SYNOPSIS

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

“STUDY OF CLINICOPATHOLOGICAL EVALUATION,

MANAGEMENT AND OUTCOME OF GASTRO-

INTESTINAL PERFORATIONS”

Name of the candidate : Dr. SUNIL SUDARSHAN H.

Guide : Dr. `JOHN JOSEPH S. MARTIS

Course and Subject : M.S. (GENERAL SURGERY)

DEPARTMENT OF GENERAL SURGERY

FATHER MULLER MEDICAL COLLEGE,

KANKANADY, MANGALORE – 575002.

1

2008

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1. Name of the Candidate

and Address

[in block letters]

SUNIL SUDARSHAN H.

PG IN GENERAL SURGERY

FR. MULLER MEDICAL COLLEGE

KANKANADY

MANGALORE – 575002

2. Name of the Institution FATHER MULLER MEDICAL COLLEGE

KANKANADY

MANGALORE – 575002.

3. Course of study and

subject

MASTER OF SURGERY

GENERAL SURGERY

4. Date of admission to

Course25\04\2008

5. TITLE OF THE TOPIC:

“STUDY OF CLINICOPATHOLOGICAL EVALUATION,

MANAGEMENT AND OUTCOME OF GASTRO-INTESTINAL

PERFORATIONS”

2

6 6.1 NEED FOR THE STUDY

Acute abdomen is one of the most common cause of emergencies which

present to a surgeon.

Gastrointestinal tract perforations account for the third most common cause

for emergency explorative laprotomy.

Peptic ulcer perforation which once accounted for the most common cause of

perforations is now on a decline due to the advances in the treatment of acid peptic

disease; giving a pseudo statistical boost to the other unheralded causes of

perforations like perforating lymphomas; spontaneous and iatrogenic perforations.

The advent of laproscopy and endoscopy have played a decisive role both in

the diagnosis and management of gastric and colorectal perforations.

In view of the above, it was decided to study clinicopathological evaluation,

management and outcome of gastro-intestinal perforations

6 6.2 REVIEW OF LITERATURE:

The increasing use of analgesics (NSAIDS), steroids and changing life

style, increasing alcoholism, smoking, have much bigger role to play in peptic ulcer

perforation.1

Hosoglu and Co-workers2 noticed a 10.5% perforation rate in patients who

were hospitalized for enteric fever.

Although intestinal ulceration especially in jejunum or ileum are rare,

3

spontaneous free perforations of intestine developed in patient with established or

suspected celiac disease due to malignant lymphoma was reported by Hugh.3

The incidence of duodenal perforation has increased from 6.5:1 in 1920 10:1

1990 and still on the rise.4

In patient who were admitted with acute abdomen and diagnosed to have

intestinal tuberculosis about 8% of them had intestinal perforations.5

Colonic perforations are the second most common cause of secondary

peritonitis in the western world and colonic diverticulitis is the most common

disease process resulting in perforation according to Malangori and Inui.6

Most small intestinal perforations are due unrecognized traumatic injuries or

intestinal ischemia.6 Small bowel perforation due to blunt trauma directly to the

inguinal region was also reported in another study.7

Iatrogenic perforations also occur in procedures like and laproscopy8.

6.3 OBJECTIVES OF THE STUDY:

• Evaluate the causes of gastro intestinal perforation and to correlate them

clinicopathologically whenever possible.

4

7.

MATERIALS AND METHODS:

7.1 Source of Data:

Patients in Fr. Muller Medical College Hospital, Mangalore during August

2008 – August 2010 with features of hollow organ perforation.

7.2 Method of Collection of Data:

Study type:

Cross sectional study

Sample and Sampling Technique

The study is estimated to include 40 who present with feature of hollow organ

perforation at Father Muller hospital with purposive sampling technique.

A complete detailed history physical evaluation relevant blood investigations,

radiological investigations are done and correlated with intra operative and or

histopathology report wherever possible.

Data Collection :

Age of the patient., Symptoms and their duration , Past history , Complete

physical examination , Laboratory investigations , Radiological investigations,

Treatment given , Complications.

Inclusion Criteria :

All patients above 15yrs who are diagnosed to have perforations

5

Exclusion Criteria:

Patients who have been operated for perforations earlier

Plan for Data - Analysis

Collected data will be analyzed with Chi square test

7.3 Does the study require any investigations or interventions to be conducted

on patients or other humans or animals?

No.

7.4 Has ethical clearance been obtained from your institution in case of 7.3

Yes.

8 REFERENCES

1. Primrose HJ – Stomach and duodenum. Short Practice of Surgery. Bailey and

Love. R.C.G. Russell, N. S. Williams, C. J. K. Bulstrode. Edition 23: 891-

930. 2000

6

2. Hosoglu S, Aldemir M, Geyilc F M. Tacyildiz I H. - Risk factors for enteric

perforations in patients with typtoid fever. Am J Epidemiol 2004;160:46-50.

3. Hugh J – Free perforation due to intestinal lymphoma in biopsy defined or

suspected celiac disease. Journal of clinical gastroenterology 37(4): 299-302 ;

Oct. 2003.

4. Humphrey G. – Epidemiology of Acute Abdomen. New England Journal of

Medicine: 60:790-794;1994.

5. Cetin AT, Mustafa A, Faut G, Alis S – Clinical review of luberculous

peritonitis in 39 patients in Diyarbakir, Turkey. Journal of Gastroenterology

and hepatology. 20 (6); 906-909: June 2005.

6. Malangoni AM, Inui T – Peritonitis – The western experience. Word journal

of emergency surgery 25 :1186/1749 -7922:2006.

7. Oncel M, Koot N, Eser M, Bahader I – Case report. Small bowel perforation

due to blunt trauma directly to the inguinal region-Hernia. 7(4) ; 218-219:

Dec 2003

8. Schaub C.-Complication associated with pneumoperitoneum for

cholecystectomy. Minerva Medica: 88: 39. 1997.

9. Signature of the candidate

10. Remarks of the guide Satisfactory.

7

11. Name and Designation of

(in block letters)

11.1 Guide

DR. JOHN JOSEPH S. MARTIS

ASSOCIATE PROFESSOR

DEPARTMENT OF GENERAL SURGERY,

FR. MULLER MEDICAL COLLEGE,

KANKANADY, MANGALORE.

11.2 Signature

11.3 Head of the Department Dr. P.S AITHALA

PROFESSOR & HEAD OF THE DEPARTMENT

DEPARTMENT OF GENERAL SURGERY,

FATHER MULLER MEDICAL COLLEGE AND HOSPITAL

KANKANADY, MANGALORE-2

11.4 Signature

12. 12. 1 Remarks of the Chairman and Dean

12.2 Signature

PROFORMA

8

Name Age /Sex

IP/OP No. DOA: DOD :

Symptoms Duration

Past History

Clinical Findings

Investigations

Hb : TC/DC

USG

HPE

X-ray abdomen

Treatment given

Complications

9