Emergency abdominal surgery encompasses a heterogeneous group of time-sensitive conditions in which delayed diagnosis or intervention can lead to bowel ischemia, perforation, sepsis, organ dysfunction, and death. Emergency general surgical conditions contribute substantially to operative workload, resource utilization, and preventable morbidity across health systems [1]. The etiological profile is not uniform across age groups because anatomical, developmental, infectious, inflammatory, degenerative, and comorbidity-related factors change throughout life. A direct comparison between children and adults can therefore provide clinically useful information for triage, operative planning, perioperative monitoring, and allocation of critical-care resources. In children, acute appendicitis remains one of the most frequent indications for urgent abdominal surgery. Its presentation can be atypical in younger patients, and diagnostic delay is associated with complicated disease and postoperative morbidity [2]. Population-level studies have also shown that disease severity, age, and operative approach influence short- and long-term outcomes after pediatric appendicitis [3]. Intussusception represents another important childhood abdominal emergency; although many cases can be reduced non-operatively, operative intervention becomes necessary when reduction fails, bowel viability is threatened, or perforation is suspected [4]. Adhesive intestinal obstruction, incarcerated hernia, abdominal trauma, and gastrointestinal perforation account for additional pediatric emergency operations, with timing of intervention influencing bowel preservation and recovery [5]. The adult spectrum is broader and is increasingly influenced by prior surgery, peptic ulcer disease, intestinal obstruction, hernia, trauma, biliary disease, malignancy, vascular disease, and age-related physiological reserve. Adhesive small-bowel obstruction is a common emergency and can progress to strangulation or ischemia when high-risk clinical features are present [6]. Perforation peritonitis remains especially important in low- and middle-income settings, where delayed presentation and diffuse contamination contribute to postoperative sepsis and prolonged

Study design and setting: This hospital-based comparative observational study was conducted at Government Medical College, Anantapuramu, Andhra Pradesh, India, from May 2022 to April 2024. The institution functions as a tertiary-care teaching centre receiving emergency surgical referrals from Anantapur and surrounding areas. Patients presenting with an acute abdominal condition were evaluated by the emergency and surgical teams, stabilized when required, and taken for emergency surgery according to the clinical diagnosis and operative indication. Study population and eligibility: Patients of either sex who underwent emergency abdominal surgery during the study period were considered for inclusion. For comparative analysis, participants were classified as children (<18 years) or adults (≥18 years). Patients were eligible when the principal indication involved an acute intra-abdominal surgical condition requiring an emergency operative procedure. Elective abdominal operations, procedures performed primarily for non-abdominal conditions, patients managed completely without surgery, and records lacking essential perioperative or outcome information were excluded. A total of 100 eligible patients were included, with 50 children and 50 adults. Consecutive eligible cases were considered until the required sample in each age group was attained. Data collection: Demographic information, presenting symptoms, duration of symptoms before hospital presentation, clinical findings, operative diagnosis, and principal surgical procedure were recorded using a structured study proforma. Etiological categories included acute appendicitis, intussusception, gastrointestinal perforation with peritonitis, intestinal obstruction, abdominal trauma, incarcerated or strangulated hernia, acute gallbladder pathology, and other less frequent causes. Operative procedures were categorized according to the principal intervention performed. Where more than one operative step was