Peritonitis is a condition that is typically the consequence of a localized or systemic infection and is defined by inflammation of the peritoneum as well as peritoneal cavity. Primary peritonitis is the result of bacterial, fungal, chlamydial, or mycobacterial infections that do not result in gastrointestinal perforation. Secondary peritonitis arises from gastrointestinal perforation, leading to acute widespread peritonitis. (1) This is a challenging situation in emergency surgical services that, if not managed appropriately, may result in significant morbidity and occasionally death, necessitating immediate surgery. (2)

A gastrointestinal perforation, also referred to as hollow viscus perforation, is a cavity that develops in wall of a specific section of gastrointestinal system. (3) It is most prevalent cause of acute abdomen and 3rd most common cause of emergency explorative laparotomy. The term "PERFORATUS" is derived from Latin meaning "to bore through." (4)

Major aetiologies of secondary peritonitis are perforated peptic ulcer illness (H. pylori infection, unintentional usage of NSAIDS, smoking and alcohol) and ischemia of intestine, appendicitis, tubercular along with typhoid ulcer perforation. Peptic ulcer disease consists of both duodenal and stomach ulcer and related with people from poor socio-economic level. Perforation owing to diverse etiologies may present with distinct consequences and requires specific care.

Acute abdominal pain accounts for around 15.0% of all emergency hospital admissions in India, with surgical causes accounting for roughly 40.0% of all cases.13.7% of cases admitted to hospitals in India each year are due to intestinal perforations.

Current study examines etiology, treatment modalities, clinical characteristics, along with factors that influence prognosis of gastro-intestinal perforations.

This was a Comparative study performed in Department of General surgery, Jorhat Medical College and Hospital.

MATERIALS USED:

Proforma containing patient history, clinical examination & Lab values Informed consent forms‖.

METHOD OF DATA COLLECTION;

Patients who met the inclusion/exclusion criteria and gave their informed consent were included in study after receiving clearance and approval from institutional ethical committee.

• In every case, initial preoperative workup and resuscitation were performed using IV fluids, antibiotics, analgesics, and nasogastric decompression.
• In addition to other factors noted in the proforma, the Mannheim's Peritonitis Index score was
• Surgery – Laparotomy – peritoneal lavage & definitive procedure was performed in all
• Additional ICU treatment and resuscitation were administered as
• Evaluation of postoperative problems and patients 48 hours
• The study's results were

SAMPLE SIZE:

A total of 60 cases of diagnosed Gastrointestinal perforation were selected and divided into two groups of 30 participants in each group over a one-year period is the anticipated sample size for proposed study.

Group A-30 (Patient having traumatic gastro intestinal perforation)

Group B-30 (Patient having non traumatic gastro intestinal perforation)

STUDY OF CASES:

All relevant information about the patient, including age, sex, religion, and address, shall be documented upon admission to the hospital. The patients will next have clinical studies, examinations, and surgery after appropriate preoperative planning.

The patient will be followed up with for one week, three weeks, and three months after they leave the hospital.

INCLUSION CRITERIA:

• Patients ―willing for definitive surgery, giving consent for
• Both traumatic (blunt and penetrating injury) and non traumatic
• All patients admitted  to General surgery department with hollow viscus perforative peritonitis‖
• Solid Organ injury
• Pediatric age group (1 year to 12 year)
• Patient ―who expired before definitive
• Not willing for the
• Not willing for‖ definitive surgery

Table 1: AGE DISTRIBUTION

According to Okidi R et al. ²⁷ (2020), we examined 30-day postoperative results of patients at Mbarara Regional Referral Hospital in southwest Uganda who had non-traumatic gastroduodenal perforation (NTGDP). ―Patients who had exploratory laparotomies for suspected NTGDP between June 2016 and July 2017 were subjects of a one-year prospective research. Median age was 60yrs (range = 13–80yrs), male-to-female ratio was 3:1, and 29 patients‖ had NTGDP. According to Pandey VK et al. ²⁸ (2020), a significant portion of trauma-related injuries and fatalities are still caused by abdominal trauma.

According to our study, we found that the largest rates of gastrointestinal perforations, both traumatic (35%) and non-traumatic (60%) occur in the 21–30 age range. Non-traumatic perforations are less common (5%) while traumatic instances are more common (35%), among those aged 41-50. The statistically significant difference in mean age between the two groups is indicated by the p-value of 0.001, which raises the possibility that age influences type of gastrointestinal perforation. The average age in our sample was 23.2±17.6 year

Table 2: GENDER DISTRIBUTION

According to Pandey VK et al. ²⁸ (2020), a significant portion of trauma-related injuries and fatalities are still caused by abdominal trauma. The average age in our sample was 23.2±17.6 years. RTAs are in charge of the majority of cases (78%), with 92% of the cases being male and 8% being female.

