Peptic Perforation Research Articles

Serum Albumin and Body Mass Index as Predictors of Outcome in Peptic Perforation Surgeries: A Hospital Based Cross‐Sectional Study

Serum Albumin and Body Mass Index as Predictors of Outcome in Peptic Perforation Surgeries: A Hospital Based Cross‐Sectional Study

“An Analytical Study To Compare The Effectiveness Of P-Possum And Possum Scores In Predicting Mortality And Morbidity Following Emergency Laparotomy"

Background: Surgical outcomes are increasingly scrutinized as part of efforts to ensure accountability and improve the quality of care. The Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) and its modification, the Portsmouth POSSUM (P-POSSUM), are widely used tools for predicting surgical outcomes. Objective: This study aimed to assess the accuracy of POSSUM in predicting morbidity and P-POSSUM in predicting mortality for patients undergoing emergency laparotomies in a North Indian tertiary care center. Methods: A hospital-based, analytic observational study was conducted at S.M.S. Medical College and Hospital, Jaipur, involving 160 patients who underwent emergency laparotomy. Preoperative physiological and intraoperative data were collected and used to calculate POSSUM and P-POSSUM scores. Mortality predictions were compared using linear and exponential analyses, and the observed-to-expected (O:E) mortality ratio was calculated. Statistical significance was determined using the Chi-square test. Results: The mean age of the cohort was 49.65 years, with males comprising 64.37% of the population. Peptic perforation (20.6%) was the most common cause of surgery. POSSUM significantly over-predicted mortality (O:E ratio = 0.26, p=0.04), while P-POSSUM provided a more accurate prediction (O:E ratio = 0.45, p=0.81). POSSUM also overestimated morbidity (O:E ratio = 0.8, p=0.51). Conclusion: While POSSUM tends to over-predict both mortality and morbidity, P-POSSUM offers a more accurate prediction of mortality in patients undergoing emergency laparotomy. These scoring systems can serve as valuable tools for surgical audits and improving the quality of care, though careful selection of the appropriate predictive model is essential

Spectrum of exploratory laparotomy for acute abdomen in a central Gujarat tertiary care centre

Background: Exploratory laparotomy is one of commonest emergency surgeries performed in the world. Despite technological advance imaging, the fundamental technique of exploratory laparotomy has remained unchanged over years. Studies quantifying the spectrum of laparotomy in central Gujarat are lacking. Methods: A retrospective study of 249 patients of emergency exploratory laparotomy for acute abdomen in SSG Hospital Baroda from May 2022 to May 2024 was done and data involving clinical presentation, imaging, operative findings and post- operative course were studied and analysed. The cases were divided into gastro-intestinal perforation, gastro-intestinal obstruction and miscellaneous cause. Results: The most common cause of exploratory laparotomy in study was perforation peritonitis including 59 ileal, 16 jejunal, 49 pre-pyloric, 29 duodenal, 1 body of stomach, 17 appendicular and 8 colon. With post op major complications like burst-11%, leak-5%, pneumonia-5%, multi-organ failure-6.5% and ileus 5%, wound infection 18%. The overall mortality was 15%. Out of 58 cases of laparotomy for obstruction including adhesions (29.3%), obstructed inguinal hernia (12%), tuberculosis (32%), malignancy (13.8%), internal hernia (12.6%). The miscellaneous causes were ruptured liver abscess (9), rupture ectopic pregnancy (2), twisted ovarian tumour (1). Conclusions: Acute abdomen remains a significant surgical problem. Peptic perforation remains a common cause of acute abdomen with high morbidity and mortality, despite improves medical management, though there is a declining trend in incidence, tuberculosis remains an important cause.

Perforated peptic ulcer: a clinical study at Shri. Shankaracharya institute of medical sciences Bhilai, Chhattisgarh

