Management of perforated duodenal ulcer at a tertiary care hospital

Abstract

Introduction: Multiple etiologies are associated with duodenal perforations such as peptic ulcer disease, iatrogenic causes and trauma. Computed tomography with intravenous and oral contrast is the most valuable imaging technique to identify duodenal perforation. In some cases, surgical exploration may be necessary for diagnosis. Materials and Methods: The case files of all the patients were retrospectively ana- lyzed for patient particulars, intra-operative findings, surgery performed, post-operative stay, morbidity and mortality. The groups were then compared with each other in terms of age, leak rates, hospital stay, morbidity, mortality and the surgery performed. Statistical analysis was done using the chi-square and the t- test by an inde- pendent comparison of each group singly against another by a statistician who was blinded to the study. A p value of < 0.05 was taken as significant. Results: The majority of patients came under the ‘small’ perforation group, but there were 38 patients (23.46 %) with large perforations as per our definition. These patients had a higher age of presentation (47.18 years) than the patients with smaller perforations (39.46 years). Giant perforations, or perforations greater than 3 cms in size were seen only 2 cases, accounting for a small percentage (1.28 %) of all cases seen. Conclusion: The type of treatment should be individualized and depends on the mechanism of injury, the timing, location and extent of the injury and the clinical state of the patient.