RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA,
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DESSERTATION
NAME OF THE CANDIDATE : DR ROHAN SHETTY
ADDRESS: :ROOM NO 30, MEN'S HOSTEL
DR B R AMBEDKAR MEDICAL
COLLEGE, BANGALORE
NAME OF THE INSTITUTION :DR B R AMBEDKAR MEDICAL
COLLEGE BANGALORE
COURSE OF STUDY & SUBJECT:M.S GENERAL SURGERY
DATE OF ADMISSION :1ST JUNE 2009
TITLE OF THE TOPIC :STUDY OF CLINICAL SPECTRUM AND
MANAGEMENT OF BENIGN CAUSES
OF GASTROINTESTINAL
PERFORATION
BRIEF RESUME OF THE INTENDED WORK:
7.1 NEED FOR STUDY
It is often said abdomen is a pandora's box and gastro intestinal perforation is one such condition to prove it. Gastrointestinal perforation is a hole that develops through the entire wall of the stomach small intestine, large bowel, or gallbladder16. This condition is a surgical emergency.Acute abdomen accounts for 40% of all emergency surgical admissions and large percentage of these patients are secondary to gastrointestinal perforation or impending perforation16. Perforation of the intestine leads to leakage of intestinal content into the abdominal cavity. This causes an inflammation called peritonitis16,17. Complications include Bleeding, Infection possibly sepsis, Intra-abdominal abscess17.Often patient undergoes battery of test to prove the site and etiology.Due to its aggressive nature,death can occur despite best of efforts17.So need of the hour is early diagnosis and effective management. This study is done to understand various aetiological causes,wide variety of its presentation and complications so that early diagnosis is attained and proper management be done.
7.2 REVIEW OF LITERATURE: Study conducted so far shows Gastrointestinal perforation can be caused by a variety of illnesses, including tuberculosis, typhoid, appendicitis, diverticulitis, ulcer disease, gallstones or gallbladder infection, and less commonly, inflammatory bowel disease, including Crohn's disease and ulcerative colitis
Acute pathological condition of abdomen(Hippocratic facies) which represents terminal stages of diffuse peritonitis have been recognized since Hippocrates (400 B.C)1
Rowlinson is credited with first published report in 1727 of perforated ulcer which happened to be gastric1.
First published report of duodenal perforation is by Hamberger's in 17461,10.
Jordan in 1985 described historical aspects of perforated peptic ulcer1,2.
Mikulicz was first to attempt closure of peptic perforation2.
1897-Brawn added posterior gastro enterostomy- widely used for next 40 yrs2.
Von Haberer advocated partial gastrectomy for perforated ulcer in 19022.
First report of successful operation for perforated DU ulcer was by Henry P Dean in 18843.
McGee & Sauryers showed 1987- superiority of resection over simple closure3,10.
Finney & Cushing surgery became standard treatment for typhoid perforation in 18005.
Reginald Fitz published paper on perforated appendix peritonitis in 18869.
Diverticular disease of colon has been termed disease of 20th century13.
7.3 OBJECTIVES OF STUDY:
§ To study the prevalence of gastro intestinal perforation
§ To study various etiological factors leading to gastro intestinal perforation and management of complications.
§ To study role of various clinical parameters and investigations aiding early diagnosis
§ To study outcome of treatment of gastro intestinal perforation depending on:
ü duration at presentation
ü Site of perforation(proximal or distal to ligament of Trietz)
ü Aetiological cause of perforation
§ To study post operative complication & management.
MATERIALS AND METHODS:
8.1 SOURCE OF DATA: The study will be obtained from patients getting admitted for gastro intestinal perforation at Dr B R Ambedkar Medical College from period of October 2009 to November 2011.
8.2 METHOD OF COLLECTION OF DATA: Patients admitted with acute pain abdomen diagnosed to have gastro intestinal perforation during period from October 2009 to November 2011 at Dr Ambedkar Medical College will be taken up for study with help of relevant history, clinical examination and appropriate investigations and treated. Written informed consent will be taken. Patients will be randomly selected based on surgeon availability and surgeon's preference at the time.
INCLUSION CRITERIA:
Patients coming to hospital with signs and symptoms of gastro intestinal perforation and are willing for management in our hospital are included after taking informed written consent.
EXCLUSION CRITERIA:
· Trauma
· Foreign bodies
· Iatrogenic causes
· Ingestion of corrosives
· Malignancy
PROFORMA:
Name:
Age:
Occupation;
Address:
Ip no:
Date of admission;
Date of discharge;
History:
Complaints:Abdominal pain
Vomiting and nausea
Fever and chills
Abdominal distension
Lack of apetite
Difficulty in passing stools
Oliguria
Gpe: pulse,BP,temp,resp rate
Pallor icterus clubbing cyanosis lymphadenopathy
Edema
Per abdomen: guarding and rigidity
Tenderness
Dullness on percussion
Absence of bowel sounds
Investigations;
Routine blood & urine investigations
X ray erect abdomen
CT abdomen
Stool examination
Peritoneal tapping & peritoneal fluid c/s
Widal test
9 REFERENCES:
Peptic perforation:
1. Anson(1983), lancet(1469)
2. Antile(1964), Acta Cin 128:403
3. B.Gall & Talbot(1984)- BGS 25:403
4. Kazoli Meyer- labrotory findings in acute perforated gastric ulcer: 646-661
Typhoid perforation:
5. Adams & Macgrith: clinical trophical disease-1964 p:428
6. Baliga-surgical complication of typhoid;11:165
7. Kannajee &Bhattacharya: Handbook book of trophical disease with treatment:6th edition p:200
8. Mackenzi's-perforation in typhoid fever
Tuberculous perforation;
9. Anderson pathology
10. Anand Ann Roy coll.surg 19:205
11. Brawn.J.Annes rer tuberculosis 3:658
12. Golbert:clinical tuberculosis 4th edn
13. Illigwoth & Dick: surgical pathology
14. Warrren & Sommers s.c-Ammer.j tuberculosis
15. Wig & Bawa: Indian journal of tuberculosis 1:6
Others:
16. Turnage RH, Richardson KA, Li bd, Mc Donald-Abdominal wall,umbilicus.peritoneum,mesesentry,omentum&retroperitoneum
17. Acute abdomen, laboratory evaluation & imaging- Schwartz MZ, Bulan
18. St Louis, Mo:wb, Saunder;2008, chapter 43
HAS ETHICAL CLEARANCE BEEN OBTAINED FROM THE INSTITUTION:
SIGNATURE OF THE CANDIDATE:
REMARKS OF THE GUIDE:
NAME AND DESIGNATION OF THE GUIDE:
DR V.KRISHNA RAO
PROFESSOR AND HEAD
DEPARTMENT OF GENERAL SURGERY
DR B.R AMBEDKAR MEDICAL COLLEGE
BANGALORE
SIGNATURE OF THE GUIDE:
CO-GUIDE IF ANY:
HEAD OF THE DEPARTMENT
DR V.KRISHNA RAO
PROFESSOR AND HEAD
DEPARTMENT OF GENERAL SURGERY
DR B.R AMBEDKAR MEDICAL COLLEGE
BANGALORE
SIGNATURE: