Sughra Parveen Qureshi, Professor, Abdul Malik Magsi, Dr, Mariam Malik, Dr, Mazhar Iqbal, Dr, Mohammad Iqbal Khan, Dr, Imran Khan, Dr, Sarwar Qureshi, Dr. Jinnah postgraduate Medical Center
Abstract: Introduction: To observe surgical emergency of Duodenal perforation with atypical presentation in already diagnosed cases of Chikungunya disease.
Methodology: This was an observational study that was conducted in the tertiary care setup of Jinnah Postgraduate Medical center. The study duration was from November, 2016 till August, 2017 and consecutive convenient sampling technique was employed. Patients diagnosed with Chikungunya presenting with symptoms of peritonitis were included in the study. Patient’s demographics, physical findings, intraoperative findings and post-operative complications were recorded. The data was entered in SPSS version 18.
Results: Included in this study were thirty (30) patients with the mean age of 45.37 ± 9.25 SD, being more common in males. Mean Duration of disease in days = 14.38 ± 4.168 SD and Mean Duration of Peritonitis = 1.683 ± 0.77 SD. With a history of Chikungunya virus of average 2 weeks, diagnosed with serum Chikungunya IgM antibodies. The unusual presentation of slit like perforation with a mean length of 1cm was observed. All the cases were repaired with Graham’s Omentopexy. Postoperatively the only complication noted was surgical site infection in 8 (eight) patients which was treated with antibiotics suggested by culture and sensitivity report and local wound care. One patient died due to sepsis at presentation.
Conclusion: Chikungunya virus was found circulating in rodents in Pakistan as early as 1983. Duodenal ulcer perforation which is a common surgical emergency in our part of the world usually presents with pinpoint perforation in ant wall of first part of duodenum unlike in already diagnosed cases of Chikungunya Disease where a slit like duodenal perforation is noted in the anterior wall of first part of duodenum. Literature and consensus relate this perforation with the excessive use of Nsaids due to usual presentation of arthritis in Chikungunya disease but the unusual presentation is still to be answered.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87697
Program Number: P190
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster