Duodenal Perforation: Outcomes after Surgical Management at a Tertiary Care Centre—A Retrospective Cross-Sectional Study

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 ( $P\le 0.001$ ), ICU stay ( $P=0.049$ ), duration of drainage ( $P\le 0.001$ ), 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.