A study of non-traumatic gastrointestinal perforations in a tropical country

Abstract

Background: Gastrointestinal perforations constitute one of the commonest surgical emergencies encountered by surgeons all over the world. However, non traumatic gastrointestinal perforations are more commonly seen in tropical countries. They cause considerable mortality and usually require emergency surgery. This study was designed to study the clinical spectrum of non traumatic gastrointestinal perforation in a tropical country and thereby assessing the surgical outcome.Methods: An observational study was conducted in the department of general surgery, Mamata medical college, Khammam to analyse the clinical spectrum and their management protocol with outcome of the patients presenting with non traumatic gastrointestinal perforation. A total number of 140 patients of various etiologies of non traumating gastrointestinal perforations were found to be treated over a period of six years. Detailed demographic profile, clinical presentations and etiological factors were studied along with various management protocols offered to them with the outcome.Results: Most common age of presentation was 41-60 years with 72%being males. Most common site of perforation was duodenum (28.57%) followed by stomach (25%). Peptic ulcer (53.57%) was the predominant etiology followed by appendicular perforation (15.71%), enteric perforation (12.85%), tubercular (4.28%), malignancy (1.42%) and diverticula (0.71%). Most common post-operative complication was wound infection (37.14%) followed by dyselectrolytaemia (31.42%). Mortality was 7.14%.Conclusions: Gastrointestinal perforations constitute one of the commonest surgical emergencies. Non traumatic gastrointestinal perforations are quite common in a tropical country like India. The high rates of mortality among those, who present late, prompt an early diagnosis and active management protocol in order to reduce mortality and morbidity in such patients.

An additional cause to be introduced in the inventory of non-traumatic perforations of the small intestine: gallstone migration.

“…The spectrum of etiology of perforation in tropical countries is different from its western counterpart. In contrast to western countries where lower gastro-intestinal tract perforations predominate, upper gastro intestinal tract perforations constitute the majority of cases in developed countries [2]. The following are the main causes of perforation: ischemic, occlusive, inflammatory (Meckel's diverticulitis), infectious (tuberculosis, typhoid fever), or traumatic (instrumentation, foreign body.…”