Spectrum of perforated peptic ulcer disease in a tertiary care hospital in South India: predictors of morbidity and mortality.

BACKGROUND: Perforated peptic ulcer remains one of the most common surgical emergencies in India with significant morbidity and mortality. The aim of this study was to identify the perioperative risk factors influencing the post-operative morbidity and mortality in patients with perforated peptic ulcer disease. METHODS: Five-hundred patients who underwent surgery for perforated peptic ulcer in our institution in the preceding 8 years were included in this observational retrospective study. Their clinical presentations, peri-operative managements were studied and analysed. RESULTS: Five hundred cases were analysed of which 96% were males. Mean age was 46.5 years. A total of 160 patients had duodenal perforation and 328 had gastric perforation with a mean size of 8.6 mm. Most patients (96.2%) underwent omental patch closure of the perforation with mean length of hospitalization being 14 days. The most common major and minor postoperative complications were prolonged intubation and pulmonary complaints respectively. Re-exploration was needed in 6.2% of cases with a post-operative leak rate of 5.8%. Age >60 years, presence of comorbid illnesses, shock at presentation and perforation size >1 cm were identified as independent predictors of postoperative morbidity. Overall mortality was 11.6% while specific mortality among males and females were 11.8% and 5% respectively. Age >60 years, shock at presentation, presence of abdominal rigidity and size of perforation >1 cm were independent predictors of mortality. CONCLUSION: Old age, comorbidities, shock at presentation, perforation size >1 cm, higher ASA grade, prolonged surgery and biliopurulent contamination >500 mL were independent predictors of both increased post-operative morbidity and mortality.

Pancreatitis with infected pseudocyst presenting as a prevertebral abscess with spontaneous rupture into the oesophagus.

The development of a prevertebral abscess due to an infected pancreatic pseudocyst and its spontaneous rupture into the oesophagus is a rare complication. We report a man who presented with odynophagia, dyspnoea and abdominal pain. Contrast-enhanced CT showed evidence of pancreatitis and a prevertebral space abscess communicating with the pancreas through the oesophageal hiatus. The patient was diagnosed to have a prevertebral abscess with chronic pancreatitis. Surgical drainage was planned, but the patient died of spontaneous drainage of the prevertebral abscess into the oesophagus and aspiration of the collection into the lungs.

Incidental Meckel's Diverticulum in Umbilical Hernia.

The presence of a Meckel's diverticulum in the hernial sac is called a Littre's hernia. It is a rare complication of Meckel's diverticulum. We present a 56-year-old male patient who complained of swelling in the umbilical region. After the clinical examination and imaging studies, we diagnosed the patient with a partially reducible umbilical hernia. The patient underwent exploration and was found to have omentum, Meckel's diverticulum, and part of the ileum within the sac. The patient underwent segmental resection of the bowel, primary repair of the hernial defect, and onlay meshplasty. Postoperatively, the patient did not develop any complications.

Chronic gastric volvulus secondary to eventration of the left hemidiaphragm due to radiation-induced phrenic nerve palsy: a rare presentation.

Partial mesentericoaxial gastric volvulus associated with acquired eventration of the left dome of the diaphragm is very rare. We present the case of a 65-year-old man who presented with features of gastric outlet obstruction. He had a prior history of laryngeal cancer for which total laryngectomy was done, and adjuvant radiotherapy was administered. He was subsequently diagnosed with eventration of the left dome of the diaphragm and partial gastric volvulus. The patient recovered completely with conservative management and was discharged.

Kimura Disease Presenting as Right Parotid Swelling and Neck Lymphadenopathy.

Kimura disease is a rare chronic inflammatory disorder commonly affecting young males. We present a 35-year-old male who had right parotid region and neck swellings for two years. The patient underwent imaging studies, blood investigations, and fine-needle aspiration cytology diagnostic of the Kimura disease. The patient was screened for the presence of renal disorder. However, there was no evidence of kidney involvement. The patient was started on oral steroid therapy and advised for further follow-up.