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.
Highlights
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
Receiver-operating characteristic (ROC) curve analysis was used to estimate the predictive ability of the Boey score. e area under the ROC curve (AUC) indicates the probability of postoperative morbidity or mortality and actual postoperative condition and is considered perfect (1), good (>0.8), moderate (0.6–0.8), and poor (
Among all the factors studied, we found that age >50 years, duration to surgery (≥4 days), presence of preoperative organ failure, and postoperative leak to be significantly associated with mortality
Summary
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. It can be secondary to an ulcer, endoscopic procedure, trauma, or surgery for a non-gastroduodenal condition and carries a mortality rate ranging from 4% to 30% reported in Western countries. There are few reports comparing its outcome depending on the cause of the perforation It was previously a major complication of peptic ulcer (DU) disease; it is becoming progressively rarer with the increasing use of acid-lowering drugs, it still affects 2%–10% of such patients. Different authors have reported mortality rates in this condition ranging from 1.3% to 20% [1, 2] It is a feared complication of endoscopic retrograde cholangiopancreatography (ERCP), and in a review of 21 prospective studies, the incidence of post-ERCP duodenal perforation was 0.6%, and the perforation-related mortality was 9.9% [3]. 20% to 50% of these patients required surgery [4,5,6]
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