Clinical Presentation, Postoperative Complications and Risk Factors of Duodenal Leakage After Graham Omentopexy for Duodenal Ulcer Perforation

Arooba Zahid, Mazhar Iqbal, Ainnan Memon, Husna Mehboob, Ayesha Mehboob

Abstract

Objective

To find out the clinical presentation, postoperative complications and risk factors of duodenal leakage after Graham omentopexy for duodenal ulcer perforation.

Study design

Cross-sectional observational study.

Place & Duration of study

Department of General Surgery Ward-2, Jinnah Postgraduate Medical Center Karachi, from April 2021 to April 2023.

Methodology••

Patients of duodenal ulcer perforation of both genders were included. Preoperative risk factors and postoperative outcome were recorded on a predesigned form. A 95% confidence interval was calculated for each proportion and tested by one sample t test for binomial proportion against null hypothesis. The results were considered significant with p <0.05.

Results 

A total of 72 patients were included. There were 67 (93.05%) males and 05 (6.95%) females. Age was from 12 years to 65 years. Twenty-seven (37.50%) patients presented within 24-hours and 20 (27.78%) after 48-hours of onset of symptoms. Prothrombin tine (PT)/INR were deranged in 15 (20.83%) patients. Serum albumin was found low in 05 (6.94%) and raised serum creatinine in 14 (19.44%) patients. Peritoneal fluid was dirty and more than 1000 ml in 15 (20.83%) patients. All patients had perforation in the anterior wall of the duodenum.

Postoperative wound infection occurred in 14 (19.44%), leakage in 12 (16.66%), paralytic ileus in 05 (6.94%), respiratory failure in 03 (4.16%), and burst abdomen in 02 (2.77%) patients. Six (8.33%) patients expired in this series. Among the 12 patients who experienced leakage after Graham omentopexy, 06 (50%) expired. Patients who died presented after 48-hours, had deranged creatinine level, deranged INR, hypotension, dirty peritoneal fluid of more than 1000 ml, perforation size greater than 01 cm, and age above 50-years.

Conclusion••

Common risk factors of leakage of duodenal ulcer perforation after Graham omentopexy were older age, delayed presentation, deranged biochemical profile with a significant intra-peritoneal collection. Mortality and morbidity were high after the leakage.

Key words 

Graham omentopexy, Duodenal perforation, Duodenal leakage, Peritonitis.