Online ISSN: 2515-8260

Keywords : Perforation

Prospective observational assessment of the aetiopathological profile of on small bowel perforation and its management

Dr. Alishala Lingam, Dr. Talluri Suresh Babu, Dr. Talla Srinivas

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 1, Pages 3583-3589

The objective of the study was to study the various causes, incidences and clinical features of small bowel perforations and various surgical procedures and it’s the outcome.
Methods: The present study was conducted in the Department of General Surgery for the period of 2 years and all the patients of small bowel perforation of both sexes and of different ages was included. 50 patients were included in the study. The protocol was reviewed and approved by the ethics committees of this institution. Patients were included after taking their informed consent for the study.
Results: In the present study, majority of the patients (36%) were of age group 36-45 followed by (28%) 26-36 age groups. There were 40 (80%) males as compared to females 10 (20%). In this study, 35 cases (70%) of perforation were due to peptic ulcers. Next order cases due to trauma consist of 10 cases (20%). Tubercular perforation was seen in 2 patients (4%), and due to Crohn’s disease, only 1 case was found. Typhoid perforation was seen in 1 case. Malignant perforation was in 1 case (2%) which was found to be gastrointestinal stromal tumours after histopathological examination. In this study, free peritoneal fluid was found in 43 cases (86%). Free gas in the peritoneal cavity was found in 40 cases (80%) due to third space fluid collection and escape of bowel gas into the peritoneum, respectively. Mesenteric lymphadenitis and thickened omentum were found in 2 cases (4%) due to tuberculosis and malignancy.
Conclusion: Duodenal perforation is the most common cause of small intestinal peforation. Smoking and consumption of alcohol & NSAIDS are the most important risk factors for small bowel perforation. Patients mainly presented with abdominal pain and distension with features of peritonitis. X-ray abdomen suggested of pneumoperitoneum in most of the patients. Resuscitation followed by closure of perforation with omental patch was the most common management procedure done.

Descriptive study of non-traumatic perforative peritonitis at a tertiary care hospital

Dr. Somashekhar L Samagandi, Dr. SB Rajashekar, Dr. Gurubasavana Gouda Yale, Dr. Vishwajith K

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 2155-2160

Introduction: Peritonitis is defined as inflammation of the serosal membrane that lines abdominal cavity and organs contained therein. Secondary peritonitis caused due to non-traumatic hollow viscous perforation is a common occurrence in this country which requires emergency surgical intervention. In our prospective study we tried to find out the incidence of perforative peritonitis which presented to our tertiary care hospital with respect to age and gender, relative frequency of anatomical site of perforation, their causes, presentation, treatment and outcome.
Methods: The study has been based on the analysis of 98 cases of non-traumatic perforated peritonitis patients admitted to our tertiary hospital, during the study period with prior inclusion criteria.
Each patient was examined thoroughly, after taking a detailed history and social demographic factors were noted. Cases were admitted as emergency and relevant immediate investigations were done. The diagnosis was made with history, clinical features and radiology to support the diagnosis.
Out of 98 cases, 92 underwent emergency laparotomy, at laparotomy the site of perforation, its pathological conditions, the amount of peritoneal contamination were noted. Perforation site specific operative procedures were done. In post-operative period, patients were closely monitored and complications were managed appropriately.
Results: Out of 98 cases 84(85.7%) were males. 25(32.7%) of the patients were in a age group of 21-30 years. Majority (35.7%) of the cases presented after 24-48 hours to our hospital. Pain abdomen was the most consistent symptom present in all the cases. Smoking (43.12%) and NSAIDs(21.4%) were the most important risk factors. Duodenum was the most common site of perforation (43.9%) followed by ileal (24.5%) and gastric (21.4%). In postoperative period 34.3% of patients had some form of complication and death occurred in 8 patients (8.16%).
Conclusion: Non-traumatic perforative peritonitis is more common in young age group (21-30 years) with male preponderance and is more common in rural population. Smoking and NSAIDs are the most common causative factors although it is multifactorial. Peptic ulcer disease is the most common cause of perforation. Delayed presentation to the hospital is the most common cause of morbidity and mortality