Background: Perforation is a serious complication of PUD and patients with perforated peptic ulcer often carries high risk for morbidity and mortality. Acute perforated peptic ulcer is a leading cause of generalized peritonitis and its management has continued to be a challenging task in moderate resource setting environment. Aim and objective was to evaluate the different pattern of risk factors, clinical presentations, management and clinical outcome of patients with acute perforated peptic ulcer. Methods: This was a hospital based prospective observational study conducted in the Department of general surgery at Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh. Total of 79 cases with diagnosis of perforated peptic ulcer treated were taken as sample size. A specially designed proforma was used to collect information on patients' demographics, symptoms, complications, duration of hospital stay and treatment outcome. Results: In present study male predominance was seen in peptic perforation cases 68.75% and M:F ratio was 2.2:1. Mortality rate was 17.71%. Mean hospital stay among survivors was 11.8 days and among non survivors 5.5±3.73 days. Most common risk factor seen was alcohol, smoking, peptic ulcer disease and NSAIDs ingestion. Whereas the most common presentation was abdominal pain, signs of peritonitis, abdominal distension. Cases with APCHE 2 score >21 had 90% mortality. Conclusions: The present study conclude that perforated PUD is a life-threatening disease with high morbidities and mortalities. Male predominance, smoking and alcohol consumption and pain in abdomen were the common characteristics. APACHE 2 score was useful in assessing the risk of mortality.

Comparative study of laparoscopic versus open peptic perforation repair

Background: Peptic perforation is very common emergency in general surgery. Peptic perforation is the terminology used for perforation of duodenal ulcer or perforation of gastric ulcer. Peptic perforations require surgical intervention by Graham’s omental patch repair. This surgical intervention can be done by laparoscopic or open surgery. Methods: The study was carried out in 40 patients between June 2022 to April 2023. In this study, we have included all the patients who present to emergency department with peptic perforation either gastric or duodenal. Patients who present with gastric perforation with/due to carcinoma and peptic perforation with septicemia and ARDS are not included in this study. In this study, patients were randomly allocated in two groups: group A (n=20) includes laparoscopic peptic perforation repair. And group B (n=20) includes open peptic perforation repair. Author have compared two groups in terms of intraoperative time, post-operative hospital stay and post-operative complications like surgical site wound infection, post-operative pain. Results: This study shows that there is no significant difference in intraoperative time between two groups but significant decrease in hospital stay, surgical site wound infection and post-operative pain in group A patient than in group B patients. Conclusions: Laparoscopic peptic perforation repair significantly reduces post-operative pain, surgical site infection and hospital stay.

Posterior Peptic Perforation and Contrast-Enhanced Computed Tomography of the Abdomen

Posterior Peptic Perforation and Contrast-Enhanced Computed Tomography of the Abdomen

ASSOCIATION OF HELICOBACTER PYLORI WITH PEPTIC PERFORATION

Background: Helicobacter pylori infections have been proved to be associated with peptic ulcer disease, gastritis, gastric adenocarcinoma, gastric lymphoma. The role of Helicobacter pylori is not well established in cases of peptic perforation. The objective of this study is to observe the presence or absence of Helicobacter pylori in cases of perforated peptic ulcer. Methods: We have done a cross sectional observational study with data from patients presenting to the emergency of a tertiary care hospital with perforated peptic ulcer and undergoing emergency exploratory laparotomy followed by omental patch repair. We collected mucosal biopsy samples from gastric/duodenal mucosa along margin of perforation site of these patients and performed rapid urease test using Rapid Urease Test kit. Of the 50 participants in our study, 48 (96%) were males Results: and 2 (4%) were females. 37 (74%) cases had perforation at pre pyloric region, and in 13 (26%) cases perforation was present at rst part of duodenum. Rapid urease test by Rapid Urease Test kit was found to be positive in 6 (12%) cases and negative among 44 (88%) cases. Conclusion: In our study, frequency of Helicobacter pylori in perforated peptic ulcer cases was found to be only 12% which proves that there may be other contributing factors in perforated peptic ulcer cases, which need further evaluation. Objective: To assess the presence of Helicobacter pylori in mucosal surface of stomach and duodenum in patients undergoing emergency exploratory laparotomy followed by omental patch repair in patients of peptic perforation.

Methamphetamine-related peptic ulcer perforation: a growing medical concern.

Many studies have been done in the literature on perforations due to substance abuse, and there are limited publications on perforations related to inhaled methamphetamine. Recently, in our clinic, we observed an increase in the number of patients with perforated peptic ulcer, which we think is secondary to a significant increase in the consumption of this drug. The main purpose of this study is to determine whether the use of inhaled methamphetamine known as 'fire and ice' is a factor directly related to peptic perforation and its complications and also to determine the demographic variables of patients with peptic ulcer perforation due to this substance use, in the context of the literature. A retrospective study was conducted by examining the medical records of 29 gastric perforation patients who underwent surgical treatment in our clinic in 2021. Data were transferred to SPSS.23 (IBM Inc., Chicago, IL, USA) program and evaluated with statistical analysis. Normality assumptions of continuous variables were examined with Kolmogorov-Smirnov test, and variance homogeneity was examined with Levene's test. Bi-level comparisons, t-test if the data are normally distributed and Mann-Whitney U-test for bi-level comparisons where the data are not normally distributed were used. Relationships between categorical variables were examined by Chi-square test analysis. P<0.05 was accepted as the level of significance in all analyzes. Twenty-nine patients were divided into two groups as methamphetamine users (n=13) and non-users (n=16). There was a statistically significant difference according to the lower age in the group using methamphetamine (31.69-48.8-P=0.025). The pres-ence of PU history differed significantly between the groups (P=0.009). Interestingly, aspartate transaminase alanine aminotransferase values were lower in substance dependents (P=0.020). Furthermore, there was a significant difference in localization between groups (P<0.001). There was no statistically significant difference between the two groups in terms of gender, clinical presentation, and other laboratory values. Methamphetamine consumption, known as fire and ice, is an important risk factor for ulcer development and subsequent perforation, especially in young patients and long-term consumption of this narcotic substance. It has been determined that this risk factor, which is currently considered rare, has been seen in a very large number in a short time in our clinic. The use of this substance, which is considered a major social threat, is becoming more and more widespread, and this study is only a small part of the iceberg reflected in the general surgery clinic of a hospital.

GASTRIC ULCER PERFORATING POSTERIORLY – A RARE CASE REPORT WITH REVIEW OF LITERATURE

The population studies have shown that peptic perforation remains a major health problem worldwide. The lifetime frequency of peptic ulcer diseases in United States has been shown to be approximately 10%. The epidemiology of peptic ulcer is showing declining trend in India over last two decades. The frequencies of both duodenal ulcer and gastric ulcer showed a decline from 1988 to 2008 that is from 12% to 2.9% and 4.5% to 2.7% respectively. Although there is decreasing trend in peptic ulcer diseases, complications are encountered in 10-20% of cases and 2-14% of ulcers perforate. Peptic ulcer can occur in body of stomach, lesser curvature, and pylorus to duodenum. These perforate most commonly on anterior aspect of duodenum. However anterior or incisural gastric ulcers may perforate posteriorly in to lesser sac, which can be particularly difficult to diagnose as these may not have symptoms of peritonitis even. If peritonitis is present and perforation not found on normal course then, they should be looked over in lesser sac also.

Graham’s Patch Repair for Peptic Perforation : A Review

Introduction : Frequently monitored, occurrences of peptic perforation due to a variety of etiologies are still frequently discovered. The surgical Graham Patch Repair technique is still regarded as having a respectable level of accuracy and profitability. Methods : The PubMed literature search engine's advanced search feature was utilized to find literature review papers for this journal. Selected periodicals from which writing was based were collected. Result Peptic perforation can occur under a variety of circumstances, and both the Graham technique and the Modified Graham Patch repair are recommended. The benefit of using the best Graham approach is that it promotes quick wound healing while lowering morbidity and mortality. Conclusion : Peptic perforation can occur in a variety of medical conditions, yet in these cases the Graham technique can still be recommended. Different surgical treatments regularly have unanticipated consequences, necessitating their modification or even combination in order to preserve the patient's life while also reducing prospective problems in the future.

OBSERVATIONAL STUDY OF ETIOLOGY AND OUTCOME IN HOLLOW VISCUS PERFORATION

Background: Gastrointestinal perforation is a common abdominal emergency having a high morbidity and mortality. Missed diagnosis and late intervention are frequent causes of increased morbidity and mortality especially in patients who survive the initial phase of insult. Diagnosis and treatment of gastrointestinal perforation remains a formidable problem in our country. Aim &amp; Objevtives: To compare certain common etiologies and their outcomes in the following diseases and sites respectively Acid Peptic Disease–Duodenal/Gastric Typhoid- Ileal Diverticulitis-Colon Trauma-Any Part Retrospec Methods: tive observational study of 50 Operated Patients done in Government Medical College Surat during period of September 2019 to December 2020 According to Inclusion and Exclusion Criteria. Data is analysed using descriptive statistics (Percentage, Proportions). Among 50 cases of hollow viscus Results &amp; Conclusion: perforation, Peptic perforation was common (33 out of 50 cases). Next being Ileal perforation. Jejunum was common site of perforation in blunt abdominal trauma. Peptic Perforations are more commonly seen in 40-60yrs of age group with alcohol and smoking as their addiction, with worker as occupation. Typhoid Perforations are more commonly seen in 20-40yrs of age group. In this study except for wound dehiscence in 4 cases which needed secondary suturing, no major morbidity noted. 4% mortality noted in the present study.

