Study of Causes and Management of Gastrointestinal Perforation in East Bihar: A Prospective Observational Study

Abstract

Background: Gastrointestinal (GI) perforation is one of the most common surgical emergencies worldwide and remains associated with considerable morbidity and mortality despite advances in perioperative care. The etiological spectrum varies geographically owing to differences in socioeconomic conditions, infectious diseases, dietary habits, and healthcare accessibility. In Eastern India, peptic ulcer disease, enteric fever, intestinal tuberculosis, and appendicular pathology continue to be major causes of gastrointestinal perforation. Early diagnosis, prompt resuscitation, appropriate antimicrobial therapy, and timely surgical intervention are essential for improving patient outcomes. Understanding regional disease patterns is important for optimizing management strategies and reducing postoperative complications.
Objective: To evaluate the causes, clinical presentation, surgical management, postoperative complications, and short-term outcomes of gastrointestinal perforation among patients presenting to a tertiary care teaching hospital in East Bihar.
Methodology: A prospective observational study was conducted in the Department of General Surgery, Jawaharlal Nehru Medical College and Hospital (JLNMCH), Bhagalpur, Bihar, between January 2024 and January 2026. One hundred consecutive adult patients with intraoperatively confirmed gastrointestinal perforation who underwent emergency surgery were enrolled. Demographic characteristics, etiological factors, clinical presentation, laboratory investigations, operative findings, surgical procedures, postoperative complications, duration of hospital stay, and mortality were recorded using a structured case record form. Statistical analysis was performed using IBM SPSS Statistics Version 26.0. Continuous variables were expressed as mean ± standard deviation, whereas categorical variables were presented as frequencies and percentages. Student’s t-test, Chi-square test, Fisher’s exact test, one-way ANOVA, and multivariable logistic regression were applied where appropriate. A two-sided p-value <0.05 was considered statistically significant.
Results: Among the 100 enrolled patients, the mean age was 44.8 ± 15.6 years, and 77% were males. The highest proportion of patients belonged to the 41–50-year age group (28%). Peptic ulcer disease (32%) was the leading etiology, followed by typhoid perforation (17%) and appendicular perforation (14%). Traumatic gastrointestinal perforation accounted for 5% of cases. Duodenal perforation (29%) was the most common anatomical site, followed by ileal perforation (27%). Graham’s omental patch repair (33%) was the most frequently performed surgical procedure. Postoperative complications occurred in 59% of patients, with surgical site infection (27%) being the most common complication. The overall in-hospital mortality rate was 10%. Multivariable logistic regression identified shock at presentation (Adjusted OR 6.31; 95% CI 2.08–19.14; p=0.001), delay in surgery >24 hours (Adjusted OR 4.82; 95% CI 1.71–13.61; p=0.003), serum albumin <3 g/dL (Adjusted OR 3.92; 95% CI 1.31–11.73; p=0.015), and age >60 years (Adjusted OR 2.87; 95% CI 1.05–7.81; p=0.039) as independent predictors of mortality.
Conclusion: Peptic ulcer disease remains the leading cause of gastrointestinal perforation in East Bihar, with duodenal perforation being the most common anatomical site. Delayed presentation, septic shock, hypoalbuminemia, and advanced age significantly increase postoperative mortality. Early diagnosis, aggressive resuscitation, timely surgical intervention, and meticulous postoperative care remain essential for improving clinical outcomes.