Original Research Article
Year: 2020 | Month: January-March | Volume: 5 | Issue: 1 | Pages: 66-76
A Study of Risk Factors, Early Evaluation and Management of Duodenal Ulcer Perforation Peritonitis
Sangita M Gavit1, Bhagyashri M Ahirrao2
1Associate Professor Government Medical College Jalgaon,
2Assistant Professor ACPM Medical College Dhule,
MUHS Nasik Maharashtra, India
Corresponding Author: Bhagyashri M Ahirrao
ABSTRACT
Background: Duodenal perforation is not commonly seen, it's a complication of peptic ulcer perforation and duodenal ulcer occurs due to an imbalance between gastro-duodenal mucosal defense mechanism and the damaging forces, particularly gastric acid, pepsin related to predisposing & risk factors. Multiple treatments of choices available for perforation peritonitis like conservative, endoscopic, laparoscopic, and surgical management. The main goal of treatment are resuscitation, control of infection, nutritional support and restoration of gastrointestinal tract continuity.
Objectives:
- To assess the Risk factors of Duodenal perforation
- To determine the mode of presentation ( symptoms)
- To assess the different modes of Management
- To assess the outcome
Methodology: It is a prospective observational study carried out at a tertiary care center from January 2013 to January 2016, of three year duration. Total 58 cases were included who were presented with perforation peritonitis. Provisional diagnosis was made from history, clinical findings & radiological findings showing gas under diaphragm but confirmed only during intraoperative. All basic laboratory investigations carried out like complete blood count, renal function test, liver function test with serum protein, serum amylase, serum electrolyte and arterial blood gas measurement, urine routine and microscopy, blood culture and sensitivity.
Procedure: With midline incision, edges of perforation refreshed & biopsy taken if needed. Primary closure of duodenal ulcer perforation done with 2-0 mersilk through and through, interrupted sutures 0.5 cm apart and 0.5 cm away from margin of perforation in single layer to approximate the defect wall and mobilization of vascularized long part of free omentum brought and placed over the closed perforation site and loosely tied knots and live omentopexy done.
Results: In our study out of 58 cases, maximum observed age group with duodenal ulcer perforation was 41-50 years. 19 cases (32.78%) and only 2 cases were of less than 20 years. Male: female ratio was 10.6:1. Pain in abdomen was the commonest presentation in all cases associated with nausea and vomiting in 49 cases (84. 48%). Commonest risk factors observed were use of NSAID, alcohol consumption, smoking, and chronic stress. Duration of pain varies; maximum 29 patients (50%) get admitted in 6 -12 hours. Routinely all patients planned for surgery but primary exploratory laparotomy done in 47 cases (81.03%) and primary closure of duodenal perforation with live omentopexy with feeding jejunostomy in 13 cases (22.41%). Commonly seen size of perforation was < 0.5 cm in 25 cases (43. 12%) and edge biopsy done in 19 cases (32.75%) to rule out malignancy. Post-operative intra-abdominal drain placed bilaterally in 48 cases (82. 76%). Commonest postoperative complications was respiratory tract infection and wound infection (SSI) 17 and 13 cases (29. 31%), (22. 41%) respectively. Generally postoperative Hospital stay was 6-10 days seen in 28 cases (48. 28%).
Conclusions: More stress in different directions some predisposing factors, risk factors have a relatively high risk to develop the Acid peptic disease which complicate to peptic ulcer & then perforation. Pragmatic early evaluation and surgical intervention for duodenal peptic ulcer perforation with live Omentopexy with or without feeding jejunostomy associated with broad spectrum antibiotics gives excellent post-operative result & outcome. But late presentation and late exploration have a high rate of complications.
Keywords: duodenal perforation, laparotomy, ulcer, peritonitis.