Role of BOEY score in association with age in predicting mortality and morbidity in peptic perforation

Background: Peptic perforation generally requires immediate surgery. BOEY scoring system is a simple way to predict the mortality and morbidity in peptic perforation. Apart from the factors mentioned in BOYE score, patient’s age is also important. The study evaluates the accuracy of BOEY scoring system in predicting post-operative morbidity and mortality in patients operated for peptic perforation as well as inclusion of age as one of the criteria for the scoring system and thus modifying the system.Methods: Total 103 patients were taken for this institution based prospective observational study. The 18th months study was planned as follow - initial 14 months for patient study, next 2 months for compilation of data, further 2 months for computation of statistics and final construction.Results: Patients with BOYE score 0, 1, 2, 3 has morbidity rates as follow 7.01,19.29, 36.85 and 36.85 respectively. Whereas mortality rate was 0, 0, 9.09 and 90.91 respectively. 76.4% of patients with post-operative complications belonged to age &gt; 45 years. All the cases of mortality were &gt;45 years of age.Conclusions: It is simple and can assist in risk stratification of patients with perforated peptic ulcer. It can help us to identify high-risk patients preoperatively and help in better use of limited facilities. And lastly, a modification can be done by including age (&gt; 45 years) with the other three parameters of the BOEY scoring system.

Management of perforated large/giant peptic ulcers: a comparative prospective study between omental plug, duodenal exclusion, and jejunal serosal patch

Background Large/giant peptic ulcer (duodenal ulcer and benign gastric ulcer) perforation is a serious life-threatening surgical emergency, with high morbidity and mortality rates. Despite that, no single surgical approach has yet been shown to be superior to others. Patients and methods This is a prospective randomized study comparing the efficacy of omental plugging, duodenal exclusion, and jejunal serosal patch as different alternating operative techniques in managing such a problem. Results Thirty patients with large/giant peptic perforation more than 2 cm in diameter were included over a period of 24 months. Patients were divided into three groups (A, B, and C) according to surgical approach applied. Males/females were 27/3, average age was 45–73 years old, and mean operative time was 75±28.4 min. Biliary leak rates were 3.3, 10, and 6.6% in group A (omental plug), group B (jejunal serosal patch), and group C (duodenal exclusion and gastrojejunostomy), respectively, with P value of 0.199. Conclusion The management of large/giant peptic (duodenal ulcer and gastric ulcer) perforations is difficult and presents a great challenge to surgeons. Duodenal stump leaks can carry high incidence of morbidity and mortality. Multiple surgical modalities are available to deal with such surgical problems.

RISK FACTORS AFFECTING PEPTIC ULCER PERFORATION

Introduction: Peptic ulcer is a sore in the lining of stomach or the rst part of the duodenum. Peptic ulcer perforation with subsequent peritonitis is commonest complication of peptic ulcer disease and is a surgical emergency. It carries with it great morbidity and mortality. AIMS: To study the risk factors associated with peptic ulcer perforation in our setting. Objectives: To Assess the role of various risk factors like age, sex, previous use of NSAIDS, Smoking &amp; other associated illness. To study the risk factors that affect operative outcome in peptic perforation peritonitis. Materials &amp; Methods: All patients of peptic ulcer with perforation peritonitis on laparotomy are included in the study.Patients with peptic ulcer Perforation of age &gt; 14 years. Results: Duodenal perforations were present In 69 cases out of 100 cases (69%). Gastric perforation was present in 31 cases (31%). In gastric cases 30 perforations were present on lesser curvature and pyloric Antrum and one perforation was present on posterior wall of stomach. Discussion: Present clinical study of peptic perforation has been carried out to nd out various risk factor associated with It's occurrence, investigation, clinical picture, preoperative ndings and post operative outcome and recurrence of perforation after taking Anti H. pylori regime was observed. Conclusion:In my study that H.pylori infection, smoking, use of NSAID's is signicant risk factor on peptic perforation

