Duodenal Perforation: Outcomes after Surgical Management at a Tertiary Care Centre—A Retrospective Cross-Sectional Study. (28th October 2020)

• Record Type: Journal Article
• Authors: Bojanapu, Srinivas; Malani, Ronak Atulbhai; Ray, Samrat; Mangla, Vivek; Mehta, Naimish; Nundy, Samiran
• Other Names: Sperti Cosimo Academic Editor.
• Is Part Of: Surgery research and practice. Volume 2020(2020)
• Publication Date: 2020-10-28
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1155/2020/8392716
• Languages: English
• ISSNs: 2356-7759

Abstract

Abstract : Introduction . Duodenal perforation is a common surgical emergency and carries mortality ranging from 4% to 30% reported in Western countries, but there is a paucity of reports from India. We aimed to determine the factors which influence the surgical outcomes in patients with duodenal perforation. Methods . We retrospectively analyzed prospectively collected data from January 2010 to December 2018. Results . A total of 55 patients were included in the study of which 69% (38) were males and 31% (17) were females (M : F = 4.5 : 2). The mean age was 52.3 years. The cause for duodenal perforation was duodenal ulcer ( n = 25, 45.5%), followed by post-ERCP complications ( n = 15, 27.3%), surgery ( n = 11, 20%), and blunt trauma ( n = 4, 7.2%) with perforations localized at D2 ( n = 28, 51%) and at D1 ( n = 27, 49%). Patients underwent primary repair with an additional diversion procedure ( n = 28, 51%) and repair only in 18 (32.8%). There were 21 (38%) deaths. Patients with ERCP-associated duodenal perforation had longer hospital stay (P ≤ 0.001 ), ICU stay (P = 0.049 ), duration of drainage (P ≤ 0.001 ), and higher leak rate (P = 0.001 ) and re-exploration rate (P = 0.037 ). A high mortality rate was seen in patients with preoperative organ failure ( n = 18, 78% versus 9.4%, P = 0.001 ), postoperative leak ( n = 7, 64% versus 32%, P = 0.05 ), and longer duration from onset of symptoms to surgery (≥4 days) (P = 0.045 ). Conclusion . Perforation of the duodenum is associated with high morbidity and mortality regardless of its cause and is higher in those who have a longer interval to surgery, preoperative organ failure, and a postoperative leak.