Background: Perforated peptic ulcer is the most common cause among all causes of gastrointestinal tract perforation which is an emergency condition of the abdomen that requires early recognition and timely surgical management. Peptic ulcer perforation is associated significant morbidity and mortality. The aim of study is to evaluate the incidence, clinical presentation, management and outcomes of the patient with peptic ulcer perforation undergoing emergency laparotomy.Methods: This retrospective study includes 45 patients who were operated for perforated peptic ulcer peritonitis at Bundelkhand Medical College and Associated Hospital, Sagar from March 2015 to April 2017. Paediatric patients of age less than 14 years, patients presenting as recurrent perforation were excluded from the study. A detailed history, clinical presentation and routine investigations were done in all cases.Results: In the present study, most of the patients were male. Most of these patients presents with clinical signs of peritonitis between 24-48 hours after onset of the pain. Among the patients of peptic ulcer perforation, duodenal perforation (93.3%) is more common and which is the most common cause of perforation peritonitis. The diagnosis is made clinically and confirmed by presence of gas under diaphragm on radiograph. Exploratory laparotomy with simple closure of perforation with omental patch was done in all cases. The most common post-operative complication was wound infection (57.5%). The overall mortality was 11.1%.Conclusions: Late presentation of peptic ulcer perforation is common with high morbidity and mortality. Surgical intervention with Graham’s omentopexy with broad spectrum antibiotics is still commonly practiced.

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Postoperative muscle pain following suxamethonium is a well known problem.',* Recently it has been reported that diazepam has protective effects against these muscle pains3 This study was taken to confirm this observation and also to observe a dosc rclatcd cffcct of diazepam on suxamethonium pains. Muterid und method.,Various factors such as age, sex, type and duration of' operation. body weight. body position and anaesthetic technique may affect the incidence of suxaniethonium pains. In this study female patients of average body weight 40 kg. aged 20 to 45 years, of physical status 1 in the ASA classification, undergoing tuba1 ligation were studied. Patients with cardiac. respiratory. renal and neurological disorders were excluded. All patients were hospitalised and were ambulatory 6 to 8 hours after operation. Patients were given various doses of diazepam (Table I). It was planned to have 25 patients in each group, but in the diazepam group nine paticnts given a dose of 5 mg diazepam required an additional dose of suxamethonium and have. therefore. been excluded from the series.All patients werc given atropine 0.65 mg intravenously prior to induction. No other drugs were used. .,. Experimrn~al Diazepam given ~~Anaesthesia for the patients in the control group was induced with 250 mg thiopentone. The same dose was uscd in all patients becausc of the infucnce of thiopentone on the incidence of pain after administration of s u~a m e t h o n i u m .~ Suxamethonium 50 mg was given immediately after the thiopentone as a single injcction. Anaesthesia was maintained with oxygen and ether through a sem-closed circuit. Thc same tcchnique was employed in the experimental group except that diazepam in 5. 10. 15 and 20 mg doses was given intravenously 5 minutes prior t o suxamethonium.Postoperatively paticnts were asked about muscle pains by a doctor who was unaware of the drugs used

Postoperative muscle pains occurred in 16% of 25 patients given 10 mg diazepam IV 5 minutes prior to succinylcholine. Postoperative muscle pains occurred in 60% of 25 patients not given diazepam before succinylcholine. The difference is statistically significant. Diazepam reduced the severity and duration of postoperative muscle pains, as well as their frequency.