Thesis in Making

DISSERTATION SUBMITTED FOR

( GENERAL SURGERY )

A STUDY OF SURGICAL MANAGEMENT OF

DUODENAL amp SMALL BOWEL PERFORATION

STUDY AT WANLESS HOSPITAL MIRAJ

NAME OF INSTITUTE

WANLESS HOSPITAL

MIRAJ MEDICAL CENTRE

MIRAJ SANGLI

MAHARASHTRA

NAME - DR ABHIJIT ANIL WHATKAR

SUBJECT - DNB GENERAL SURGERY

DURATION 3 YEARS

1st JULY-AUG 2010 TO 31st JULY2010

REGISTRATION NO

INSTITUTE WANLESS HOSPITAL MIRAJ

TOPIC STUDY OF SURGICAL MANAGEMANT OF DUODENAL amp SMALL BOWEL

PERFORATION

NAME OF GUIDE Dr TBMORE

MSGENERAL SURGERY

Dr TBMORE

DNB GUIDE

GENERAL SURGERY

WANLESS HOSPITAL

Dr DMKAMLE Dr DMKAMLE

HEAD OF DEPT DIRECTOR

SURGERY WANLESS HOSPITAL

WANLESS HOSPITAL MIRAJ

LIST OF ABBREVIATIONS

ARDS - Acute Respiratory Distress Syndrome

ATT - Anti Tubercular Treatment

CD - Crohnrsquos disease

CT - Computerised Tomography

DIC - Disseminated Intravascular Coagulation

GI - Gastrointestinal

GIT - Gastro intestinal Tract

MODS - Multi Organ Dysfunction Syndrome

MOF - Multi Organ Failure

Perf - Perforation

RPM - Right Paramedian

S Creat - Serum Creatinine

SIRS - Systemic Inflammatory Response Syndrome

TB - Tuberculosis

WI - Wound Infection

ABSTRACT

BACKGROUND

Small bowel perforation is commonly encountered problem in surgical practice There are

different modes of presentation of cases which can be misleading in the diagnosis of its origin It is

necessary to know the current surgical procedures for different perforations to manage such a case An

effort has been made here to know the different modes of presentation diagnosis and management of

perforation pre operative amp post operative And a special attention has been given to the time between the

operation and pre-operative time for resuscitation

MATERIAL AND METHODS

A prospective study of 50 patients presenting to Wanless Hospital with a clinical diagnosis

of Small bowel perforation between August 2010 and July 2011 is done The clinical data the

investigations done and the surgical procedure undertaken are recorded according to the proforma

decided

OBSERVATIONS

Pain abdomen was the presenting complaint of all the patients followed by Vomiting (76)

Fever (46) and Distension (44) Diagnosis was made clinically with guarding and rigidity being

present in 84 cases and obliteration of liver dullness in 42 cases Erect abdomen X-ray showed air

under diaphragm in 70 cases

Right Para median incision was employed in 50 of cases The most common cause of

Small bowel perforation was Ileal perforation Tubercular perforation was the most common cause of ileal

perforation

Resection and anastomosis in two layers was the commonly done procedure Patients were followed up in

the post operative period to know the post operative complications morbidity and mortality rates

The most common complication in this series was wound infection which accounted for 17 cases (34)

Wound dehiscence was seen in 3 cases

CONCLUSIONS

Pain abdomen (100) is the most common presenting symptom in Small bowel

perforation followed by vomitingfever abdominal distension and constipation Erect abdomen X-ray and

USG abdomen are very useful investigation for diagnosis in perforation

Resection and anastomosis was the most common procedure employed The most common

complication in this series was wound infection Mortality rate in our study was 10

KEY WORDS Small bowel Perforation Management Mortality Morbidity

CONTENTS

1 Introduction

2 Aims and objectives

3 Review of literature

4 Anatomy

5 Physiology

6 Pathophysiology

7 Material methods and observation

8 Discussion

9 Summary

10 Conclusions

11 Performa

12 Bibliography

13 Master chart

14 Abbreviations

INTRODUCTION

Perforation of the small bowel especially terminal ileum is a common abdominal emergency faced

by the general surgeon Perforation of the small bowel from a wide variety of causes comprises the

majority of emergency surgical admissions

Perforation of the small bowel is relatively uncommon in western societies except in regions where

typhoid tuberculosis and parasitic infestation are endemic1

The preeminent complication of typhoid is perforation seen in 3rd week The ileum is the main site of

perforation 2

The perforated viscus challenges the surgeonrsquos skill as a technician and his knowledge of pre-operative

intra-operative and post-operative care of severely ill surgical patient 3

Majority of the patients present with sudden onset of abdominal pain A high index of suspicion is

essential to diagnose hollow viscus perforation early as significant mortality and morbidity results from

diagnostic delay

Surgery plays an important role in the management of perforations Evaluation and management of gastro

intestinal perforation provide some of the most challenging experiences for a surgeon with the advent of

new technology

This study is undertaken to find out the age and sex incidence etiological factors clinical features and

various surgical procedures for gastro intestinal perforations its complications in our setup

AIMS amp OBJECTIVES

1 To study the various causes of small bowel perforation

2 To study various clinical features of small bowel perforation

3 To study various diagnostic modalities especially X-ray abdomen erect

4 To study various surgical procedures amp outcomes

5 To study post surgical complications amp management

6 To study outcomes after certain time of resuscitation

REVIEW OF LITERATURE

The Hippocratic facies seen in terminal stages of peritonitis was described by hippocrates in 460

Aristotle was the first to discribe intestinal injury as consequence of blunt abdominal trauma 5

Singhai et al showed that ileo-caecal region was a commonest site of involvement in abdominal

tuberculosis 6

Bhansali et al in 1968 reported that closure of tubercular perforation with or without bypass has been show

to give poor results and hence resection and anastomosis recommended 7

Das PShukla in 1968 showed that abdominal tuberculosis was 2 to 3 times more common in females 8

Nair SK in 1981 reported maximum morbidity in the form of wound infection in 52 of the patients

followed by fecal fistula (16) septicemia (8) respiratory infections (4) 9

Beniwal Uday Singh in 2003 concluded that repair of the typhoid perforation is better procedure than

temporary ileostomy in enteric perforation due to its cost effectiveness and absence of complications

related to ileostomy 10

Ileostomy and ileo transverse bypass should be considered as a treatment option in patients with unhealthy

GROSS ANATOMY

The length of the alimentary tract in normal humans averages about 453 cm from

the nose to the anus The duodenum is approximately 21 cm long and the colon is

approximately 109 cm long The combined length of the jejunum and ileum is 261 cm

or about three fifths of the entire canal 11 The jejunum begins at the duodenojejunal

angle supported by the ligament of Treitz The jejunum constitutes the proximal two

fifths of the small intestine and the ileum makes up the distal three fifths however there

is no clear demarcation between jejunum and ileum The small intestine which decreases

in luminal diameter as it proceeds distally is convoluted or folded upon itself to occupy

the central and lower part of the abdominal cavity it is enclosed laterally and superiorly

by the colon 12

Figure 1 Mucosa and Musculature of Jejunum

Figure 2 Mucosa and Musculature of Ileum

Mesentery

The mesentery a large fold of peritoneum suspends the small intestine from the

posterior abdominal wall The base of the mesentery attaches to the posterior abdominal

wall to the left of the second lumbar vertebra and passes obliquely to the right and

inferiorly to the right sacroiliac joint The mesentery contains blood vessels nerves

lymphatics and lymph nodes as well as considerable fat It attaches to the small intestine

along the length of one side the mesenteric border leaving the remainder of the surface

of the bowel covered by its visceral peritoneum the serosa The broad-based attachment

of the mesenteric base stabilizes the small bowel and prevents it from twisting upon its

blood supply

Blood Supply

The small intestine receives its blood supply from the superior mesenteric artery

the second large branch of the abdominal aorta The superior mesenteric artery courses

anterior to the uncinate process of the pancreas and the third portion of the duodenum

where it divides to supply the pancreas duodenum and entire small intestine as well as

the ascending and transverse colon The intestinal arteries branch within the mesentery to

unite with adjacent arteries to form a series of arterial arcades before sending small

straight arteries to the small intestine The intestinal arteries contact the small intestine on

the mesenteric border where they pass toward the antimesenteric border sending small

branches into the layers of the intestine The veins of the small intestine drain into the

superior mesenteric vein a major tributary to the portal vein

Lymphatics

Peyers patches are lymph nodules aggregated in the submucosa of the small

intestine These lymphatic nodules are most abundant in the ileum but the jejunum also

contains them The lymphatic drainage from the small intestine passes into three sets of

mesenteric nodes a first set close to the wall of the small intestine a second set adjacent

to the mesenteric arcades and a third set along the trunk of the superior mesenteric

artery The superior mesenteric preaortic group drains into the intestinal trunk which

drains into the cisterna chyli The lymphatic drainage of the small intestine constitutes a

major route for transport of absorbed lipid into the circulation

Mucosa

The mucosal surface of the small intestine contains numerous circular mucosal

folds called the plicae circulares (valvulae conniventes or valves of Kerckring) These

folds are 3 to 10 mm in height they are taller and more numerous in the distal duodenum

and proximal jejunum becoming shorter and fewer distally Intestinal villi barely visible

to the naked eye resemble tiny finger-like processes projecting into the intestinal lumen