Assessment of clinico-demographic profile of patients with ileal perforations

Dr.Mushtaq Ali, Dr Manzoor Ahmed

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 2116-2119

Background:To assess the clinico-demographic profile of patients with ileal perforations.
Materials & methods: A total 50 patients were enrolled for the present study. Complete demographic and clinical details were obtained. A Performa was made and complete medical history was recorded separately. Clinical examination of all the patients was carried out. Ultrasonographic examination of all the patients was done afterwards. Based on the clinical history, etiologic spectrum of all the patients was established. Detailed description of the ileal perforation was recorded separately
Results: Mean age of the patients with ileal perforation was 41.3 years. Out of 50 patients with ileal perforation, 76 percent of the patients were males while the remaining were females. Among the 50 patients with ileal perforation, most common presenting complaint was abdominal pain and distension found to be present in 100 percent of the patients. Constipation, fever and vomiting was seen in 92 percent, 70 percent and 40 percent of the patients respectively. Typhoid was the chief etiologic factor responsible for ileal perforation, found to be present in 50 percent of the patients. Tuberculosis and traumatic cause of ileal perforation was seen in 20 percent and 16 percent of the patients respectively. In 14 percent of the patients, the cause was non-specific/unknown. 
Conclusion: Typhoid is the most common cause of ileal perforation with abdominal distension and abdominal pain being the most common clinical manifestations.


Dr. Shashank Rai, Dr. Karan Kaul, Dr. Ashish Kumar Goyal, Dr. Ashutosh Niranjan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 3029-3033

Background: Laparoscopic cholecystectomy (LC) has replaced open cholecystectomy as the standard procedure for gallbladder removal whenever possible. The present study was conducted to compare three- port versus standard four port in patients undergoing laparoscopic cholecystectomy.
Materials & Methods: 70 patients of cholelithiasis of both genders were divided into 2 groups of 35 each. Group I patients were subjected to the three- port technique and group II patients to conventional four port technique. Parameters such as intra- operative findings, pain score etc. was compared.
Results: The mean VAS was 2.13 minutes in group I and 4.35 minutes in group II. The mean mean operative time was 50.6 in group I and 61.8 in group II. The difference was significant (P< 0.05). Intra- operative complications were perforation seen in 5 patients in group I and 3 in group II, stone spillage 3 in group I and 3 in group II, bleeding from liver 4 in group I and 3 in group II, cystic artery bleeding 2 in group I and 1 in group II. Post- operative complications were fever seen 4 patients in group I and 7 in group II, vomiting 5 in group I and 6 in group II, Basal pneumonitis 3 in group I and 5 in group II. The difference was significant (P< 0.05).
Conclusion: Three port cholecystectomy is a safe and feasible option with fewer surgical scars and less post operative pain in selected patients.


Dr Anshu Sood

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 11483-11488

Background: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharges or otorrhoea through a tympanic perforation. The present study was conducted to assess factors affecting the surgical outcome in tympanoplasty in children.
Materials & Methods: 54pediatric patients of persistent perforation of the tympanic membraneof both genders were enrolled. Age at time of surgery, state of contralateral ear, previous adenoidectomy, cause of perforation, size of perforation, infection at the time of surgery, state of mucosa, age at first occurrence of perforation, presence of craniofacial dysmorphia, and surgical technique were recorded.
Results: Out of 54 patients, boys were 34 and girls were 20. Success rate was seen in 30 and failure in 24 cases. Contralateral ear normal in 22 and 18 and CME in 8 and 6. Cause of perforation was infection in 24 and 19, previous adenoidectomy was not done in 17 and 14 and done in 13 and 10, size of perforation was <50% in 16 and 16 and >50% in 14 and 8, state of mucosa was normal in 25 and 17, surgical technique was onlay in 24 and 18, otorrhea at time of surgery was absent in 28 and 20 and present in 2 and 4 in success and failure cases respectively. The difference was significant (P< 0.05). Closure of perforation was seen in 50. Hearing gain was seen in 32 and no gain in 22. Air-filled space was adequate in 46, otitis media with effusion in 6 and partial atelectasis in 2 cases. The difference was significant (P< 0.05).
Conclusion: Study mitigates against delaying tympanoplasty type I in paediatric patients.

