Non-Traumatic Gastric Perforations

Abstract

BACKGROUND Gastric perforation is a common surgical emergency. Majority is due to benign ulcers, but rarely it may be cancer perforation. Usually it is on the anterior surface of the stomach. Only rarely we get perforation on the posterior surface. Pre-pyloric area is a common location of stomach perforation. Surgical options like primary closure or omental patch repair are favoured in the literature as these options carry good results as well as low mortality in an emergency setting. Traditionally it is said that gastric perforation carries high incidence of malignancy so should either be resected or at least a biopsy is essential before closure. The objectives of this study were-1. To identify the most common location of gastric perforations. 2. To identify the total incidence of malignancy. 3. To determine the rate of malignancy in different locations. 4. To evaluate the need for intraoperative biopsy. 5. To identify the best treatment options for these patients. MATERIALS AND METHODS This is a retrospective cohort study. Patients operated for gastric perforations during the period 2013-2016 were identified and details collected from data base. The collected data was subjected to statistical analysis with the help of SPSS Version 21.0. RESULTS Results of the analysis are presented in the form of tables and graphs. CONCLUSION Most common location of gastric perforation is pre-pyloric region. Incidence of malignancy is less in pre-pyloric perforation (1.3%). Malignancy incidence is more in other locations in stomach (24%). Intra operative biopsy is essential, since malignant perforation was detected in all locations, especially in locations other than pre-pyloric region of stomach. Gastrectomy in the setting of perforated stomach carries high mortality.