Emergency Laparotomies at a Tertiary Care Center-a Hospital-Based Cross-Sectional Study

Abstract

Emergency laparotomy is a common high-risk surgical procedure, but with a few outcome data and few data on postoperative care. This was a hospital-based descriptive study of 376 consecutive emergency midline laparotomies performed in a tertiary care center. The aim of the study was to identify the clinical presentation, surgical indications, preoperative delay, intraoperative findings, and postoperative complications. Majority of the patients belonged to the 40-80-year age group. Broadly, the indications could be divided into acute abdomen and trauma. Most of the cases (82 %) presented with acute abdomen, out of which 57 % cases had gastrointestinal perforation, and 33 % had intestinal obstruction. In trauma laparotomies, 63 % of cases were done for blunt abdominal trauma and the rest for penetrating injury. The clinical features were analyzed, of which most frequent were abdominal tenderness (88.8 %), abdominal distension (88 %), tachycardia (74.2 %), and guarding (70.7 %). Nearly three fourths of the patients underwent laparotomy within 24 h of entry to the casualty. The most common condition that resulted in an emergency laparotomy was duodenal perforation which was seen in 93 patients, followed by gastric perforation in 60 patients. Postoperatively, 54.5 % of patients did not develop any complication. The most common complication encountered was wound infection (26.6 %). Mortality following emergency laparotomy was 13 %. Age-specific mortality was maximum in patients with age more than 80 years. The diagnosis-specific mortality was higher for large bowel perforation and mesenteric ischemia among the acute abdomen cases, and liver injury or great vessel injury among the trauma cases.

Keywords: Acute abdomen; Intestinal obstruction; Intestinal perforation; Laparotomy.

Fig. 1

Clinical features of the patients taken up for emergency laparotomy

Fig. 2

Percentage distribution of USG abdomen findings