Assessment of cases of traumatic tympanic membrane perforation

Dr. Puneet Maheshwari, Dr. Shivendra Pandey, Vijeta Maheshwari,Jagriti Tholia

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 240-243

Background:Traumatic tympanic membrane (TM) perforation is an injury of the eardrum,
which is frequently encountered by otolaryngologists. The present study was conducted to
assess the cases of traumatic tympanic membrane perforation (TTMP).
Materials & Methods:136 cases of traumatic tympanic membrane perforation of both
genders were recorded. Parameters such as size, site, complaint and mechanism of injury was
Results: Side involved was left in 80, right in 56. Site was anterior in 50, posterior in 60 and
undefined in 26. Complaints was otalgia in 48, tinnitus in 60, otorrhoea in 30 and vertigo in
104. The mechanism of injury was domestic violence in 32%, RTA in 54%, armed robbery in
8% and self- inflicted in 6%. The difference was significant (P< 0.05).
Conclusion: Common side involved in traumatic tympanic membrane perforation was left,
site was anterior, posterior and undefined. Complaints was otalgia, tinnitus, otorrhoea and

Evaluation of Ohmann Score in the Diagnosis of Acute Appendicitis in Patients Admitted in a Tertiary Care Hospital

Nandula Sai Bharath, M. Anurag, Lavudya Srinivas, Ganesh Banothu

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 4729-4737

Background:To Diagnose Acute Appendicitis based on Ohmann score and correlating it
with postoperative histopathological report.
Materials and Methods: This study was undertaken in 80 patients with a provisional
diagnosis of acute appendicitis getting operated over a period of 18. months.Ohmann
score was applied in the preliminary diagnosis, which was confirmed by intra operative
and histopathological findings.
Results: Fifty-eight patients were males and 22 were females. There was no statistical
significance in the male to female ratio. The highest incidence was found in the age
group of 21-30 and the lowest was seen in the age group of >40. Ohmann score of 13.5
was found in 11 patients and score of 14 was also seen in 11 patients .1.5 was least
ohmann score seen who had a normal appendix on histopathology. As ohmann score
was categorised into 3 categories,3 patients had Ohmann score of less than 6 out of
which 2 had a normal appendix on histopathology and the other patient had
appendicitis on histopathology. Depending on the cut-off value taken, sensitivity ranges
from 100% to 4.54%, specificity ranges from 14.28% to 100%, positive predictive value
ranges from 84.61% to 100% and negative predictive value ranges from 100% to
Conclusion: Ohmann scoring system significantly reduces the number of negative
laparotomies without increasing overall rate of appendicular perforation. It can work
effectively in routine practice as an adjunct to surgical decision making in questionable
acute appendicitis. It is simple to use and easy to apply since it relies only on history,
clinical examination and basic lab investigations.


Ritesh Nandwani, Ravi Bhatia

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 11036-11040

Background: Tympanic membrane perforations are common cause of hearing loss. This
study was designed to analyze the relation between tympanic membrane perforation
and hearing loss.
Methods: In this prospective study, patients with dry tympanic membrane perforations
of safe type were included. The patients were divided into groups in according to size,
site and duration of perforation
Results: 49 patients with 70 dry tympanic membrane perforations were studied. Data
was analyzed statistically using paired t-test. Hearing loss increased as the size of
perforation increased. Posterior quadrant perforations were associated with more
hearing loss as compared to anterior quadrant perforations. Also duration of disease
was in linear relation with mean hearing loss.
Conclusions: The degree of conductive hearing loss as a result of tympanic membrane
perforation would be expected with the size, site and duration of perforation.