Innervation

The parasympathetic and sympathetic divisions of the autonomic nervous system

provide the efferent nerves to the small intestine The parasympathetic preganglionic

fibers pass through the vagus nerves to synapse with neurons of the intrinsic plexuses of

the intestine The sympathetic preganglionic fibers arise from the ninth and tenth thoracic

segments of the spinal cord and synapse in the superior mesenteric ganglion The

postganglionic sympathetic fibers pass along the branches of the superior mesenteric

artery to the intestine Pain from the intestine is mediated through thoracic visceral

afferents not vagal afferents Although the vagus contains large numbers of afferent

fibers thoracic visceral afferents not vagal afferents mediate pain from the intestine 13

MICROSCOPIC ANATOMY

The small intestine consists of four layers From the lumen outward they are the

mucosa the submucosa the muscularis and the adventitia or serosa

Mucosa

The mucosa of the small intestine encompasses the epithelium the lamina

propria and the muscularis mucosae The mucosal surface has two important structural

features the villi and the crypts of Lieberkuumlhn The villi have a columnar epithelial

surface and a cellular connective tissue core of lamina propria Each villus contains a

central lymphatic vessel called a lacteal a small artery a vein and a capillary network

Human jejunal villi measure 05 to 10 mm high and number 10 to 40 villi per square

millimeter of mucosal surface In addition to the vessels the villi contain smooth muscle

fibers extending from the muscularis mucosae providing contractility to each villus The

crypts of Lieberkuumlhn or intestinal glands reside adjacent to the bases of the villi and

extend down to but not through the muscularis mucosae The lamina propria between

the intestinal epithelium and the muscularis mucosae contains blood and lymph vessels

nerve fibers smooth muscle fibers fibroblasts macrophages plasma cells lymphocytes

eosinophils and mast cells as well as elements of connective tissue 14

Scanning electron micrographs provide an in-depth perspective of the mucosa

with excellent resolution The villi vary in shape from circular to flattened or finger-

shaped The finger-shaped villi are 01 to 025 mm in diameter are corrugated by deep

horizontal clefts and have holes 3 to 8 m across on the surface representing the

openings of the goblet cells 23 The muscularis mucosa is a thin layer of smooth muscle

separating the mucosa from the submucosa 15

Cells of the Epithelium

Cells of the Villi The columnar epithelial cells are responsible for absorption

These cells 22 to 26m tall exhibit a striated luminal border (brush border) and a basally

placed nucleus The microvilli which are projections 1 m tall and 01 m wide and are

produced by numerous folds in the apical plasma membrane account for the brush border

appearance The microvilli greatly increase the absorptive surface of the epithelial cell

The membrane of the microvillus is continuous without fenestrations and it separates the

lumen of the gut from the interior of the epithelial cell The brush border contains high

concentrations of digestive enzymes particularly disaccharidases The plasma membrane

contains 80 to 90 of the disaccharidase activity of the intestinal cell These findings

indicate that the microvilli besides increasing absorptive surface perform an important

digestive function

Goblet cells are present in both the villi and the crypts These cells have

cytoplasm filled with mucous granules between the nucleus and the apical brush border

Intestinal goblet cells secrete their mucus by merocrine secretion 13

Cells of the Crypts

Enterochromaffin cells reside in the crypts of the small intestine and in other parts

of the gastrointestinal system as well including the esophagus stomach colon

gallbladder and pancreas These cells do not contact the intestinal lumen and their

secretory granules are usually below the nuclei away from the lumen suggesting

secretion into the blood rather than the lumen The enterochromaffin cells have an

endocrine function

Paneth cells occur in the base of the crypts and are structurally similar to cells

known to secrete large amounts of protein such as pancreatic or parotid acinar cells The

function of Paneth cells is unknown

Undifferentiated cells the most frequent cell in the base of the crypts multiply

and differentiate to replace lost absorptive cells

Epithelial Renewal

The epithelium of the small intestine is a dynamic rapidly proliferating tissue in

which old dying cells are constantly replaced by newly formed cells thus maintaining the

structural integrity of the mucosa Mitotic division of undifferentiated cells occurs in the

crypts New growth replaces the population of intestinal epithelial cells every 3 to 7 days

Submucosa

The submucosa is a strong fibroelastic and areolar connective tissue layer

containing vessels nerves and lymph nodules

Muscular Layer and Intramural Neural Structures

Two distinct layers of smooth or nonstriated muscle an outer longitudinal coat

and an inner circular coat form the muscular portion of the small intestine Intestinal

smooth muscle fibers are spindle-shaped structures about 250 m long The plasma

membrane of adjacent cells approximate at points forming structures called nexuses The

nexuses allow electrical continuity between smooth muscle cells and permit conduction

through the muscle layer

The small intestine has four identifiable neural plexuses (1) The subserous

plexus noticeable on the mesenteric attachment forms the transition between the

mesenteric nerve fibers and the myenteric plexus Ganglia occur in the subserous plexus

(2) The myenteric plexus is located between the longitudinal and circular muscle layers

and consists of three networks linking various ganglia and ramifying within the muscle

layers (3) The submucosal plexus is a network of nerve fibers and ganglia in the

submucosa (4) The mucous plexus consists of fibers from the submucosal plexus

extending into the mucosa This plexus does not contain nerve cell bodies 131416

PHYSIOLOGY

DIGESTION AND ABSORPTION

Carbohydrate

The digestion of starch by amylase probably occurs predominantly in the lumen

of the alimentary tract Maltose maltotriose and dextrin as well as the dietary

disaccharides lactose (glucose-galactose) and sucrose (glucose-fructose) are completely

broken down to the constituent monosaccharides by the microvilli

The intestinal cells actively transport glucose and galactose against a

concentration gradient Glucose and galactose compete for transport in a manner similar

to competitive inhibition in other enzyme substrate systems The active transport of

sugars requires metabolic energy as well as oxygen Sodium ion is important in the

transport of glucose and galactose Glucose and galactose are absorbed by carrier-

mediated active transport The absorption of glucose and galactose depends on Na+

movement into the cell produced by the Na+K+ ATPase located on the basolateral cell

membrane Fructose the other significant monosaccharide is not absorbed by active

transport but probably enters the intestinal cells by facilitated diffusion 1316

Protein

The intestinal enzyme enterokinase converts trypsinogen to trypsin The

activation of trypsinogen is autocatalytic that is trypsin also activates trypsinogen

Trypsin likewise activates the other pancreatic proteolytic enzyme precursors Amino

acids are the final product of protein digestion However some dipeptides are also

absorbed

Amino acids are absorbed from the intestinal lumen by carrier-mediated active

transport The transport of amino acids requires oxygen and sodium The sodium pump

on the basolateral cell membrane of the intestinal epithelial cells maintains an electrical

potential across the brush border Digestion and absorption of protein are usually 80 to

90 completed in the jejunum 13

The bile salts that occur in humansmdashglycine or taurine conjugates of cholic acid

deoxycholic acid or chenodeoxycholic acidmdashare detergents they are water-soluble at

one portion of the molecule and fat-soluble at the other In solution substances produce

polymolecular aggregates called micelles which can dissolve fat 17 Lecithin a

phospholipid greatly enhances the capacity of bile salts to form micelles and dissolve fat

