Perforated Gas Containing Hollow Viscus : A study in a Hospital, Bangladesh

                 Syed Mahbubul Alam1, Mukhlesur Rahman Bhuiya2, Aminullslam3, Swapan Paul4


Summary

During the period from May 2001 to December 2001, a total number of emergency admissions in surgery unit -V. of DMCH was 450. Out of them lOO were due to perforated gas containing hollow viscus (Table-1 ), majority of them were from duodenal ulcer (72%),10% from typhoid ulcer, 06% from intestinal tuberculosis and the remaining were from other causes (Table-7). 84% were male and 16% were female (Table-3), 60 were of age between 21-40 yrs (Table-2). All of the patients presented with pain in the abdomen, 64% with vomiting, 72% with abdominal distension, 44% were febrile, 6% with shock (Table-4). 80% of patients were of low 'socio- economic status, 74% were smoker, 84% were involved in stressful job, 60% of irregular dietary habit and 72% perforation developed in fasting state (Table-10). Most of the patients attended after 6 hours of onset of symptoms,14 came after 24 hours, two even came after 12 days (Table-5). 94 were surgically treated, of which 60 were recovered uneventfully, 30 developed complications and 4 died post-operatively (Table-11 ,12). On 50 patients repair with omental patch was performed, others were managed by different techniques including definitive surgery in some cases (Table-9).

Introduction

Perforation of gas containing hollow viscus still covers a large number of hospital emergencies in our country despite the improvement of diagnostic and treatment facilities of the conditions causing this problem. It is a leading cause of morbidity and mortality in all age group in our country. It constitutes a serious surgical emergency which needs early surgical intervention after adequate resuscitation and no doubt in all aspect, time spending from occurrence of perforation to operation is the most important factor for it's management. It is also important that in all sorts of cases a surgical expert with a dependable team which can support the preoperative and post-operative situations adequately is needed to decrease both the morbidity and mortality of patients significantly. Clinical examinations supported by simple radiology is almost sufficient to take decision for laparatomy .15 a case of perforated gas containing hollow  viscus. But cause may be So diverse that only simple repair may not be the justified surgery in all cases. If general condition of the patient and other situations permit definitive surgery for the preexisting causative factor can be performed successfully during the same sitting.

Materials and Methods

In our current study 100 different types of perforated cases who were treated in su-5 of DMCH after admission through emergency dept. during the period from May - October, 2001 were considered. Patients who had positive findings after laparatomy with those who had not undergone surgery but diagnosed clinically and radiologically were included in this study. Patients died both pre-operatively and post-operatively also included. Thus a total of 100 patients were studied ultimately.

Clinical findings with radiological supports and in few cases four quarter peritoneal taping was the diagnostic techniques. In some cases laboratory investigations like Hb% ,serum electrolyte, urea, creatinine, ECG were performed. Blood grouping done in all cases. Proper resuscitation including fluid and electrolyte balance, correction of anaemia by blood transfusion, antibiotics to control infection, management of shock was carried out in necessary cases. Children below 12 yrs. were not studied.

Result

During the mentioned period oulof 450 total emergency admissions under surgery-v of Dhaka
Medical College
 Table -1
 Incidence of perforated hollow viscus

Total Nos. of emergency admission

450

Total Nos. of perforated hollow viscus

100

% of perforations among emergency admission

22.22

Hospital 100(22.22%) were perforated gas containing hollow viscus (Table -1 ). Of them 84 (84%) were male,16 (16%) were female; with a male-female ratio 5.02:1

Table -3
Sex incidence
Sex Nos. of cases % of total numbers
Male 84 84
Female 16 16

(Table-3). Regarding age 5 were below 20 yrs. 30 were above 40 and 60 (60%) were between 21- 40yrs (Table- 2). Males were mostly affected and middle-aged group people of low socio-economic class (80%) involved in

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DR. SYEO MAHBUBUL ALAM,
FCPS (Surgery}, FICS Associate Prof. Dept. of Surgery, DMCH.
DR. MO. MUKHLESUR RAHMAN BHUIYA, PhD (Japan} Consultant, Dept. of Surgery, DMCH.
DR. AMINUL ISLAM, Indoor Medical Officer, Dept. of Surgery, DMCH, Student of MS Surgery, BSMMU.
DR. SWAPAN PAUL, Indoor Medical Officer, Surgery, DMCH, Student of MS Ortho-Surgery, BSMMU.