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

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.