Bile salt and lecithin solubilize lipid in an aqueous environment to produce a micellar

solution This provides an optimal physicochemical environment for the action of

pancreatic lipase Pancreatic bicarbonate regulates the pH of the intestinal lumen to allow

lipase to function optimally An alkaline pH favors ionization of fatty acids and bile salts

which increases their solubility in micelles An alkaline pH also increases the solubility

of bile salts

Chylomicrons pass from the epithelial cells into the lacteals where they pass through the

lymphatics into the venous system Medium-chain triglyceride (C 8 to C 10) may be

absorbed without hydrolysis and pass into portal blood rather than into lymph via the

formation of chylomicrons

The jejunum absorbs most dietary fat Although unconjugated bile acids are absorbed in

the jejunum by passive diffusion the conjugated bile acids that form micelles are

absorbed in the ileum by active transport There they are almost completely absorbed and

pass via the portal venous blood to the liver for resecretion as bile

Water and Electrolytes

Large quantities of water enter the small intestine Some water is ingested but the

digestive glands secrete a larger amount to provide the luminal environment for optimal

digestion and absorption Five to 10 liters of water enters the small bowel daily whereas

only about 500 ml or less leaves the ileum and enters the colon The small intestine

therefore absorbs large quantities of water18

The important factors in the movement of water across the intestinal mucosa are diffusion

and osmotic filtration caused by osmotic or hydrostatic pressure differences across the

membrane Intestinal cells have a sodium pump (Na+K+ ATPase) on the basolateral cell

membrane that moves Na+ out of the cell into the basolateral intercellular space

Movement of K+ into the cell accompanies the Na+ movement The sodium pump

produces a concentration gradient that moves Na+ into the cell from the lumen This

movement of Na+ by the sodium pump also transports glucose amino acids and

oligopeptide into the intestinal epithelial cells

In the jejunum a small portion of sodium absorption is mediated by active transport but

most of jejunal sodium absorption occurs by bulk flow along osmotic gradients The

jejunum effectively absorbs bicarbonate against steep electrochemical gradients19

The human ileum absorbs Na+ Cl- against steep electrochemical gradients this

absorption is unaffected by water flow and is not stimulated by glucose galactose or

HCO 3 - Potassium is passively absorbed from the intestine according to its

electrochemical gradients

Calcium is absorbed particularly in the proximal small intestine (duodenum and

jejunum) by a process of active transport This ion is absorbed better from an acid than

from an alkaline environment which may explain the better absorption in the proximal

intestine Vitamin D and parathyroid hormone enhance calcium absorption

An important electrolyte absorbed by the small intestine is iron One of the important

functions of the small intestine is to regulate the body pool of iron

MOTILITY13 16

There are several types of visible small intestinal muscular activity The

segmenting contraction is a localized circumferential contraction of the circular muscle

over a length of about 1 cm of the small intestine Segmenting contractions divide the

luminal content within the area of contraction Their rhythmic segmenting activity occurs

in the proximal small intestine at about nine contractions per minute Segmenting

contractions occurring regularly and rhythmically in adjacent portions of the small

intestine divide and subdivide the intestinal content mixing it and exposing it to larger

areas of mucosa which facilitates digestion and absorption Peristalsis consists of

intestinal contractions passing aborally at a rate of 1 to 2 cm per second through several

centimeters of intestine Peristalsis is slower in the distal than in the proximal small

bowel The major function of peristalsis is the distal movement of intestinal chyme

The Migrating Myoelectrical Complex (MMC)

During the interdigestive period there are cyclically occurring contractions that

move aborally along the intestine every 75 to 90 minutes during fasting Most of these

fronts of activity begin in the stomach or duodenum last about 4frac12 minutes and pass

along the gut at about 68 cm per minute The MMC is thought to sweep or cleanse the

intestine during the interdigestive period Motilin may regulate the MMC 16 20

Regulation of Small Intestinal Motility

Myogenic Factors

Two types of electrical activity can be recorded from the small intestine Slow-

wave electrical activity begins in the longitudinal muscle layer of the duodenum and is

propagated distally This phenomenon called the basic electrical rhythm (BER) is

independent of the intrinsic neural plexuses and is unrelated to motor activity Intestinal

spike potential may occur spontaneously during depolarization or from stretching of the

bowel and it is associated with motor activity

Neurogenic Factors

Intrinsic neural regulation is initiated by stimulation of the mucosa particularly

by distention which causes contraction of longitudinal and circular muscle propelling

luminal content distally The intrinsic nerve supply regulates rather than initiates motor

action In general sympathetic activity inhibits motor function whereas parasympathetic

activity stimulates it Epinephrine inhibits small intestinal motor activity whereas

acetylcholine stimulates it Distention of the small intestine can inhibit small intestinal

motility by the intestinointestinal inhibitory reflex Distention of the ureter renal pelvis

or biliary system or peritoneal irritation may inhibit intestinal movements 13

Hormonal Factors

Gastrointestinal hormones may be important in regulating intestinal motility

Gastrin stimulates gastric and intestinal motility and relaxes the ileocecal sphincter

Cholecystokinin-pancreozymin (CCK-PZ) also stimulates intestinal motility and may

decrease intestinal transit time Secretin and chemically similar glucagon inhibit intestinal

motility

ENDOCRINE FUNCTION

The mucosa of the small intestine is an important source of peptide hormones

whose main function is to regulate the gastrointestinal tract21

Secretin

Secretin is released from duodenal mucosal S cells in response to intraluminal

H+ Secretin promotes digestion by stimulating copious secretion of water and

bicarbonate from the pancreas This action facilitates entry of pancreatic enzymes into the

intestinal lumen and provides a pH favoring digestion of fat Secretin is also a choleretic

and inhibits gastric acid secretion and gastrointestinal motility

CCK-PZ

Cholecystokinin and pancreozymin are the same substance and are released from

intestinal mucosal I cells CCK-PZ facilitates digestion and absorption by stimulating

emptying of the gallbladder as well as by increasing bile flow and relaxing the sphincter

of Oddi Another important action of CCK-PZ is stimulation of pancreatic enzyme

secretion

Other Gut Hormones

Enteroglucagon is released from the EG cells which occur predominantly in the

distal small intestine Enteroglucagon is released by carbohydrate and long-chain

fatty acid and inhibits intestinal motility

Gastric inhibitory polypeptide GIP is released from K cells predominantly in

the jejunum on stimulation by carbohydrate or fat The concentration of serum

GIP increases after meals and it is believed that its most significant action is to

stimulate insulin secretion

Motilin is released from the EC cells of the intestine predominantly the jejunum

Motilin inhibits gastric emptying in humans and may also alter the interdigestive

myoelectrical complex and cause changes in the lower esophageal sphincter

IMMUNOLOGIC FUNCTION OF THE INTESTINE

The intestine is a source of immunoglobulin particularly IgA22 It is believed that

this immunoglobulin arises from plasma cells in the lamina propria and after linkage

with a protein synthesized by epithelial cells it is secreted into the lumen Secretory IgA

contains antibody activities the exact roles of which are not yet known

SMALL BOWEL PERFORATION

CLASSIFICATION 123

The causes of perforation are broadly classified into

10487131048713Non-traumatic

10487131048713Inflammatory bowel disease

10487131048713Acute ndash Typhoid fever

Necrotizing entero colitis

10487131048713Chronic - Tuberculosis

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Oral contraceptive pill

o Embolism

o Aortic aneurysm

o Valvular heart disease

10487131048713Non occlusive

o Spasm

o Reflex due to systemic hypo perfusion

o Drugs digoxin vasopressin

o Congestive heart failure

o Arrhythmia

10487131048713Venous

10487131048713Intra-abdominal

o Portal stasis

o Pelvic and abdominal infections

o Tumor

o Volvulus

o Adhesions

10487131048713Secondary to blood dyscrasia

o Polycythemia

o Splenic anaemia

10487131048713Thrombo phlebitis migrans

10487131048713Oral contraceptive pill

10487131048713Neoplastic

10487131048713Leiomyosarcoma

10487131048713Adenocarcinoma

10487131048713Kaposi sarcoma

10487131048713Lymphoma

10487131048713Miscellaneous

10487131048713Meconium ileus

10487131048713Diverticular disease

10487131048713Foreign body

10487131048713Round worm

10487131048713Radiation enteritis

10487131048713Peptic ulcer in ZE syndrome

10487131048713Acute intestinal obstruction of any etiology

10487131048713Drugs steroids KCl

10487131048713Traumatic

10487131048713External violence due to blunt or penetrating abdominal injury

10487131048713Operative injury

Typhoid is the commonest cause of ileal perforation in tropics Analysis of 12 regional reports from

different parts of India between 1972 and 1989 reveals that the causes of small bowel perforation in

