# Surgical Management of Perforative Peritonitis Following Gastroduodenal Peptic Perforation: A Prospective Observational Study

## TL;DR

This study examines surgical treatments and outcomes for peptic ulcer perforations in India, finding that duodenal perforations have better results than gastric ones.

## Contribution

The study provides insights into surgical techniques and outcomes for peptic ulcer perforation in a resource-limited setting.

## Key findings

- Duodenal perforations were more common (66.67%) than gastric ones (33.33%).
- Graham’s omental patch technique was predominantly used for repairs.
- Gastric perforations had higher complication rates and mortality than duodenal ones.

## Abstract

Introduction

Peptic ulcer perforation is a life-threatening surgical emergency with significant morbidity and mortality, particularly in resource-limited settings. This study aimed to evaluate the surgical management and outcomes of patients with perforative peritonitis secondary to gastroduodenal perforation, analyzing demographic patterns, clinical presentations, surgical techniques, and postoperative outcomes.

Methods

A prospective observational study was performed over 18 months at Mata Gujri Memorial Medical College and Lions Seva Kendra Hospital in Kishanganj, Bihar, India. The study enrolled thirty patients who exhibited clinical symptoms and radiological signs consistent with gastroduodenal perforation. Collected data included demographic information, clinical presentation, laboratory results, imaging studies, operative findings, surgical interventions utilized, and postoperative outcomes. The primary surgical methods for repair involved Graham's patch and the modified Graham's patch techniques.

Results

The study population had a mean age of 50.23 ± 18.45 years with male predominance (21/30, 70%, M:F ratio 2.33:1). Duodenal perforations were more common (20/30, 66.67%) than gastric perforations (10/30, 33.33%). All patients presented with abdominal pain, while 15/30 (50%) had nausea or vomiting. Most perforations were small, less than 0.5 cm, observed in 20/30 (66.67%) cases. Graham’s omental patch technique was predominantly used, 16/30 (53.33%) for duodenal and 6/30 (20%) for gastric perforations. Gastric perforations showed higher complication rates, with 2/10 (20%) abscess formation and 1/10 (10%) mortality, compared to duodenal perforations, which had 3/20 (15%) abscess rate and 1/20 (5%) mortality.

Conclusion

Perforative peritonitis due to peptic ulcer disease remains a significant surgical emergency predominantly affecting middle-aged males. Graham's omental patch repair offers favorable outcomes in majority of cases. Gastric perforations demonstrate higher morbidity and mortality compared to duodenal perforations. Prompt diagnosis, timely surgical intervention, and efficient perioperative care are critical for improving clinical outcomes.