required, the procedure representing the major therapeutic component was used for classification. Outcome assessment: Patients were followed during the postoperative hospitalization. The primary comparative outcomes were the occurrence of any postoperative complication and duration of postoperative hospital stay. Secondary outcomes included surgical-site infection, postoperative ileus, pulmonary complications, postoperative sepsis, intensive-care unit admission, reoperation, and in-hospital mortality. Individual postoperative complications were recorded independently; consequently, a patient with more than one complication could contribute to multiple complication categories. Contemporary evidence emphasizes structured perioperative care and infection prevention in emergency abdominal surgery [10-13]. Statistical analysis: Continuous variables were summarized as mean ± standard deviation and categorical variables as frequency and percentage. Continuous variables between children and adults were compared using the independent-samples t-test. Categorical variables were compared using the chi-square test; Fisher's exact test was used when expected cell frequencies were small. The overall distribution of etiological categories was assessed using a chi-square test. A two-sided p-value <0.05 was considered statistically significant. Ethical considerations: Confidentiality of patient information was maintained during data handling and analysis. Necessary Permissions were obtained before starting the study. Consent documentation should likewise be verified against the approved study protocol

A total of 100 patients undergoing emergency abdominal surgery were included in the study, comprising 50 children (<18 years) and 50 adults (≥18 years). The mean age of the pediatric group was 9.3 ± 4.2 years, whereas the mean age of the adult group was 44.8 ± 16.3 years. Males constituted 62.0% of the pediatric group and 58.0% of the adult group. The mean duration of symptoms before hospital presentation was significantly shorter among children than adults (28.4 ± 15.6 hours vs. 38.7 ± 22.4 hours; p = 0.009). Baseline characteristics are presented in Table 1. Table 1. Baseline demographic and clinical characteristics of study participants (n = 100) Characteristic Children (n = 50) Adults (n = 50) p-value Age, years, mean ± SD 9.3 ± 4.2 44.8 ± 16.3 <0.001 Male, n (%) 31 (62.0) 29 (58.0) 0.683 Female, n (%) 19 (38.0) 21 (42.0) — Symptom duration before presentation, hours, mean ± SD 28.4 ± 15.6 38.7 ± 22.4 0.009 Fever at presentation, n (%) 19 (38.0) 16 (32.0) 0.529 Vomiting, n (%) 29 (58.0) 25 (50.0) 0.422 Abdominal distension, n (%) 13 (26.0) 18 (36.0) 0.280 Features of peritonitis, n (%) 10 (20.0) 18 (36.0) 0.075 Values are presented as mean ± SD or n (%), as appropriate. Continuous variables were compared using the independent-samples t-test; categorical variables used the chi-square test. Etiological Spectrum The spectrum of underlying surgical conditions differed between children and adults (overall p = 0.013). Acute appendicitis was the most common indication for emergency abdominal surgery among children, accounting for 28 cases (56.0%), compared with 18 cases (36.0%) among adults. In contrast, gastrointestinal perforation with peritonitis was more frequent in adults, occurring in 14 patients (28.0%), compared with 4 children (8.0%; p = 0.017). Intussusception was observed exclusively among children, affecting 7 patients (14.0%), whereas no adult cases were identified (p = 0.012). Intestinal obstruction accounted for 5 cases (10.0%) in children and 8 cases (16.0%) in adults. Abdominal trauma and incarcerated or strangulated hernia constituted smaller proportions in both groups. The detailed etiological distribution is shown in Table 2. Table 2. Etiological spectrum of emergency abdominal surgical conditions Etiology Children (n = 50), n (%) Adults (n = 50), n (%) Total (n = 100), n (%) p-value Acute appendicitis 28 (56.0) 18 (36.0) 46 (46.0) 0.070 Intussusception 7 (14.0) 0 (0.0) 7 (7.0) 0.012 Gastrointestinal perforation/peritonitis 4 (8.0) 14 (28.0) 18 (18.0) 0.017 Intestinal obstruction 5 (10.0) 8 (16.0) 13 (13.0) 0.554 Abdominal trauma 3 (6.0) 4 (8.0) 7 (7.0) 1.000 Incarcerated/strangulated hernia 2 (4.0) 3 (6.0) 5 (5.0) 1.000 Acute gallbladder pathology 0 (0.0) 2 (4.0) 2 (2.0) 0.495 Other causes 1 (2.0) 1 (2.0) 2 (2.0) 1.000 Overall etiological distribution: χ² = 17.76, degrees of freedom = 7, p = 0.013. Pairwise comparisons with small expected frequencies were assessed using Fisher's exact test. Operative Procedures Appendectomy was the most frequently performed emergency operation in the overall study population, accounting for 46 procedures (46.0%). It was performed in 28 children (56.0%) and 18 adults (36.0%). Surgical reduction or bowel resection for intussusception was performed in seven pediatric patients. Closure of gastrointestinal perforation with peritoneal lavage was considerably more frequent among adults, involving 14 patients (28.0%), compared with four children (8.0%). Adhesiolysis or decompression for intestinal obstruction was performed in four children and six adults, while bowel resection with anastomosis was required in two children and five adults. The principal operative procedures are summarized in Table 3. Table 3. Principal emergency surgical procedures performed Surgical procedure Children (n = 50), n (%) Adults (n = 50), n (%) Total, n (%) Appendectomy 28 (56.0) 18 (36.0) 46 (46.0) Intussusception reduction/resection 7 (14.0) 0 (0.0) 7 (7.0) Perforation closure with peritoneal lavage 4 (8.0) 14 (28.0) 18 (18.0) Adhesiolysis/bowel decompression 4 (8.0) 6 (12.0) 10 (10.0) Bowel resection and anastomosis 2 (4.0) 5 (10.0) 7 (7.0) Emergency hernia repair 2 (4.0) 3 (6.0) 5 (5.0) Trauma-related laparotomy/repair 2 (4.0) 2 (4.0) 4 (4.0) Other procedures 1 (2.0) 2 (4.0) 3 (3.0) Postoperative Outcomes The postoperative course was uneventful in 78 patients (78.0%), including 43 children (86.0%) and 35 adults (70.0%). At least one postoperative complication occurred in 22 patients (22.0%), with a numerically higher complication rate among adults than children (30.0% vs. 14.0%; p = 0.090). Surgical-site infection occurred in 9 patients (9.0%), comprising two children and seven adults. Postoperative ileus was documented in seven patients, while five developed postoperative sepsis. Pulmonary complications were recorded in five patients. Because individual patients could experience more than one complication, individual complication frequencies were not mutually exclusive. The requirement for postoperative intensive care was higher among adults (20.0%) than children (6.0%), although this difference did not reach conventional statistical significance (p = 0.071). The mean postoperative hospital stay was significantly longer among adults (7.2 ± 3.4 days) than children (5.4 ± 2.1 days; p = 0.002). Three postoperative deaths occurred, all in the adult group, yielding an overall mortality rate of 3.0%. No deaths were recorded among pediatric patients. The postoperative outcomes are detailed in Table 4. Table 4. Comparison of postoperative outcomes between children and adults Outcome Children (n = 50), n (%) Adults (n = 50), n (%) Total (n = 100), n (%) p-value Uneventful postoperative recovery 43 (86.0) 35 (70.0) 78 (78.0) 0.090 Any postoperative complication 7 (14.0) 15 (30.0) 22 (22.0) 0.090 Surgical-site infection 2 (4.0) 7 (14.0) 9 (9.0) 0.160 Postoperative ileus 2 (4.0) 5 (10.0) 7 (7.0) 0.436 Pulmonary complications 1 (2.0) 4 (8.0) 5 (5.0) 0.362 Postoperative sepsis 1 (2.0) 4 (8.0) 5 (5.0) 0.362 ICU admission 3 (6.0) 10 (20.0) 13 (13.0) 0.071 Reoperation 1 (2.0) 3 (6.0) 4 (4.0) 0.617 Mortality 0 (0.0) 3 (6.0) 3 (3.0) 0.242 Postoperative hospital stay, days, mean ± SD 5.4 ± 2.1 7.2 ± 3.4 6.3 ± 3.0 0.002 Individual complications are not mutually exclusive. Fisher's exact test was used for sparse categorical comparisons; postoperative stay was compared using the independent-samples t-test. Overall, acute appendicitis predominated among pediatric emergency abdominal surgeries, whereas adults demonstrated a broader etiological distribution with a substantially greater proportion of gastrointestinal perforation and peritonitis. Adults also experienced longer postoperative hospitalization and numerically higher rates of postoperative complications, intensive-care requirement, and mortality.