450 cases out of 513 (877) were Typhoid24

As evidence obtained from studies in university hospitals Ibaban Nigeria by JAS Dickson and

GJ Cole in 196425 the causes of perforation of terminal ileum has aroused a considerable speculation and

suggested causative agents include

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

Archampong26 from Ghana has reported that in Tropics perforation of Ileum is most frequently

encountered complication of Typhoid fever Other causes were

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Mackelrsquos Diverticulum

bull Intussusception

bull Crohnrsquos Disease

bull Malignancy

bull Non-specific ulceration

SK Nair9 from New Delhi in a series of 50 cases of non-traumatic perforation has reported that

Typhoid Tuberculosis Amoebiasis and Round worms were most common causes

TYPHOID

Typhoid Pathogenesis Typhoid Perforation is the foremost and most dreaded complication of typhoid

fever and is fairly common surgical emergency in the tropics and sub-tropics Amongst all the intestinal

perforation is the most serious complication of typhoid fever Typhoid fever is caused by Gram negative

bacillus Salmonella typhi and is contracted by ingestion of contaminated water or food The ingested

bacteria enter the blood stream via peyerrsquos patches multiply in RE system during next 14 days and then

spread hematogenously This phase is corresponding with onset of clinical symptoms Bacteria reach the

gut wall via blood stream or bile and concentrate in peyerrsquos patches of terminal ileum which swell There

is an associated mesenteric adenitis Ulceration of the payerrsquos patches in a cranio caudal access of bowel

occurs and complicated by hemorrhage or perforation which most frequently is on the anti-mesenteric

border of terminal ileum Perforation usually occurs 8 to 11 days after the onset of clinical symptom2

Intestinal lesions which are confined to the lymphoid tissue are most marked in the lower part of ilum but

may involve greater part of small intestine The Peyers patches and solitary follicles are crowded with

large mononuclear phagocytes so that the lymphoid masses project above the surface Edema associated

with hyperplasia leads to vascular obstructions necrosis and consequent death of the covering mucosa and

formation of an ulcer

The typhoid ulcers are ovoid or round in shape with irregular undermined edges The long axis of the ulcer

lie along the long axis of the bowel along which lies the peyerrsquos patches The ulcers are usually shallow

but the sub-mucosa is often perforated so

that the floor of the ulcer is formed by muscularis propria or the serosal layer If extensive may lead to

erosion of the blood vessels or perforation of the gut wall The ulcers usually heal by scaring without

causing intestinal obstruction as the scar do not encircle the intestine

Sudden acute abdominal pain followed by guarding and rigidity of the abdomen cessation of bowel

sounds loss of liver dullness vomiting gas under the diaphragm is typical of small bowel perforation

The patient with typhoid fever usually respond in a few days to treatment with chloramphenicol but the

condition of the intestine may not match the clinical improvement and perforation may occur after the

temperature has fallen and patient seems well on the way to recovery

The incidence of perforation varies from 05 ndash 39 of typhoid fever as reported various authors from

different countries

Age and Sex 25-34 There is a male predominance with second and third decades as a peak age group

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

Year M F Peak Age (Yrs)

Duration of illness prior to perforation25-34 Three weeks is the duration of illness prior to perforation

Table 3 Duration of illness

prior to Typhoid Perforation

Author

Year Duration (days)

Rowland 1961 5 ndash 16

Dickson and Cole 1964 1 ndash 30

Abdal Meneim 1969 8 ndash 30

Theodore P Welchi 1974 1 ndash 30

Prasad et al 1975 7 ndash 28

Gandhi 1975 4 ndash 9

JM Eustache 1983 7 ndash 14

ROHNrsquoS DISEASE

Incidence41

The disease is as common in men as in women and can strike persons of any age although the

peak age of onset is between the second and fourth decades of life The disease is more common among

whites than blacks or Asians A familial tendency is noted but the disease is not inherited in an autosomal

dominant pattern

Etiology42

No specific etiology of the disease has been identified

Microbiologists have long sought a specific micro-organism that might be the cause of the disease

Recent reports of the isolation of Mycobacterium paratuberculosis from segments of bowel affected with

Crohns disease excited interest but this organism as a specific etiology for the disease has yet to be

proved Also no virus has been identified as an etiologic agent

An immunologic origin of the disease has also been sought Some have postulated that a childhood

sensitization to milk impairs mucosal integrity and allows bacteria or bacteriologic products to enter the

body A cellular and humoral immune response to these products then ensues The ileocolic epithelium in

particular may be the target of a necrotizing immune response with ensuing ulceration tissue destruction

and the clinical appearance of the disease Although an immunologic response certainly plays a role in the

pathogenesis of the condition its role as an etiologic agent is still unclear

Smoking may exert a stimulating effect on the disease many patients with Crohns disease are heavy

smokers

Pathology

Location of Lesions

Crohns disease is a generalized inflammatory disorder of the alimentary tract that can involve any

area from the mouth to the anus The disease however is discontinuous and segmental The small

intestine and the large intestine are the most frequent sites of gross macroscopic involvement 55 of

patients had involvement of small and large intestine 30 of small intestine alone and 15 of large

intestine alone

Gross Pathologic Features

Aphthous Ulcers One of the earliest macroscopic signs of Crohns disease is the appearance of

aphthous ulcers in the mucosa of the gastrointestinal tract These small flat soft ulcers have a whitish

center and a red border They are scattered in the mucosa with normal areas of mucosa in between As the

disease progresses the aphthous ulcers deepen and coalesce penetrating through the entire mucosa and

forming longer ulcers that may reach 1 cm or larger The ulcers remain discontinuous and asymmetrical

They often appear first on the mesenteric border of the bowel and have a linear pattern along the wall of

the intestine Islands of normal mucosa can remain in between the ulcers to give the surface of the bowel a

cobblestone appearance As the ulcers grow and the inflammation spreads the lesions extend deep into the

wall of the bowel through the mucosa and muscularis out to the serosa to form transmural fissures and

thornlike defects The inflammatory response creates a thickening of the bowel wall and a narrowing of its

lumen the so-called rubber-hose intestine The inflammatory response on the serosa and adjacent

mesentery also thickens these structures and the fat of the

mesentery creeps around the side of the bowel to add to the thickening The intestinal lymphatic

vessels are engorged and the lymph nodes in the adjacent mesentery are enlarged

Crohns disease is characterized pathologically by

bull Sharply demarcated and transmural involvement of the bowel by an inflammatory process with

mucosal damage

bull Non caseating granuloma

bull Fissuring and Fistula

Microscopic Features

Focal Chronic Inflammation A chronic inflammatory infiltrate appears in the mucosa and submucosa and

extends transmurally through the bowel wall The areas of inflammation are focal and scattered in

between areas of uninvolved bowel Distortion of the normal architecture of the intestinal crypts

accompanies the inflammation

Granulomas A characteristic microscopic lesion of Crohns disease is the granuloma which appears in the

mucosa submucosa or elsewhere in the wall of the bowel or its adjacent lymph nodes in association with

the chronic inflammatory response

Diagnosis is based on the history physical findings and appropriate laboratory tests The physical

findings include the palpation of the thickened bowel wall or adjacent inflammatory response or abscesses

in the abdomen Hyperactive bowel tones are heard using auscultation and peristaltic rushes in the small

intestine may even be seen through

a thin abdominal wall Abdominal distention occurs On inspection the perianal skin appears bluish and

perianal fissures abscesses and fistulas can be identified

Colonoscopy delineates the extent of the lesions in the large intestine The hallmarks of Crohns disease

are the discontinuous and asymmetrical nature of the endoscopic findings Biopsies taken during

endoscopy show chronic inflammation and sometimes granulomas

Roentgenographic examination of the gastrointestinal tract using BaSO4 reveals the ulcerating

lesions scattered in a segmental irregular pattern along the wall of the involved intestine producing

irregular areas of ulceration luminal narrowing and thickened bowel wall Proximal dilatation of the

bowel accompanies obstructing lesions Long lengths of narrowed terminal ileum may reduce the caliber

of the lumen to the size of a string (the string sign) Areas of dilatation may alternate with areas of

constriction The cobblestone appearance of the mucosa may be apparent as may the rake ulcers Fissures

fistulas and perienteric abscesses may be found Computed axial tomography may help delineate

thickened bowel perienteric abscesses and perforations Free air in the abdomen is present with free

perforation

Perforation Acute perforation with a diffuse spreading peritonitis is rare and alarming manifestation of

regional enteritis

Treatment43

Simple suture is quite inappropriate and comes with high mortality Resection is necessary but primary

end-to-end anastomosis is restricted to only those patients who are

healthy without gross peritoneal soiling If this is present thorough peritoneal lavage debridement with

antibiotic lavage is given

Ileocoloecostomy with reestablishment of intestinal continuity at later date is considered

SMALL INTESTINE TRAUMA44

The incidence of small bowel injury secondary to blunt trauma ranges from 5 to 15 and

approaches 50 for all penetrating abdominal injuries

Injuries to the small intestine following blunt trauma may be due to three mechanisms (1) crush injury

between the vertebrae and the anterior abdominal wall (2) sudden increase in the intraluminal pressure

and (3) tears at the junction of a mobile and a fixed segment of bowel Motor vehicle accidents child

abuse bicycle accidents and assorted falls account for most of these injuries The sudden deceleration

causes the mobile portion of the bowel to move away from its point of fixation (ligament of Treitz

ileocecal junction sites of adhesions) causing a tangential tear Rarely adhesions involve a portion of the

bowel in such a manner that during sudden compression of the abdomen a closed-loop phenomenon is

created with a resultant blow-out of the area Occasionally direct trauma from a blow or seat belt may be

responsible for the damage that occurs at the point of impact The association of chance-type lumbar

fracture with intestinal injuries in children and adults wearing only a lap belt restraining device has now

been recognized with sufficient frequency as to require its exclusion

Clinical features

Most patients with a perforated small intestine exhibit some evidence of peritoneal irritation and

may have frank abdominal rigidity Lacerations of the lower small bowel may be particularly deceptive

however because surrounding loops may wall off the damaged area quickly and efficiently In such cases

the patient may appear surprisingly well for days demonstrating only mild localized tenderness Free air

may not

be visible radiographically and bowel sounds may persist Such patients may eat and have bowel

movements for a week or more before fever and other signs of intraperitoneal sepsis appear Occasionally

damage may occur to the mesentery without involving the bowel Minor tears are of little significance but

large hematomas may ultimately compress the adjacent mesenteric vessels and cause intestinal ischemia

with later perforation

Investigation

Diagnostic peritoneal lavage is 95 accurate in identifying small bowel injury Diagnostic errors

are generally due to small intestinal perforations with minimal bleeding that have developed delayed signs

of peritonitis CT scanning is less precise and requires both oral and intravenous contrast agents and

careful inspection for the presence of bowel wall thickening mesenteric hematoma or fluid of nonblood

density pooling in the pelvis The presence of any of these signs particularly when combined with

abdominal tenderness or absent bowel sounds warrants further emergency evaluation or surgical

exploration

During any laparotomy for possible intra-abdominal injuries the entire small bowel should be

meticulously examined Each tear as it is encountered should be clamped or quickly sutured to prevent

further leakage and contamination of the peritoneal cavity during the remainder of the exploration The

wounds of entrance and exit on the abdominal wall cannot be used to predict the likely site of a small

bowel injury because of the mobility of the small intestine and the variability of the patients position at

the time of injury

Treatment

Simple lacerations of the small bowel are sutured with a single layer of interrupted nonabsorbable

Lembert sutures after removal of any tissue that is even questionably nonviable Patients who have

multiple additional injuries shock dilated small bowel or a coagulopathy may benefit from a two-layer

closure to ensure hemostasis Care is taken to avoid excessive narrowing of the bowel by repair Where

damage to the bowel wall is extensive or where multiple tears are situated fairly close to one another

resection of the involved segment rather than repair of the individual perforations is preferred Removal of

the extensively damaged intestine is generally safer provided that a sufficient length of viable bowel

remains to permit adequate absorption of food

COMPLICATIONS

Complications of hollow viscous perforations are due to peritonitis

10487131048713Systemic

bull Bacteremia endotoxic shock

bull Broncho pneumonia respiratory failure

bull Renal failure

bull Marrow suppression

bull MOF

10487131048713Abdomen

bull Wound infection

bull Wound dehiscence

bull Incisional hernia

bull Obstruction

bull Paralytic ileus

bull ResidualRecurrent abscess

bull Portal pyemialiver abscess

INTRODUCTION

Small bowel perforation is commonly encountered in surgical practice The different modes of

presentation of cases may be misleading in the diagnosis of its origin It is necessary to know the current

surgical procedures for different perforations to manage such a case

An effort has been made here to know the different modes of

presentation diagnosis and management of perforation

Perforation of the small bowel especially duodenum amp terminal ileum is a common abdominal

emergency faced by the general surgeon Perforation of the small bowel from a wide variety of causes

comprises the majority of emergency surgical admissions

typhoid tuberculosis and parasitic infestation are endemic

The preeminent complication of typhoid is perforation seen in 3rd week The terminal ileum is the

main site of perforation

The perforated viscus challenges the surgeonrsquos skill as a technician and his knowledge of pre-

operative intra-operative and post-operative care of severely ill surgical patient

diagnostic delay

new technology

This study is undertaken to find out the age and sex incidence etiological factors clinical features and various

surgical procedures for gastro intestinal perforations its complications in our institute

PATHOPHYSIOLOGY

Small bowel perforations amp duodenal perforations presents as acute pain in abdomen There are

many etiological factors that can lead to perforations

The perforations are sequely of ulcers of gastrointestinal mucosa

Duodenal ulcers amp small bowel ulcers are caused by infective or traumatic means

The foremost etiological factor comes forward is ulcers due to Acid peptic disease Typhoid ulcers ulcers

due to intestinal tuberculosis amp Crohnrsquos disease

ACID PEPTIC DISEASE

Duodenal ulcers due to APD presents as an acute emergency Patients give history of dyspepsia

acidity burning sensation

Most occur in the first part of the duodenum A chronic ulcer penetrates the mucosa and into the

muscle coat leading to fibrosis The fibrosis causes deformities such as pyloric stenosis When an ulcer

heals a scar can be observed in the mucosa Sometimes there may be more than one duodenal ulcer

The situation in which there is both a posterior and an anterior duodenal ulcer is referred to as

lsquokissing ulcersrsquo Anteriorly placed ulcers tend to perforate and in contrast posterior duodenal ulcers tend

to bleed sometimes by eroding a large vessel such as the gastroduodenal artery

Occasionally the ulceration may be so extensive that the entire duodenal cap is ulcerated and

devoid of mucosa With respected to the giant duodenal ulcer malignancy in this region is so uncommon

that under normal circumstances surgeons can be confident that they are dealing with benign disease even

though from external palpation it may not appear so

Acid peptic disease is major reason in duodenal perforations

In contrast to this typhoid ulcers occurs in terminal part of ileum

TYPHOID

Intestinal lesions which are confined to the lymphoid tissue are most marked in the lower part of

ilum but may involve greater part of small intestine

The Peyers patches and solitary follicles are crowded with large mononuclear phagocytes so that

the lymphoid masses project above the surface Edema associated with hyperplasia leads to vascular

obstructions necrosis and consequent death of the covering mucosa and formation of an ulcer

