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<p>Hollow viscus perforation (HVP) is a life-threatening surgical emergency frequently encountered in gastrointestinal surgery. Despite advancements in surgical techniques, antibiotic therapy, and critical care, HVP continues to contribute significantly to morbidity and mortality, especially in resource-limited settings. Variability in etiology, presentation, and outcomes across geographic regions underscores the importance of region-specific studies to guide clinical decision-making. This retrospective cohort study analyzed 468 patients diagnosed with HVP and treated at a tertiary care center in North India between January 2010 and May 2024. Data were extracted from medical records and included demographics, etiology, site of perforation, surgical interventions, and outcomes. Statistical analyses involved chi-square tests, t-tests, ANOVA, and logistic regression to identify predictors of mortality. The cohort had a male predominance (71.6%), with a mean age of 47.1 years. Infective and inflammatory etiologies were most common (68%), with sigmoid diverticulitis and enteric perforations being the leading causes. The ileum was the most frequently affected site, followed by the duodenum and sigmoid colon. The overall mortality rate was 15.2%, with duodenal, jejunal, and pancreatitis-associated perforations showing the highest mortality. Surgical interventions included primary repair (28%), resection-anastomosis (22%), and exteriorisation (50%). Mortality was significantly associated with increasing age and delays in surgery. ANOVA and Tukey HSD tests confirmed that age and admission-to-surgery delay were significant predictors of mortality (<i>p</i> &lt; 0.05), with logistic regression supporting these findings. This study highlights the evolving epidemiological landscape of HVP in India, with infection remaining the predominant etiology but a noticeable rise in neoplastic and iatrogenic causes. Delays in surgical intervention and older age were major predictors of mortality. These findings emphasize the need for early diagnosis, timely surgical intervention, and tailored management strategies to improve outcomes. Further prospective multicentric studies are warranted to refine guidelines for HVP management in the Indian context.</p>

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Spectrum of Hollow Viscus Perforation from a Tertiary Care Centre in North India

  • 期刊论文

  • 发表日期：

    2025年11月14日

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  • Soumyadip Sain,
  • Shikhar Tripathi,
  • Sri Aurobindo Prasad Das,
  • Amitabh Yadav,
  • Samiran Nundy

摘要

Hollow viscus perforation (HVP) is a life-threatening surgical emergency frequently encountered in gastrointestinal surgery. Despite advancements in surgical techniques, antibiotic therapy, and critical care, HVP continues to contribute significantly to morbidity and mortality, especially in resource-limited settings. Variability in etiology, presentation, and outcomes across geographic regions underscores the importance of region-specific studies to guide clinical decision-making. This retrospective cohort study analyzed 468 patients diagnosed with HVP and treated at a tertiary care center in North India between January 2010 and May 2024. Data were extracted from medical records and included demographics, etiology, site of perforation, surgical interventions, and outcomes. Statistical analyses involved chi-square tests, t-tests, ANOVA, and logistic regression to identify predictors of mortality. The cohort had a male predominance (71.6%), with a mean age of 47.1 years. Infective and inflammatory etiologies were most common (68%), with sigmoid diverticulitis and enteric perforations being the leading causes. The ileum was the most frequently affected site, followed by the duodenum and sigmoid colon. The overall mortality rate was 15.2%, with duodenal, jejunal, and pancreatitis-associated perforations showing the highest mortality. Surgical interventions included primary repair (28%), resection-anastomosis (22%), and exteriorisation (50%). Mortality was significantly associated with increasing age and delays in surgery. ANOVA and Tukey HSD tests confirmed that age and admission-to-surgery delay were significant predictors of mortality (p < 0.05), with logistic regression supporting these findings. This study highlights the evolving epidemiological landscape of HVP in India, with infection remaining the predominant etiology but a noticeable rise in neoplastic and iatrogenic causes. Delays in surgical intervention and older age were major predictors of mortality. These findings emphasize the need for early diagnosis, timely surgical intervention, and tailored management strategies to improve outcomes. Further prospective multicentric studies are warranted to refine guidelines for HVP management in the Indian context.