Comparative study between POMPP score versus Boey score to predict morbidity and mortality in peptic perforation peritonitis

Background: Peptic ulcer disease (PUD) results from an imbalance between stomach acid-pepsin and mucosal defense barriers. It affects 4 million people worldwide annually. Peptic ulcer perforation is one of the most common surgical emergencies and is associated with a high rate of morbidity and mortality. This is due to presence of various risk factors among the population like H. pylori infection, long term NSAID use, alcohol ingestion, smoking and steroid use. Peptic ulcer perforation peritonitis usually requires an emergency surgical intervention and hence the need for this study, to compare POMPP and Boey scores as predictors of morbidity and mortality in patients with peptic perforation peritonitis.Methods: This prospective observational study was conducted in the hospitals attached to Bangalore Medical College and Research Institute from November 2018 to May 2020. All patients above 18 years with features of hollow viscus perforation with per-operative finding of perforated peptic ulcer were included in the study. Patients with histopathology suggestive of malignancy were excluded.Results: A total of 65 patients were included in the study. On analysis of the data by Chi-square test, P value of both POMPP and Boey scores was found to be &lt;0.05 which is statistically significant. The most important predictive factors of mortality and morbidity were duration of perforation &gt;24 hours, age &gt;65 years and pre-operative shock.Conclusions: Both scoring systems are easy to use and can assist in accurate and early identification of high-risk patients and are important in predicting mortality and morbidity in patients with peptic ulcer perforation.

Pre-operative serum albumin and body mass index as predictors of post-operative morbidity and mortality in perforation peritonitis secondary to peptic ulcer disease

Background: Peptic ulcer disease (PUD) affects 4 million people worldwide annually. Perforated peptic ulcer is a serious complication of PUD and patients often present with acute abdomen that carries high risk for morbidity and mortality. This is worsened in patients who are malnourished. The incidence of malnutrition is around 30% in patients with gastrointestinal disease and is frequently unrecognized. Albumin or prealbumin levels may help identify these patients. Obesity is also another cause for morbidity and has deleterious effects on wound healing. Therefore this study was carried out to assess if preoperative serum albumin and body mass index can be used as predictors of morbidity and mortality in patients with perforated peptic ulcers.Methods: 70 patients with peptic perforation peritonitis presented to the hospitals attached to Bangalore Medical College and Research Institute from November 2018 to May 2020 and were included in the study. Pre-operative Serum Albumin and BMI was noted and the patients were followed up for 30 days.Results: Mean albumin level in our study was 3.01. The patients with Serum Albumin &lt;3.5 g/dl have more complications compared to patients with &gt;3.5 g/dl. Morbidity and mortality increases with severity of hypoalbuminemia. This study was statistically significant with a p value &lt;0.05. In our study, we also found that patients with abnormal BMI have more complications than patients with normal BMI but it is statistically insignificant with a p value &gt;0.05.Conclusions: Serum albumin is a good indicator for predicting postoperative morbidity and mortality in peritonitis secondary to peptic ulcer disease.

A prospective cohort study of patients with peptic perforation to identify high-risk clinical characteristics

Introduction: Peptic ulcer perforation is the most common complication in peptic ulcer disease and can lead to serious complications and mortality; however, despite the widespread use of antisecretory agents and eradication of Helicobacter pylori, the incidence of peptic ulcer perforation remains largely unchanged. This study aimed to evaluate the risk factors for perioperative morbidity and mortality in patients with peptic ulcer perforation. Methods: This was a prospective, observational study involving patients with perforated peptic ulcer disease admitted to the Al-Basra Teaching Hospital from January 2017 to December 2019. A total of 100 patients were followed for 4 weeks. Patients’ demographic data, history of chronic diseases, American Society of Anesthesiologist (ASA) score, nonsteroidal anti-inflammatory drug (NSAID) and steroid use, duration before surgery, preoperative shock status, previous symptoms of peptic ulcer disease, smoking habits, and fasting status were evaluated, and significant correlations with postoperative complications were analyzed statistically. Results: A total of 100 patients aged 16–87 years were included in the study, and the male-to- female ratio was 3:1. Sixty-seven (67%) patients underwent surgery within 12 h after admission, 41% of patients had a history of chronic disease, 54% of patients had an ASA score of 1, 57% of patients were smokers, 45% of patients reported previous peptic ulcer symptoms, and 22% of patients had preoperative shock status. Thirty-seven (37%) patients developed postoperative complications, and 8% of patients died. Conclusion: This study confirmed that advanced age, a high ASA score, preoperative shock, comorbidities, and delayed presentation before surgery were all risk factors for postoperative complications and mortality in patients with perforated peptic ulcer disease. Habitual smoking, fasting status, and NSAID and steroid use were not correlated with mortality.

