Kannan Ross1, Ramalakshmi Venkatraman2, Chinni Vikram A3, Kadhirvel S4

Malignancies in the setting of acute general surgical emergencies are rare to present. The commonly presenting malignancies to the general surgeon in emergency conditions are perforation, obstruction, haemorrhage or urinary retention. Though their incidence when compared to benign conditions presenting with same clinical presentations are rare, they should never be neglected. The general surgeon must be aware of such presentations and hereby decide the management and follow up according to the malignancy he encounters on the operation theatre. The management should aim at radical procedures and regular follow up if needed with chemotherapy or radiotherapy and also should be well informed of the morbidity and mortality following intervention considering the malignancy grade, age of patient, duration of presentation and co-morbid conditions.
In this study, we consider all patients taken up in emergency operative procedures, study their findings on operation theatre, correlate with their biopsy report for any malignancy and follow up during their immediate postop up to <30 days and also late post beyond the procedure and bring about the incidence, common modes of presentation, malignancies encountered, age and sex distribution and the perioperative morbidity and mortality rates of the those malignancies.

The incidence of malignancies presenting as acute abdominal emergencies in this study was found to be around 8.27%. The number of males who presented with such malignancies outnumbered females in a significant manner in the ratio 1.6:1. Among the malignancies, gastric (25%) and colonic malignancies (59.38%) were the most common. Perforation was the only presentation as acute emergency in carcinoma stomach. Incidence of malignancy in gastric perforation was 57.14% when compared to that reported by Emer Ergul et al that about 10-16% of all gastric perforations are caused by gastric carcinoma.11
Perioperative mortality in gastric malignancy perforation was 50%, well within range of 0-82% reported in various studies.5 Obstruction was the most common presentation in colonic malignancies (95%) and perforation was the only other mode of presentation (5%). Mortality rate in colonic malignancies presenting acutely was found to be 21.05%. Out of 10 patients who died in the perioperative period one had history of pulmonary TB, one had only DM, one had CAD alone, whereas six patients had both DM with CAD. Among all the co-morbid factors, the presence of cardiac disease appears to affect survival to the maximum.
The conclusion from this study is that every patient is a textbook and that it is impossible to rule out malignancy in any patient presenting in emergency merely by his/her age and that the general surgeon be aware and deal with the malignancy accordingly.