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A CLINICAL STUDY OF

DUODENAL ULCER PERFORATION

DISSERTATION SUBMITTED TO
Dr. N.T.R. UNIVERSITY OF HEALTH SCIENCES,
VIJAYAWADA, A.P.

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE AWARD OF THE DEGREE OF
MASTER OF SURGERY
IN
GENERAL SURGERY
APRIL 2010

By
Dr. K. RAGHU

DEPARTMENT OF SURGERY

KAKATIYA MEDICAL COLLEGE
WARANGAL – A.P.
2010

Raghu. DEPARTMENT OF SURGERY KAKATIYA MEDICAL COLLEGE WARANGAL CERTIFICATE This is to certify that this Dissertation entitled “ A Clinical Study of Duodenal Ulcer Perforation” submitted in partial fulfillment of the requirement for the award of the degree of Master of Surgery in General Surgery of N. Professor and Head of the Department of Surgery Kakatiya Medical College Warangal. K. Dr. Andhra Pradesh is a bonafide dissertation work carried out by Dr.R. M..P. University of Health Sciences. Date : Place : Warangal .S. Satyadev M. A.T.

P.S. Kakatiya Medical College.R University of Health sciences. K. Warangal. A. Andhra Pradesh is a bonafide dissertation work carried out by Dr. Dr. Warangal. K. Professor of surgery.T. Date : Place : Warangal . Ramakrishna M. DEPARTMENT OF SURGERY KAKATIYA MEDICAL COLLEGE WARANGAL CERTIFICATE This is to certify that this Dissertation entitled “A Clinical study of Duodenal Ulcer Perforation” submitted in partial fulfillment of the requirements for the award of Degree of Master of Surgery in General Surgery of N. Raghu under my guidance and supervision in the surgical wards of Mahatma Gandhi Memorial Hospital.

Dr. Ramakrishna.. K.S. T. M. Retired Professor of surgery.M. M. Dr. M. S. I express my regard and thankfulness to Dr. Laxman Murthy. Shabnam.. M. B. K.S. Ashok Reddy.S. R. Venkanna.S. Professors of sugary and all my teachers who helped me and encouraged me in carrying out this work . Karunaker Reddy M. for their help and co-operation. Krishna Kishore. K. .. I am highly indebted to him for his excellent guidance.S.S.G. Suresh Climant. Dr.S. Kakatiya Medical College.D. Finally I am Grateful to all my patients who have co-operated with me for this study. M.S. Dr. I wish to thank my senior colleagues Dr. Professor of surgery.I owe my sincere thanks to them for their timely suggestions and guidance. Asst.. M.S .. H. Professor of surgery. constant encouragement. Nageshwar Rao. Dr. Dr.S. Professor of surgery for initiating me to undertake this topic for my dissertation. M. I extend my thanks to superintendent of M. S. I express my deep regard and thankfulness to Dr. for permitting me to utilize the statistical data and case records of this hospital for my study. Hospital Warangal. M. Dr. Ward Theatre boys for their co-operation and helpfulness in my study.S. Dr.Satyadev. M. Madhu. M. staff nurses. meticulous care and constructive criticism in shaping this dissertation throughout the period of study.S. NachGiri. Associate Professors of surgery who have been constant source of inspiration and encouragement in carrying out this work. Shanthi Kumar. Warangal for their whole hearted encouragement and valuable guidance for the preparation of this dissertation. M. Praveen Kumar... ACKNOWLEDGMENT I wish to express my deep regard and thankfulness to Dr. Record section staff.. S.Ramesh. Special thanks to Anaesthetists. M. I sincerely convey my gratitude and respect to my teacher and guide Dr. G. M.Professor of surgery. Ramchander. and Dr. and my junior colleagues Dr. Professor and Head of the Department of surgery and Dr. and without whose help this work could not have been completed..S.

PATHOLOGY 20 7. GASTRIC PHYSIOLOGY IN RELATION TO 9 PEPTIC ULCER 4. PHOTOGRAPHS 82 . MANAGEMENT 35 9. PART-I 1. PROGNOSIS 45 PART – II 1. Dr.Raghu CONTENTS Page No. SURGICAL ANATOMY OF STOMACH 3 AND DUODENUM 3. CASE SHEETS 46 2. CLINICAL ASPECTS OF DUODENAL ULCER 28 PERFORATION 8. INCIDENCE 14 5. HISTORY AND INTRODUCTION 1 2. ETIOLOGY 16 6.K.

CONCLUSIONS 99 4. DISCUSSION 90 3. ANALYSIS OF DATA 86 2. BIBILOGRAPHY 102 PART – I .PART –III 1.

PART – II .

PART – III .