Hollow viscus perforation, is the perforation of the gastrointestinal tract anywhere from the stomach, duodenum, jejunum, ileum to the small intestine and the large intestine. The breach in the wall causes leakage of alimentary contents, leading to contamination, infection and ultimately peritonitis.¹ Leakage of alimentary contents into the peritoneal cavity, is a common surgical emergency encountered in the emergency department.Perforation can be spontaneous or traumatic. Traumatic perforations can be due to foreign body ingestion of sharp objects or corrosive items or itraogenic like during endoscopies. Peptic Ulcer disease (PUD) remains the main cause of spontaneous perforation. Other causes like malignant tumors, Crohn's disease, diverticulitis and appendicitis can also lead to rupture of bowel.^(2,3,4) The main etiology of PUD being Helicobacter pylori (H.Pylori) along with use of  NSAIDs, alcohol abuse, smoking and environmental factors.^(5,6,7,8) It occurs due to an imbalance between mucosal defense mechanism and the damaging forces, particularly gastric acid and pepsin. Failure of mucosal defenses against gastric acid and pepsin results in ulceration.⁽⁹⁾ Peptic ulcer disease may lead to duodenal or gastric perforation. Approximately, 5-10% of patients with duodenal ulcer may develop perforations.⁽¹⁰⁾ Anterior duodenal ulcers perforate and posterior ulcer bleeds. Patients usually presents with acute abdomen with or without signs of peritonitis (sepsis). Plain picture abdomen ( Xray in erect posture) may show signs of gas under diaphragm. USG might reveal intraperitoneal free air.  Of all investigations, abdominal CT is the most sensitive and specific for identifying the exact cause of perforation.⁽¹¹⁾

Duodenal perforation is a rare but potentially life threatening condition. The mortality ranges from 8% to 25 %.^(12,13,14) Immediate surgery is required for patients presenting with peritonitis and or intra abdominal sepsis. Conservative management seems to be feasible in stable patients with sealed perforations.

Muralto and Lenepneau first described perforate duodenal ulcer in 1688.⁽¹⁵⁾ Dean reported the first successful surgical closure of a perforated duodenal ulcer in 1894.⁽¹⁶⁾

Aim of our study is to find out the prevalence of duodenal perforation among the patients admitted in the department of surgery, Lakhimpur Medical College and Hospital.

Objectives - the objective of our study is to evaluate the prevalence of duodenal perforation with respect to age, sex, economic status and clinical features, among the patients admitted in the department of surgery, Lakhimpur Medical College.

METHODOLOGY

After obtaining Institutional ethical clearance, data was collected from medical records department of Lakhimpur Medical College. The total number of patients admitted in the department of surgery from 1st Jan, 2022 to 31st Dec, 2025 was found to be 10552.  Out of which 5078  were males and 5474  were females. Among those patients, a total of 79 patients were admitted with hollow viscus perforations with 71 were males and 8 females. The demographic profile of the patients were collected in respect to age, sex, indications and socio economic status.

RESULTS

In our study, a total of 10552  patients were admitted in the department of surgery, in the period of 4 years, viz 1st Jan, 2022 to 31st Dec, 2025. Total 79 patients had undergone emergency exploratory laparotomy suspected of hollow viscus perforation. 57(72.1%)  number of patients were confirmed for duodenal perforation, 55  were males, 2 were females.

The age distribution of patients were from (16 - 85) years in males and  (15- 45) years in females.

The most common complaint was pain abdomen followed by distension.

57.8 % belongs to lower, 33.33% to middle and 8.77% to upper socio economic group.

Table 1. Age distribution of patients undergoing emergency exploratory laparotomy for suspected hollow viscus perforation

Figure 1

Table 2. Gender distribution of patients with Duodenal perforation

Table 3. Chief complaints of patients with Duodenal Perforation

Figure 2.

Table 4. Socio economic distribution

Figure 3

Table 5. Type of perforation

Figure 4.

DISCUSSIONS

In our study, we tried to evaluate 79 number of patients admitted for hollow viscus perforation. 57 (72.1%) number were found to have duodenal perforation after exploratory laparotomy. Males were more affected (96.5%) than females, and age group between 21-40 (37%) were predominantly affected. Other causes of perforation were appendicular (12.6%) and gastric perforation (11.4%).

Our findings are similar with Paul. H. Jordan, M.C.Danpat et al, Ramesh C et al,^(17,18,19) with duodenal perforation being common in males within 20-40 age group. Males with 96.5% and females with 3.5% were affected with duodenal ulcer. The minimum age recorded was 16 years and maximum was 85 years.

Out of 57 patients, 33 (57.8%) were from lower economic group. 19 (33.3%) from middle and 5 (8.77%) from upper economic group. Venkata Reddy M et al⁽²⁰⁾  also concluded that lower socioeconomic status had a higher prevalence of duodenal perforation due to higher incidence of smoking, alcohol and indiscriminate use of NSAIDs.

The most common complaints of the patients were pain abdomen (96.4%) followed by distention of abdomen (89.4%).

CONCLUSIONS

Hollow viscus perforation is one of the common acute abdominal emergencies encountered in surgical departments. And Duodenal perforation is the most common finding among them. Males have  higher prevalence, may be due to unhealthy habits.

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