Svetlana G. Gorelik, Oleg V. Zacharov, Md All Rayhan, Viktor V. Bulynin , Yuri A. Parkhisenko

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 2, Pages 5567-5577

A ruptura espontânea do esôfago é relativamente rara, variando de 2 a 3% de todos os casos de lesões esofágicas com mortalidade acima de 90% devido ao desenvolvimento de complicações graves, como mediastinite purulenta, sepse, empiema pleural, pericardite, erosão de grandes navios de sredosteniye e multiorg um fracasso. 22 pacientes com ruptura espontânea do esôfago foram tratados no Hospital Clínico Regional de Voronezh nº 1 no período de 1998 a 2017. Todos os pacientes foram divididos em 4 grupos: grupo 1 - 8 pacientes submetidos à drenagem da cavidade pleural; grupo 2 - 2 pacientes com sutura das feridas de esôfago; grupo 3 - 2 pacientes submetidos à sutura do defeito da parede esofágica, fundoplicatura com pontos cobertos pela parte inferior do estômago; grupo 4 - 10 pacientes com orifício perfurado não suturado, mas formado um manguito do fundo do estômago, cobrindo a perfuração (fundoplicatura segundo Chernousov), a cavidade pleural foi drenada. Entre os pacientes do grupo 1, a mortalidade foi de 62,5% (5 pacientes). Em pacientes do grupo 2, falha de sutura e mortalidade - 2 pacientes (100%). Nos pacientes do grupo 3, falência da sutura do esôfago e do manguito ocorreu em 2 pacientes (100%), 1 deles morreu. 2 pacientes (20%) morreram entre os pacientes do grupo 4. Os dados obtidos mostraram que o método mais eficaz de tratamento cirúrgico de pacientes com ruptura de esôfago é o método de confecção de um manguito pelo fundo do estômago, cobrindo a perfuração sem sutura o orifício perfurado.

Evaluating the effect of intentional perforation of dental implants into the maxillary sinus in different depths (Stability andRadiographicalstudy)

Evan Namrud Youhanna; Shehab Ahmad Hamad; Luqman Fawzi Omar

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 1, Pages 4359-4383

The sinus membrane perforationcombined withexposing dental implant into the maxillary sinus is considered as a potential risk factor for implant failure and sinus complication.The present studyinvestigated the incidence of intentional sinus membrane perforation by dental implant in different depths and the possible risk factors associated with membrane perforations and assessed the implant osseointegratin and the survival rate of implants placed in the posterior maxillain a dog model. A total of 32 titanium implants were placed in the bilateral maxillary first molar areas of 16 adult mongrel dogs with different penetrating depths of implants into the maxillary sinus cavities (group A: 0 mm; group B: 1 mm; group C: 2mm; group D: 3 mm). The sample, block biopsies were harvested six months after surgery and evaluated by Biomechanical analysisandradiographic observation.After six months healing period, no signs of inflammatory reactions or complications were observed in any maxillary sinus of the sixteen doges. The results showed that the posterior maxillary edentulous areas with reduced bone height may be successfully rehabilitated with implants that penetrate the Schneiderian membrane and extended into the maxillary antrum. During the 6-monthes observational period in canines, despite the different protrusion extent, penetration of dental implant into the maxillary sinus with membrane perforation did not compromise the dental implant osseointegation processes and the sinus health. It was also found out when penetrating depth into the sinus is less than 2 mm, the apical portion of implant could be re-covered by regenerating membrane.No significant differences were found among groups regarding implant stability, bone-to-implant contact (BIG) and bone area in the implant threads (BA). In conclusion, invading the maxillary sinus by dental implant is not necessarily associated with significant complications as was generally expected, and stable osseointegrated dental implant that perforate the sinus without apparent immediate complication cannot be considered a harmful factors that necessitate its immediate removal, so could be left provided that they were initially stable.