European Journal of Cardiovascular Medicine

Background: Perforated hollow viscus is characterized by loss of gastrointestinal wall integrity with subsequent leakage of enteric contents. Aim: The aim was to conduct diagnosis and treatment of non-traumatic hollow viscus perforation and the principles of management that have evolved through years will be addressed. Materials and Methods: This study was done in the Department of General Surgery. A total number of 50 cases were included in this study, which satisfied the inclusion and exclusion criteria. Results: Most common age group involved is in 3rd  to 4th  decade in the present study. Male preponderance (82%) was seen, with a male to female ratio was 4.6:1. The time lapse between onset of symptoms and presentation at the hospital was more than 24 hours in 24% of the study population. Abdominal pain was the most consistent symptom and was seen in 100% of the study population in the present study followed by  vomiting (52%) and fever (46%). Distended abdomen was seen in 46% of study population in the present study. Tenderness was seen in all the cases and is more prominent at the site of perforation. Guarding/rigidity and absent bowel sounds were seen in 92% of the study population. Sensitivity of imaging in detecting gas under diaphragm was 72% by USG abdomen and 80% by plain radiography. Benign  causes  of  gastrointestinal  perforation  constituted  majority  of  non- traumatic gastrointestinal perforations. Perforated peptic ulcers were responsible for 68% of non-traumatic gastrointestinal perforations. Peptic   ulcer   perforation   (68%)   is   the   major   cause   of   gastrointestinal perforation in the present study followed by appendicular (24%) and typhoid (4%) perforations. Most  common  site  for  non-traumatic  gastrointestinal  perforations  in  the present study was duodenum (48%) followed by appendix (24%) and pre- pyloric region of stomach (20%). Simple closure with omental patch was the operative procedure done for all cases of peptic ulcer perforation and appendicectomy for appendicular perforation. Ileal perforations secondary to typhoid perforation were treated with resection and end-to-end anastomosis in the present study. Colonic perforation was managed with Hartmann’s procedure. Most  common  complication  in  this  study  was  SSI  (34%),  followed  by respiratory  infection  (22%).  Burst  abdomen  was  seen  in  2%  of  cases. Mortality in the present study was 8% and was due to septicaemia. Conclusion: There were many risk factors for increased morbidity and mortality which includes older age group, delayed presentation and features of shock, so, aggressive resuscitation and early meticulous surgery is required to decrease morbidity and mortality in hollow viscus perforation cases.