E-poster Presentation 2014 World Cancer Congress

Malignant perforation peritonitis: Challenge to a general surgeon (#1152)

Puneet Malik 1 , Bhanwar Yadav 1
  1. General Surgery, SMS Hospital, Jaipur, India

Background:Perforations are most common surgical emergencies seen worldwide, often managed by general surgeons. Situation worsens when the cause of perforation turns out to be malignant. It is an open challenge for the surgeon to proceed the case without adequate investigations. The management and outcome in such cases varies from that of perforation peritonitis caused by other aetiologies.

Aim:This study was done to know the spectrum of etiopathology, clinical presentation, management and treatment outcomes of patients admitted with malignant perforation peritonitis in our hospital.

Methods:A prospective study was done over a period of 3 years from January 2011 to December 2013 in a tertiary centre which included 1400 patients diagnosed with perforation peritonitis. 78 cases were found to have malignant perforations. We collected data on age, sex, tumour stage, histological finding, surgical treatment, morbidity and mortality.

Results:Majority (62.8%) were males. Mean age of presentation was 59.1 years. The time taken for resuscitation and preparation of patient for surgery was less than 12 hours in 83.4% patients. Most common symptom with which patient presented was abdominal pain (99%) followed by nausea and vomiting (85%), abdominal distension(71%) and altered bowel habit(62%). 86% cases had colorectal perforation followed by gastric (11.5%) and small intestinal (2.5%) perforations. 82.3% had advanced tumour stage. Majority of colorectal perforation patients underwent Hartmann’s procedure(88.1%). 55.5% of gastric perforations underwent gastrectomy. Intestinal perforation cases underwent resection and anastomosis. 52.5% patients received chemotherapy. Complications included wound infection(31%), electrolyte imbalance(19.5%), pneumonia(23%), septicaemia(9%), renal failure(8%), intraabdominal abscess(6%). Mortality rate within one month was 30.7%.

Conclusions:In developing countries with limited resources, ignorance, financial constraints and lack of specialist medical knowledge, perforations associated with malignancies are quite common and lead to increased morbidity and mortality.