S.S.,Shrinarayan . An experience with cases of peritonitis at Bheri zonal hospital, Nepalgunj. J soc SurgNepal 2002; 5(l):33-36 .

15. Washington BC, Villalba MR, Lauter CB: Cefamendole-erythromycin- heparin peritoneal irrigation. An adjunct to the surgical treatment of diffuse bacterial peritonitis. Surgery; 1983; 94: 576-81.

16. Watkins RM, Dennison AR, Collin J. What has happened to perforated peptic ulcer? Br J Surg.71:774, 1984.

17. Sarath Chandra S, Siva Kumar S. Definitive or conservative surgery for perforated gastric ulcer? - An unresolved problem. Int J Surg. Dec 25 2008;

18. T. Kemparaj, S.I.S. Khadri : Gastrointestinal Perforations - Our Experience .The Internet Journal of Surgery. 2012 Volume 28 Number 2. DOI: 10.5580/2ab1.

19. Shinagawa N, Muramoto M, Sakurai S, Fukui T, Hon K, Taniguchi M, Mashita K, Mizuno A, Yura J: A bacteriological study of perforated duodenal ulcer. Jap J Surg; 1991; 21: 17.

20. Calcuttawala MA, Nirhale DS. Perforated Duodenal Ulcer Emerging Pattern. WebmedCentral GENERAL SURGERY 2013;4(1):WMC003966