The Treatment and Complications of Non-Traumatic Upper Gastrointestinal Perforation: An Observational Study

Background: Gastrointestinal tract (GI) Perforations are emergency situations that require early diagnosis and prompt management. These may account for nearly half of admissions in the General Surgical ward, presenting with Acute Abdomen. A rapid diagnosis and early treatment are important and delay leads to increased mortality and morbidity. The treatment is mainly surgical, with conservative management being reserved for hemodynamically unstable patients with co-morbidities. The common causes of Gastrointestinal Tract Perforation are Blunt or Penetrating Trauma, Peptic Ulcer, Inflammatory Disease, Foreign Body, estrogenic or Neoplasms. These may have variable clinical presentations, notably in the early clinical course. The aim of the author is to investigate the modes of treatment and complications, associated with Non-traumatic Upper Gastrointestinal Perforation.

Methods: This Cross-sectional Observational study was carried out in the Department of General Surgery at Late Lakhiram Agrawal Memorial, Government Medical College (LAMGMC) Raigarh, Chhattisgarh, India, from September 2014 to August 2016. A total of 100 adult subjects (both males and females) of all age groups were included in this study.

Results: Operative management was done in 44 patients (44%), 38 patients (38%) were managed conservatively & 18 (18%) of cases were managed with Peritoneal drainage under Local Anesthesia (LA). The most common complication in patients with Peptic perforation was Toxemia in 32.3% of patients, followed by Wound breakdown in 17.9% and Respiratory complications in 11% of patients. The most common complications in patients with Typhoid perforation were Toxemia in 50%, Respiratory complications in 32.4% of patients, Operative site infection in 22.2% and Wound dehiscence in 18.5% of cases. Similarly, the most common complication in cases with Appendicular perforation was Wound breakdown in 50% of patients, followed by Toxemia in 40% of patients. The average duration of stay in hospital was 16.52 days. The average duration of hospital stay in patients with Peptic perforation was 17.3 days, for Typhoid perforation 18.3 days, for Appendicular perforation 18.5 days and for other perforation was 12 days.

Conclusions: Gastrointestinal (GI) Perforation is an important emergency situation that usually requires prompt surgery often delay in diagnosis and treatment leads to severe complications and increase morbidity and mortality. The majority of the cases underwent Operative management and the most frequent complication encountered was Toxemia followed by Wound Breakdown and Respiratory Complications. The average duration of stay in the hospital was nearly the same for all cases but the stay was less in patients who were managed conservatively.