Afolabi AO et al. ³⁰ (2020) discovered that general surgeons in sub-Saharan Africa do not have a lot of documentation of their surgeries. ―Majority of patients were between the ages of 25 and 44; their mean age was 41.4 ± 16.8 years, and their male to female ratio was 1.5:1. Eighty- three percent of 2,537 procedures were elective

According to our study, we found that 80% of non-traumatic gastrointestinal perforations and 85% of traumatic ones occur in men, whereas 20% and 15%, respectively, occur in women. The distribution of gastrointestinal perforations in males and females does not appear to differ significantly, according to the p-value of 0.024

Table 3: SITE OF PERFORATION

The most common perforation among all the hollow viscera in the body according to Pal N et al. ²⁶ (2020) is the ileum accounts for 37.01% of perforations, followed by the duodenum with a maximum of 28.36%. In 27.40% of 171 cases, cause of the perforation was acid peptic disease. According to our study, we found that duodenum accounts for 50% of non-traumatic gastrointestinal perforations, with the gastric region coming in second at 20% and the appendix base at 15%. In contrast, traumatic gastrointestinal perforations mostly happen in ileum (35%), jejunum (55%), and transverse colon (10%). Type of gastrointestinal perforation and perforation site are highly significantly correlated, as indicated by p-value of less than 0.0001.

According to Okidi R et al. ²⁷ (2020), we examined 30-day postoperative results of patients at Mbarara Regional Referral Hospital in southwest Uganda who had non-traumatic gastroduodenal perforation (NTGDP). 26 patients (90%) underwent Graham's omentopexy.

According to our study, we found that primary closure (45%), primary repair (25%), and resection and anastomosis (30%) were the most common methods of managing traumatic gastrointestinal perforations, whereas modified Graham's patch repair (60%) and open appendectomy (30%) were the most common methods for non-traumatic gastrointestinal perforations. A very significant difference in the type of surgery performed depending on the type of perforation is indicated by a p-value of less than 0.0001.

Table 5: COMPLICATIONS

   In tropical nations, peritonitis is one of the most frequent surgical emergencies, according to Traore M et al. ³¹ (2020). Wound infection was the most frequent surgical complication, accounting for‖ 261 postoperative problems overall (38.6%) in 242 patients. 73 patients required a repeat laparotomy.

According to our study, we found that overall complication rates for traumatic and non- traumatic gastrointestinal perforations were comparable, with 45% of cases in each category showing no issues. Sepsis was less common in traumatic perforations (0%), while it was more common in non-traumatic perforations (40%). Compared to non-traumatic instances (0%), wound gap problems were more common in traumatic situations (30%). ―A statistically significant correlation between the type of gastrointestinal perforation and the consequences noted is indicated by the p-value of 0.001.

This comparison of traumatic and non-traumatic gastrointestinal perforations reveals significant distinctions between two groups with regard to age, the way the perforation began, the location of the perforation, the type of surgery, complications, and hospitalization. Non-traumatic perforations happened without any visible harm, but traumatic perforations were more frequently linked to blunt and penetrating traumas. Patients with traumatic

Perforations needed different surgical procedures, including primary closure and resection, and their hospital stays were longer than those of patients having non-traumatic perforations. Comorbidities and smoking history were among the characteristics that displayed trends, but they did not always achieve statistical significance. The significance of knowing the differences between traumatic and non-traumatic gastrointestinal perforations in clinical management and therapeutic approaches is generally highlighted by this study.

1. Turnage RH, Mizell J, Badgwell. Abdominal Wall, Umbilicus, Peritoneum, Mesenteries, Omentum, & Retreoperitoneum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, Sabiston Textbook of surgery-The Biological basis of modern surgical practice.21^st edition 2022. p. 1075–8.
2. Langell JT, Mulvihill Gastrointestinal perforation and the acute abdomen. Med Clin North Am. 2008 May;92(3):599–625, viii–ix.
3. Ramachandra ML. Age, sex incidence with signs and symptoms of peritonitis. Int J Res Med Sci. 2014;2:916–9.
4. Kellog A treatise on peptic ulcer perforations. Surgery. 1939;6:524–30.
5. Oheneh-Yeboah M. Postoperative complications after surgery for typhoid ileal perforation in adults in Kumasi. West Afr J Med. 2007;26(1):32–6.