Experience of Graham's Patch Omentoplasty for Duodenal Perforation in Azad Kashmir

Abstract

To evaluate the etiology and clinical presentation of duodenal perforation and also to
evaluate the outcome of surgery with Graham's patch omentoplasty in an area remote from tertiary
care hospitals.
Study Design: Cross sectional descriptive.
Place & Duration: DHQ hospital, Kotli,Azad Kashmir and three other private hospitals. July
2009 to Dec
2013.
Material & Methods: Patients with duodenal perforation underwenl laprotomy and
Graham's patch omentoplasty was performed. Data was analyzed for age, sex, main
presenting features, duration of symptoms, pre› ious history of peptic ulcer disease,
use of NSAIDS and steroids, operative findings, management outcome, complications, mortality
and mean hospital stay.
Results: Out of 94 patients 68 {72.3%) were male with a male:female ratio of2.6: 1. The average age
was 38.5 years, and commonest etiology was known peptic ulcer disease in smokers
(53.2%). 57 (60.6%) cases presented within 24 hours of perforation. The main presenting features
were sudden abdominal pain, vomiting and peritonitis. The mean size of perforation was 7.5 mm. The
main complications were atelectasis (45.7%), post-operatis'e fever (22.3%), prolonged ileus
(20.2%) and wound infection ( 14.9%). Mortality was 4.3%. The average duration ofhospital stay
was 8 days and 95.7% were satisfactorily discharged home.
Conclusion: Graham's patch omentoplasty is a safe technique in remote areas where no
tertiary hospital facilities are available.