The typhoid ulcers are ovoid or round in shape with irregular undermined edges

The long axis of the ulcer lie along the long axis of the bowel along which lies the peyerrsquos patches The

ulcers are usually shallow but the sub-mucosa is often perforated so that the floor of the ulcer is formed by

muscularis propria or the serosal layer

If extensive may lead to erosion of the blood vessels or perforation of the gut wall The ulcers

usually heal by scaring without causing intestinal obstruction as the scar do not

encircle the intestine

Like this there are many pathophysiological factors that can come across the study of Small bowel

perforations amp duodenal perforations

METHODOLOGY

This study carried out over a span of 3 years extending from July-Aug 2010 to Dec 2013 of 50 patients

admitted to Wanless Hospital with a diagnosis of Small Bowel perforation with peritonitis

Only patients who will undergo surgery will be included The data shall be collected by purposive

sampling with respect to their age and sex

A detailed clinical history will be obtained for all the patients with an emphasis on the presenting

complaints

A thorough physical examination will be done for all patients Vital signs will be recorded

Presence of Guarding Rigidity rebound tenderness liver dullness obliteration shall be looked for in all

patients

Absence or decreased bowel sounds will also recorded

The investigations which will be particularly asked for are white cells counts Blood routine

An Erect Abdomen X-ray will be done for all patients to particularly look for presence of gas under the

diaphragm

All patients will be operated upon after adequate resuscitation Patients will be subjected for per-

cutaneous intraperitoneal drainage when patients GC is not good for anaesthesia Patients will be

subjected for laparotomy with incisions depending on the probable site of perforation

The perforation shall be managed according to the protocol followed in our hospital

The surgical procedures undertaken will be recorded Patients will be followed up in the post operative

period to know the post operative complications morbidity and mortality rates

The data shall be analyzed to find the usefulness of clinical features and investigations for the diagnosis

Inclusion Criteria

Patients aged gt 20 years

Patients presenting with Small bowel perforation

Exclusion Criteria

Patients aged lt20years

Patients managed conservatively (non surgically)

CONCLUSION

bull A prospective study of 50 patients admitted to Wanless Hospital with a diagnosis of Small Bowel

perforation during the period of Augndash2010 to Julyndash2013 was included under the study

bull Only patients who underwent surgery were included The data was collected by purposive sampling

with respect to their age amp sex

bull Incidence is more in the economically productive age group 2nd ndash 4th decade

bull There was a MF ratio of 41

bull A detailed clinical history was taken for all these patients with an emphasis on the presenting

complaints A thorough physical examination was done for all patients vital signs were recorded

bull Pain abdomen was the presenting symptom in almost all cases under study followed by vomiting

(76) fever (46 ) and distension of abdomen (44) Constipation accounted for only 14 of

bull Presence of Guarding Rigidity rebound tenderness liver dullness obliteration was looked for in all

patients Absence or decreased bowel sounds were also recorded

bull Majority of cases had guarding and rigidity at presentation (84) rebound tenderness (84) absent

bowel sounds were in 72 cases distension of abdomen (66) obliteration of liver dullness

(42) and per rectal tenderness (12)

bull An Erect Abdomen X-ray was done for all patients to particularly look for presence of gas under

diaphragm Pneumoperitoneum was detected in 70 of cases

bull Patients were subjected for laparotomy with incisions depending on the probable site of perforation

Right Para median incision was employed in 92 of cases

bull The perforations were managed according to the protocol followed in our hospital The surgical

procedures undertaken were recorded

bull In our study the most common cause of Small bowel perforation was Ileal perforation

bull Resection and anastomosis in two layers was the commonly done procedure

bull Patients were followed up in the post operative period to know the post operative complications

morbidity and mortality rates

bull The most common complication in this series was wound infection which accounted for 17 cases

(34) Wound dehiscence was seen in 3 cases Renal failure and ARDS were also part of the

complication

bull Mortality rate in our study was 10 Delay in the surgery and septicemia were associated with high

mortality

SUMMARY

bull Males are affected 4 times more than females

bull Age groups between 20 and 40 are most commonly involved

bull Pain abdomen is the most common presenting symptom in Small bowel perforation followed by

vomiting fever abdominal distension and constipation

bull Erect abdomen X-ray and USG abdomen are very useful investigation for diagnosis in Small bowel

perforation

bull Resection and anastomosis was the most common procedure employed Primary closure of

perforation also is done for bowel perforations

bull Wound infection was the most common post operative complication

BIBLIOGRAPHY

1 Taylor BA Gastro intestinal emergencies Glimore Ian T Robert Shields Spontaneous perforation

of the gut1st edition WB Saunder company

1992359-79

2 Sleisenger and Fordtran Gastro intestinal and liver disease pathophysiology diagnosis and

management Hamer Davidson H Sherwood L Gorbach Infectious diarrhea and bacterial food

poisoning 7th edition WB Saunder company 20021882-851889-1901

3 William Schumer and Sheldono Burman The perforated viscus diagnosis and treatment in surgical

emergencies Nyhus Lloyd The surgical clinics of North America 197252(1) 231-38

4 Christopher J Bulstrode and RCG Russel Jermy Thompson The peritoneum omentum mesentry

and retroperitoneal space Bailey and Loversquos Short Practice of Surgery Page No 1133 ndash 1152

24th edition 2004

5 Thal Erwin R abdominal trauma The surgical clinics of North America 1990 70(3) 517-75

6 Singai Abdominal tuberculosis Indian journal of surgery 1964 26440-50

7 Bhansali SK Desai AN Abdominal tuberculosis Indian journal of surgery 1968 30218-19

8 Shukla and Das P clinical diagnosis of Abdominal tuberculosis British journal of surgery 1976

63941-46

9 Nair SK Singhal VS Sudhir Kumar Non-traumatic intestinal perforationIJS 1981 43(5)371-78

10 Beniwal Udai Singh Jindal Dinesh Sharma Jagdish Jain Sumita Shyam Ghan

Comparative study of operative procedures in typhoid perforation IJS

2003 65(2) 172-177

11 Hirsch J E Arhens E H Jr and Blankenhorn D H Measurement of the human intestinal

length in vivo and some causes of variation Gastroenterology 31274 1956

12 Gray H Anatomy of the Human Body 28th ed Goss C M (Ed) Philadelphia Lea amp Febiger

13 Code C F (Ed) American Physiological Society Handbook of Physiology Section 6

Alimentary Canal Baltimore Williams amp Wilkins 1967ndash1968

14 Bloom W and Fawcett D W A Textbook of Histology 9th ed Philadelphia W B Saunders

1968 p 560

15 Marsh M N and Swift J A A study of the small intestinal mucosa using the scanning electron

microscope Gut 10940 1969

16 Kutchai H The gastrointestinal system In Berne R M and Levy M N (Eds) Principles of

Physiology 3rd ed St Louis Mosby Year Book 1993 p 614

17 Hoffman A F A physicochemical approach to the intraluminal phase of absorption

Gastroenterology 5056 1966

18 Visscher M D Fetcher E S Jr Carr C W Gregore H P Bushey M S and Barker D E

Isotopic tracer studies on the movement of water and ions between intestinal lumen and blood

Am J Physiol 142550 1944

19 Turnberg L A Bieberdorf F A Morawski S G and Fordtran J S Interrelationships of

chloride bicarbonate sodium and hydrogen transport in human ileum J Clin Invest 49557

20 Scratcherd T and Grundy D The physiology of intestinal motility and secretion Br J

Anaesth 563 1984

21 Grossman M I Spectrum of biological actions of gastrointestinal hormones In Anderson S

(Ed) Nobel Symposium XVI Frontiers in Gastrointestinal Hormone Research Stockholm