APPLICATION OF POMPP SCORING SYSTEM TO PREDICT POST OPERATIVE MORTALITY IN PATIENTS WITH PERFORATED PEPTIC ULCER: IS IT REALLY A PRACTICAL SCORE FOR INDIAN POPULATION?

Background: The POMPP (Practical scoring system of mortality in patients with perforated peptic ulcer) score is a simple method which is new and easily applicable scoring system. Our aim is to predict the post operative mortality rate in patients with perforated peptic ulcer by using POMPP scoring system in Indian population. Method: A prospective study of total 100 patients of perforated peptic ulcer operated in J.L.N. Hospital, Ajmer were included in our study. Three parameters corresponding score 1 for each are included in this multivariate analysis which are age &gt; 65 years, albumin ≤ 1.5 g/dl and BUN (Blood urea nitrogen) &gt; 45 mg/dl. All data that may be potential predictors with respect to hospital mortality were analyzed and compared with previous studies. Results: In our study of 100 patients with M: F ratio 7.33 around 17 deaths was recorded out of which 14 were males and 3 were females. We have observed that mortality rates were signicantly affected by the parameters of POMPP scoring system with 0%, 11.76%, 35.29% and 52.95% mortality for scores 0, 1, 2 and 3 respectively. We also observed out of 17 deaths 15 deaths were seen in age group &gt; 65 years, 11 deaths were associated with albumin &lt; 1.5gm/l and 16 deaths were associated with blood urea nitrogen &gt; 45mg/dl. Data analysis was done using chi square method. Conclusion: POMPP scoring system consists only age and routinely measured two simple laboratory tests (albumin and BUN), its application is easy and prediction power is satisfactory. It provides early detection of high risk peptic perforation cases; allow other supportive treatment modality apart from surgery which can decrease the mortality

Applications of hepatic round ligament/falciform ligament flap and graft in abdominal surgery-a review of their utility and efficacy.

Despite their ubiquitous presence, easy availability and diverse possibilities, falciform ligament and hepatic round ligament have been used less frequently than their potential dictates. This article aims to comprehensively review the applications of hepatic round ligament/falciform ligament flap and graft in abdominal surgery and assess their utility and efficacy. Medical literature/indexing databases were searched, using internet search engines, for pertinent articles and analysed. The studied flap and graft have found utility predominantly in the management of diaphragmatic hernias, gastro-oesophageal reflux disease, peptic perforations, biliary reconstruction, venous reconstruction, post-operative pancreatic fistula, post-pancreatectomy haemorrhage, hepatic cyst cavity obliteration, liver bleed, sternal dehiscence, splenectomy, reinforcement of aortic stump, feeding access, diagnostic/therapeutic access into portal system, composite tissue allo-transplant and ventriculo-peritoneal shunting where they have exhibited the desired efficacy. Hepatic round ligament/falciform ligament flap and graft are versatile and have multifarious applications in abdominal surgery with some novel and unique uses in hepatopancreaticobiliary surgery including liver transplantation. Their evident efficacy needs wider adoption to realise their true potential.

Duodenal Ulcer Perforation in Pediatric Population: A Rare Entity

In pediatric age group peptic ulcer disease and duodenal perforation are usually rare condition. We report here a case of 3 years old girl who presented with upper abdominal pain, fever. On examination, she was febrile, tachycardia, with the feature of peritonitis. X-ray Abdomen reveled pneumoperitoneum. After resuscitation and investigating the child, a provisional diagnosis of peritonitis due to hollow viscus perforation was made. The child was planned for laparotomy. Intraoperative diagnosis of first portion of duodenum perforation was made and she underwent repair of perforation.