The present comparative study demonstrates clear age-related differences in the etiological profile of emergency abdominal surgery. Acute appendicitis dominated the pediatric group, whereas adults had a more heterogeneous distribution with a substantially greater proportion of gastrointestinal perforation and peritonitis. This pattern is clinically plausible and aligns with the established predominance of appendicitis among children requiring emergency abdominal surgery [2,3]. Intussusception occurred only in children in the present series, reinforcing its characteristic pediatric distribution and the continuing role of operative treatment when non-operative reduction is unsuitable or unsuccessful [4]. Gastrointestinal perforation with peritonitis was significantly more frequent among adults. Studies from developing and resource-variable settings describe perforation peritonitis as a major cause of emergency laparotomy, often accompanied by contamination, sepsis, and considerable postoperative morbidity [7,8]. The greater burden of perforation in adults in our cohort also helps explain their longer symptom duration, higher frequency of peritonitis at presentation, and greater postoperative resource use. Evidence from large gastrointestinal perforation cohorts indicates that age, shock, renal dysfunction, and severe inflammatory derangement are important predictors of poor outcome [9]. Although these variables were not all evaluated in the present analysis, they highlight the physiological vulnerability associated with complicated intra-abdominal infection. Postoperative complications occurred in 22.0% of the overall cohort and were more frequent among adults than children, although the difference did not reach statistical significance. Surgical-site infection was the most frequently documented specific complication. Emergency operations carry inherent contamination and infection risks, particularly when perforation or diffuse peritonitis is present; contemporary guidance emphasizes appropriate antimicrobial therapy, source control, wound protection, and evidence-based intraoperative infection-prevention practices [13]. The adult group also required intensive care more often and had a significantly longer postoperative hospital stay. These observations are consistent with broader emergency general surgery literature showing that increasing age and physiological burden are associated with more complications and longer hospitalization [14]. The three deaths in this study occurred exclusively among adults, producing an overall mortality of 3.0%. The between-group mortality difference was not statistically significant, which is expected with a limited sample and few events. Nevertheless, the direction of the finding is compatible with the greater proportion of perforation, peritonitis, and prolonged prehospital symptom duration in adults. Structured emergency laparotomy pathways emphasize rapid assessment, correction of physiological derangements, timely surgery, and coordinated postoperative care to reduce preventable adverse outcomes [12]. Minimally invasive approaches, when technically appropriate and supported by surgical expertise, have also been associated with favorable short-term outcomes in selected emergency general surgery populations [10,11]. Taken together, these findings support age-sensitive emergency surgical pathways rather than a uniform approach. Pediatric services should maintain rapid diagnostic pathways for appendicitis and intussusception, while adult services require strong systems for early recognition of perforation, obstruction, sepsis, and physiological deterioration. Larger multicentre studies with adjustment for comorbidity, disease severity, operative approach, and time to source control would provide more precise estimates of the independent effect of age on postoperative outcomes. Limitations This study has several limitations. The single-centre design and modest sample size restrict external generalizability and statistical power for uncommon outcomes such as mortality and reoperation. Equal allocation of children and adults does not represent the natural age distribution of emergency surgical admissions. Detailed comorbidity indices, physiological severity scores, operative approach, time to surgery, and post-discharge complications were not included in the comparative analysis.

Emergency abdominal surgery demonstrates important age-related differences in both etiology and early postoperative course. Acute appendicitis and intussusception formed the predominant pediatric indications, whereas adults showed a greater burden of gastrointestinal perforation and peritonitis. Adults also had longer postoperative hospitalization and numerically higher frequencies of complications, intensive-care admission, reoperation, and mortality. These findings emphasize the value of age-specific diagnostic pathways, rapid resuscitation, timely source control, and targeted postoperative surveillance. Early recognition of perforation, obstruction, and sepsis is particularly important in adults, while prompt diagnosis of appendicitis and intussusception remains central in children. Larger multicentre studies should clarify independent predictors of adverse outcomes and support context-specific emergency surgical protocols. for practice.

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