Almqvist amp WiksellGebers Forlag 1973

22 Tomasi T B Jr Human immunoglobulin A N Engl J Med 2791327 1968

23 Ladha A Gastro intestinal perforations IJS 1988 50500-505

24 Mansonrsquos Tropical diseases Gordan Cook Alimuddin Jumla20th ednWBSaunderrsquos

publications849-873

25 Dickson JA Cole GJ Perforation of the terminal ileum A review of 38 cases Br J Surg 1964

51893-7

26 Archampong EQ Typhoid ileal perforation Why such mortalities British Journal of Surgery

1979 April 63(4) 317-21

27 Rowland HA The complication of Typhoid fever Journal of Tropical Medical Hygiene1961

June 64143-152

28 Chambers Clinet E perforation of ileum Archives of surgery1972 105550-552

29 Theodore P Welchi Nimith C Martin Surgical diagnosis of typhoid perforation The Lancet1975

11078-80

30 Gandhi GM Desai GB Srikantaiah RTanga MR typhoid entric perforation Quarterly journal of

surgical science1975 11137-142

31 Kim JP Oh SK Jarret F Management of ideal perforation due to typhoid fever Ann Surg 1975

18188-91

32 Eagleton FC Santoshi B Singh CM Typhoid perforation of bowel Annals of surgery1979

19031-35

33 Swadia ND Trivedi PM Thakkar AM Problem of enteric ileal perforation Indian J Surg 1979

41643-651

34 Jean Marie Eustache David J Kras Typhoid perforation of intestine Archives of surgery1983

Nov 1181269-71

35 Sepaha GC Khandekar JD Chabra MC Enteric perforation A study of 60 cases

Journal of Indian Medical Association1970 June 16 54(12) 558-61

36 Huckstep RL Recent advances in the surgery of typhoid fever Ann Roy Coll Surg Engl

196026207-10

36 Bhansali SK Gastrointestinal perforation a clinical study of 96 cases J Postgrad Med 1967 131

37 Bhansali SK Abdominal tuberculosis American journal of gastro enterology1977 67324-37

38 Kapoor VK Acute tubercular abdomen IJS 1991 53(3) 71-75

39 Joshi MJ Surgical management of intestinal tuberculosis- A conservative approach IJS 1978

40(3) 78-83

40 Bhansali SK The challenge of abdominal tuberculosis in 310 cases IJS 1978Feb 65-77

41 Hellers G Crohns disease in Stockholm County 1955ndash1974 A study of epidemiology results of

surgical treatment and long-term prognosis Acta Chir Scand (Suppl) 4901 1979

42 Mekhjian H S Switz D M Melnyk C S Rankin G B and Brooks R K Clinical features

and natural history of Crohns disease Gastroenterology 77898 1979

43 Andrews H A Keighley M R Alexander-Williams J and Allan R N Strategy for

management of distal ileal Crohns disease Br J Surg 78679 1991

44 R Scott Jones Courtney M Townsend Jr Trauma Sabiston Textbook of surgery 17th ed Vol1

Pg 819-820 Saunders 2004

BIBLIOGRAPHY

1 Gray H Anatomy of the Human Body 28th ed

2 Journal of Indian Medical Association

3 Harrisonrsquos internal medicine 17rsquoth edition

4 Baileyrsquos amp loversquos Short practice of surgery 24rsquoth edition

5 Schwartzs Principles of Surgery - 9th Edition

6 Management of IV FLUIDS in surgery ndash Dr Pandya

7 Sabiston Textbook of Surgery 18th Edition

8 Ganongs Review of Medical Physiology 23rd Edition

PROFORMA

Topic Surgical management of duodenal amp small bowel

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Time of onset Mode of onset

Character Degree ndash Mild mod severe

Radiation according to site of pain

Aggravating Relieving factors

Food ndash increase decrease

Movement ndash increase decrease

Vomiting - Yes No

Time of onset

Frequency

Contents

Projectile non projectile

relation to pain ndash incre decre

Distension of abdomen Yes No

Time of onset

Relation to pain ndash incre decre

Bowels

Last evacuated

Constipation Diarrhoea

Fever- Yes No

Duration- Degree Chills Rigors

HO Drug Intake-

Past History

HO ndash Haemetamesis Malena TB Previous

treatment Surgery Hypertension Diabetes Asthma

Family history

Personal history Smoking alcoholism

Food habits Regular irregular

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Systemic Examination

Per Abdominal Examination

Inspection

Umbilicus

Scars of pre surgery

Hernial orifices

Palpation

Tenderness ndash site

Guarding rigidity ndash Yes No

Rebound tenderness ndash Yes No

Organomegaly ndash Yes No Mass

Percussion note over abdomen

Obliteration of liver dullness Yes No

Shifting dullness Yes No

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

PROVISIONAL DIAGNOSIS

INVESTIGATIONS

Haemogram -

Blood sample for cross matching

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

HIV (spot) HBsAg Hepatitis C-

Radiological investigations

1 X-rayndashabdomen erect ndash

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

4 Other ndash CT scan

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Type of procedure definitive surgery

Drain ndashput not put

Closure ndashsingle layered Layered closure

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

Rylersquos tube aspiration-

Oral feeds started on

RT removed on

Drain removal

Suture removal

Complications

General ndash

Pulmonary renal toxemia thrombosis others

Treatment of complications

Conditions on discharge -

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

Mucosa amp musculature of jejunum

mucosa amp musculature of ileum

CONTENTS


AIMS amp OBJECTIVES

Typhoid is the commonest cause of ileal perforation in tropics Analysis of 12 regional reports from different parts of India between 1972 and 1989 reveals that the causes of small bowel perforation in 450 cases out of 513 (877) were Typhoid24

Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

NAME - DR ABHIJIT ANIL WHATKAR

SUBJECT - DNB GENERAL SURGERY

DURATION 3 YEARS

1st JULY-AUG 2010 TO 31st JULY2010

REGISTRATION NO

INSTITUTE WANLESS HOSPITAL MIRAJ

TOPIC STUDY OF SURGICAL MANAGEMANT OF DUODENAL amp SMALL BOWEL

PERFORATION

NAME OF GUIDE Dr TBMORE

MSGENERAL SURGERY

Dr TBMORE

DNB GUIDE

GENERAL SURGERY

WANLESS HOSPITAL

Perf - Perforation

TB - Tuberculosis

ABSTRACT

BACKGROUND

decided

OBSERVATIONS

perforation

CONCLUSIONS

CONTENTS

1 Introduction

4 Anatomy

5 Physiology

6 Pathophysiology

8 Discussion

9 Summary

10 Conclusions

11 Performa

12 Bibliography

13 Master chart

14 Abbreviations

INTRODUCTION

perforation 2

diagnostic delay

new technology

AIMS amp OBJECTIVES

tuberculosis 6

GROSS ANATOMY

by the colon 12

Mesentery

blood supply

Blood Supply

Lymphatics

Mucosa

Innervation

MICROSCOPIC ANATOMY

Mucosa

digestive function

Cells of the Crypts

endocrine function

Epithelial Renewal

Submucosa

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Dr TBMORE

DNB GUIDE

GENERAL SURGERY

WANLESS HOSPITAL

Perf - Perforation

TB - Tuberculosis

ABSTRACT

BACKGROUND

decided

OBSERVATIONS

perforation

CONCLUSIONS

CONTENTS

1 Introduction

4 Anatomy

5 Physiology

6 Pathophysiology

8 Discussion

9 Summary

10 Conclusions

11 Performa

12 Bibliography

13 Master chart

14 Abbreviations

INTRODUCTION

perforation 2

diagnostic delay

new technology

AIMS amp OBJECTIVES

tuberculosis 6

GROSS ANATOMY

by the colon 12

Mesentery

blood supply

Blood Supply

Lymphatics

Mucosa

Innervation

MICROSCOPIC ANATOMY

Mucosa

digestive function

Cells of the Crypts

endocrine function

Epithelial Renewal

Submucosa

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Perf - Perforation

TB - Tuberculosis

ABSTRACT

BACKGROUND

decided

OBSERVATIONS

perforation

CONCLUSIONS

CONTENTS

1 Introduction

4 Anatomy

5 Physiology

6 Pathophysiology

8 Discussion

9 Summary

10 Conclusions

11 Performa

12 Bibliography

13 Master chart

14 Abbreviations

INTRODUCTION

perforation 2

diagnostic delay

new technology

AIMS amp OBJECTIVES

tuberculosis 6

GROSS ANATOMY

by the colon 12

Mesentery

blood supply

Blood Supply

Lymphatics

Mucosa

Innervation

MICROSCOPIC ANATOMY

Mucosa

digestive function

Cells of the Crypts

endocrine function

Epithelial Renewal

Submucosa

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

TB - Tuberculosis

ABSTRACT

BACKGROUND

decided

OBSERVATIONS

perforation

CONCLUSIONS

CONTENTS

1 Introduction

4 Anatomy

5 Physiology

6 Pathophysiology

8 Discussion

9 Summary

10 Conclusions

11 Performa

12 Bibliography

13 Master chart

14 Abbreviations

INTRODUCTION

perforation 2

diagnostic delay

new technology

AIMS amp OBJECTIVES

tuberculosis 6

GROSS ANATOMY

by the colon 12

Mesentery

blood supply

Blood Supply

Lymphatics

Mucosa

Innervation

MICROSCOPIC ANATOMY

Mucosa

digestive function

Cells of the Crypts

endocrine function

Epithelial Renewal

Submucosa

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

ABSTRACT

BACKGROUND

decided

OBSERVATIONS

perforation

CONCLUSIONS

CONTENTS

1 Introduction

4 Anatomy

5 Physiology

6 Pathophysiology

8 Discussion

9 Summary

10 Conclusions

11 Performa

12 Bibliography

13 Master chart

14 Abbreviations

INTRODUCTION

perforation 2

diagnostic delay

new technology

AIMS amp OBJECTIVES

tuberculosis 6

GROSS ANATOMY

by the colon 12

Mesentery

blood supply

Blood Supply

Lymphatics

Mucosa

Innervation

MICROSCOPIC ANATOMY

Mucosa

digestive function

Cells of the Crypts

endocrine function

Epithelial Renewal

Submucosa

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

CONCLUSIONS

CONTENTS

1 Introduction

4 Anatomy

5 Physiology

6 Pathophysiology

8 Discussion

9 Summary

10 Conclusions

11 Performa

12 Bibliography

13 Master chart

14 Abbreviations

INTRODUCTION

perforation 2

diagnostic delay

new technology

AIMS amp OBJECTIVES

tuberculosis 6

GROSS ANATOMY

by the colon 12

Mesentery

blood supply

Blood Supply

Lymphatics

Mucosa

Innervation

MICROSCOPIC ANATOMY

Mucosa

digestive function

Cells of the Crypts

endocrine function

Epithelial Renewal

Submucosa

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

CONTENTS

1 Introduction

4 Anatomy

5 Physiology

6 Pathophysiology

8 Discussion

9 Summary

10 Conclusions

11 Performa

12 Bibliography

13 Master chart

14 Abbreviations

INTRODUCTION

perforation 2

diagnostic delay

new technology

AIMS amp OBJECTIVES

tuberculosis 6

GROSS ANATOMY

by the colon 12

Mesentery

blood supply

Blood Supply

Lymphatics

Mucosa

Innervation

MICROSCOPIC ANATOMY

Mucosa

digestive function

Cells of the Crypts

endocrine function

Epithelial Renewal

Submucosa

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

INTRODUCTION

perforation 2

diagnostic delay

new technology

AIMS amp OBJECTIVES

tuberculosis 6

GROSS ANATOMY

by the colon 12

Mesentery

blood supply

Blood Supply

Lymphatics

Mucosa

Innervation

MICROSCOPIC ANATOMY

Mucosa

digestive function

Cells of the Crypts

endocrine function

Epithelial Renewal

Submucosa

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

tuberculosis 6

GROSS ANATOMY

by the colon 12

Mesentery

blood supply

Blood Supply

Lymphatics

Mucosa

Innervation

MICROSCOPIC ANATOMY

Mucosa

digestive function

Cells of the Crypts

endocrine function

Epithelial Renewal

Submucosa

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

GROSS ANATOMY

by the colon 12

Mesentery

blood supply

Blood Supply

Lymphatics

Mucosa

Innervation

MICROSCOPIC ANATOMY

Mucosa

digestive function

Cells of the Crypts

endocrine function

Epithelial Renewal

Submucosa

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

GROSS ANATOMY

by the colon 12

Mesentery

blood supply

Blood Supply

Lymphatics

Mucosa

Innervation

MICROSCOPIC ANATOMY

Mucosa

digestive function

Cells of the Crypts

endocrine function

Epithelial Renewal

Submucosa

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Mesentery

blood supply

Blood Supply

Lymphatics

Mucosa

Innervation

MICROSCOPIC ANATOMY

Mucosa

digestive function

Cells of the Crypts

endocrine function

Epithelial Renewal

Submucosa

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Blood Supply

Lymphatics

Mucosa

Innervation

MICROSCOPIC ANATOMY

Mucosa

digestive function

Cells of the Crypts

endocrine function

Epithelial Renewal

Submucosa

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Mucosa

Innervation

MICROSCOPIC ANATOMY

Mucosa

digestive function

Cells of the Crypts

endocrine function

Epithelial Renewal

Submucosa

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

MICROSCOPIC ANATOMY

Mucosa

digestive function

Cells of the Crypts

endocrine function

Epithelial Renewal

Submucosa

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

digestive function

Cells of the Crypts

endocrine function

Epithelial Renewal

Submucosa

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

endocrine function

Epithelial Renewal

Submucosa

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

PHYSIOLOGY

Carbohydrate

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Protein

absorbed

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

of bile salts

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

MOTILITY13 16

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Myogenic Factors

Neurogenic Factors

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Hormonal Factors

motility

ENDOCRINE FUNCTION

Secretin

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

CCK-PZ

secretion

Other Gut Hormones

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

CLASSIFICATION 123

Crohns disease

10487131048713Vascular

10487131048713Arterial

10487131048713Occlusive

o Thrombosis

o Atherosclerosis

o Embolism

o Aortic aneurysm

o Spasm

o Arrhythmia

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

10487131048713Venous

o Portal stasis

o Tumor

o Volvulus

o Adhesions

o Polycythemia

o Splenic anaemia

10487131048713Lymphoma

10487131048713Round worm

10487131048713Traumatic

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

bull Typhoid

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Tuberculosis

bull Trauma

bull Ascariasis

bull Amoebiasis

bull Malignancy

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

TYPHOID

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

different countries

Table2 Age and

Sex Incidence of

Typhoid

Perforations

Author

ROHNrsquoS DISEASE

Incidence41

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

dominant pattern

Etiology42

smokers

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Pathology

Location of Lesions

intestine alone

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

mucosal damage

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

perforation

regional enteritis

Treatment43

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Clinical features

may not

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Investigation

exploration

the time of injury

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Treatment

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

COMPLICATIONS

10487131048713Systemic

bull Renal failure

bull MOF

10487131048713Abdomen

bull Obstruction

INTRODUCTION

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

diagnostic delay

new technology

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

PATHOPHYSIOLOGY

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

ACID PEPTIC DISEASE

TYPHOID

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

METHODOLOGY

complaints

patients

diaphragm

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Inclusion Criteria

Exclusion Criteria

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

CONCLUSION

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

complication

mortality

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

SUMMARY

perforation

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

BIBLIOGRAPHY

1992359-79

24th edition 2004

63941-46

2003 65(2) 172-177

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

1968 p 560

Anaesth 563 1984

publications849-873

51893-7

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

1979 April 63(4) 317-21

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

June 64143-152

11078-80

18188-91

19031-35

41643-651

Nov 1181269-71

196026207-10

40(3) 78-83

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

BIBLIOGRAPHY

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

PROFORMA

Perforation

Case No

Name Hospital No

Age Sex

Address

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

DOA DOO

History

Chief Complaints

Pain - Yes No

Vomiting - Yes No

Time of onset

Frequency

Contents

Time of onset

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Bowels

Last evacuated

Fever- Yes No

HO Drug Intake-

Past History

Family history

General Examination

Consciousness

Built Nourishment

Hydration

Pulse min

BP mm of Hg

Pallor

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Inspection

Umbilicus

Hernial orifices

Palpation

Auscultation

Bowel sounds ndash

Frequency

Character

Per rectal

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Per vaginal

Other systems

INVESTIGATIONS

Haemogram -

Urine-

Biochemistry-

S Electrolytes

Urea S creat

BSL (R) -

Serology -

Air under diaphragm

Air fluid level

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Other findings

3 Ultrasonography-

Pre-op treatment

Antibiotics

Gastric aspiration

Others

Operative details

Anaesthesia-

Incision

Laparotomy findings

Post-op Management

Antibiotics

H2 blockers PPI

Blood transfusions

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

RT removed on

Drain removal

Suture removal

Complications

General ndash

Follow up

1rsquost-

2rsquond-

3rsquord-

4rsquoth-

CONTENTS


AIMS amp OBJECTIVES


Incidence41

Etiology42



METHODOLOGY

BIBLIOGRAPHY


PROFORMA


Bowel sounds ndash

Documents

Thesis in Making