Surgical emergencies are an important component of hospital admissions globally and continue to be a large contributor to preventable morbidity and mortality, especially in low and middle-income countries (LMICs).[1] These can present in a variety of acute presentations such as acute abdomen, intestinal obstruction and perforated viscus, appendicitis, traumatic injury, soft tissue infection and vascular emergency, all of which require prompt diagnosis and immediate treatment.[2] Poor recognition or management may lead to poor clinical outcomes, extended hospital stay, increased healthcare expenses and mortality rates.[3] Tertiary care hospitals, particularly in low-resource areas, are often overwhelmed with more severe and late presentations of surgical emergencies.[4]

Emergency surgical conditions constitute a significant proportion of surgical workload around the world, and certain studies have reported that acute surgical conditions were responsible for almost 30-50% of all general surgical admissions in many tertiary care centers.[5] Globally, almost 4.4 million individuals die each year from trauma alone, and a large percentage are registered as road traffic accidents, falls and interpersonal violence, many of which must be managed surgically immediately.[6] Acute abdominal emergencies like appendicitis, bowel obstruction and bowel perforation continue to be the most frequently presented indications for emergency laparotomy.[7] Limited access to healthcare, socioeconomic barriers, and low awareness pose a further challenge in countries such as Pakistan, where often the disease reaches an advanced stage by the time it is received in hospital.[8]

The spectrum of pathological patterns in surgical emergencies is wide and depends on the demographic, comorbidities, epidemiology of infection, nutritional condition, and seeking medical attention.[9] It is crucial for understanding such patterns to ensure the accuracy of diagnosis, to prepare the surgeon, and to better support emergency care.[5] Many tertiary care centers, however, still do not have detailed local data on the clinical profile and underlying pathological diagnosis of patients coming with surgical emergencies.[10]

Hence, the study was undertaken to study the clinical profile and pathological patterns of the surgical emergencies presented in a tertiary care hospital by conducting a retrospective study. The objective of this study is to determine the common emergency surgical conditions, their demographic and clinical characteristics and to create an awareness of trends that might help in early suspicion, better triage and optimization of the use of resources to provide emergency surgical care..

The study was a hospital-based retrospective cross-sectional study design for the assessment of clinical profile and pathological pattern of surgical emergencies presented to a tertiary care hospital. This study was carried out in the Department of General Surgery. The study was conducted over a period of six months, from July 2025 to December 2025.

The OpenEpi (Version 3.01) was used to calculate the sample size using the single population proportion formula. The expected proportion of 61% surgical emergencies was reported in a previous study.[11] The sample size required for a given level of precision and a 95% confidence interval, with an 8% margin of error, was determined to be 143 patients.

A non-probability consecutive sampling technique was used. The study included patients of all genders and age groups, who were brought in with acute surgical conditions that required urgent or emergent surgical intervention to the emergency department. All patients with complete and retrievable medical records available in the hospital database who were admitted to the Department of General Surgery during the study period were included.

Patients were excluded from the study if they had incomplete or missing medical records. Patients who were not surgically diagnosed but treated conservatively were also excluded. Patients who were referred to other health care facilities before definitive diagnosis or management were also excluded from the final analysis, as were patients with non-surgical medical emergencies.

Data were collected from the medical record system of the tertiary care hospital, Department of General Surgery, in the past. All the pertinent sources of information, such as the registers for admission to emergency, patient case files, operation theatre records, radiology records, and histopathology records, were examined in detail. A proforma with a predefined, standard structure was used to guarantee uniformity and completion of data extraction.

Demographic data (age, gender, place of residence), clinical presentation (chief complaints, number of days since onset of symptoms), nature of surgical emergency, provisional clinical diagnosis, radiological findings, intra-operative findings, and final pathological diagnosis (if applicable) were included in the proforma. Other factors for which data were collected included comorbid illnesses, the delay between symptoms and presentation at the hospital and the type of surgical procedure carried out. The principal investigator collected data, supervised by a senior consultant surgeon, to prevent observer bias and to achieve accuracy. Patients were given an identifying number for each one and no names or hospital numbers were included in the final data to ensure confidentiality and security of the data.

The data collected were entered, coded and analyzed using IBM Statistical Package for Social Sciences (SPSS) version 24. Data cleaning was done to detect and fix errors, missing values, and inconsistencies before analysis. The data were summarized using descriptive statistics. Quantitative variables like age were presented as mean ± SD and medians and IQR were computed where applicable for skewed variables. Categorical variables such as gender, type of surgical emergencies, clinical presentation and pathological patterns were described as frequencies and percentages. A cross-sectional analysis of surgical emergencies was carried out among the various age groups and genders to look for patterns and trends. The Chi-square test (χ² test) was used to evaluate associations between categorical variables (age group, gender, comorbid conditions, type of emergency, and pathological diagnosis). Fisher's exact test was applied to replace the chi-square test in situations where the expected cell frequency was less than five to guarantee valid statistics. A p-value of ≤ 0.05 was considered statistically significant.

A total of 143 patients who came with surgical emergencies constituted the study population. The mean age distribution revealed that most of the patients were of age 21 and 40, followed by those between 41 and 60 years, and the fewest were below the age of 20. Overall, a higher proportion of patients were male (60.1%) compared to females (39.9%). The majority of patients were rural residents (55.2%), suggesting a higher proportion of late and/or complicated presentation in rural communities (Table 1).

Abdominal pain was the commonest clinical manifestation, followed by vomiting and abdominal distention. Fever was also seen in a significant number of patients, and less frequently in patients presenting with trauma-related injuries and gastrointestinal bleeding. A small proportion of patients had atypical or miscellaneous presentations, indicative of the diversity of emergency surgical presentations (Table 2).

Acute appendicitis was found to be the most common surgical emergency in the disease spectrum, followed by intestinal obstruction and perforated viscus. Acute cholecystitis, soft tissue infections, and vascular emergencies were the other significant conditions; the latter was the least common. This distribution is useful to highlight the predominance of acute inflammatory and obstructive conditions in the emergency surgical admissions (Table 3).

The clinical diagnosis was confirmed by findings in the operation, namely, an inflamed appendix was the most common finding during the operation. Other common conditions included gangrenous bowel, perforations, and adhesive intestinal obstruction. Fewer patients developed abscess or ischemic changes of the bowel, and a few patients had normal or nonspecific findings on exploration (Table 4).

Pathological examination revealed inflammatory patterns to be the most common patterns, followed by infective patterns. A moderate number of ischemic changes were present in cases, and a relatively lower number of cases were of traumatic and neoplastic changes. A few cases were categorized as other miscellaneous pathological cases, which reflects the diversity of surgical emergencies (Table 5).

Outcome analysis of patients showed majority of the patients got successfully discharged after treatment, while some were admitted to the intensive care unit because of the severity of the disease. Some of these had been referred to higher-level facilities for specialist care, and there was a relatively low death rate in this group. The overall outcomes were favorable for recovery in most of the patients who underwent emergency surgery, where timely intervention was provided (Table 6).

Association analysis revealed that there were no significant differences between the distributions of major surgical emergencies by gender, but there did appear to be some differences between the various diagnostic categories. There was a statistically significant association with age-specific patterns; however, younger patients had more appendicitis and middle-aged patients had mixed patterns of obstruction and appendicitis, while older patients had more perforation and ischemic conditions (Tables 7 and 8).

Table 1: Frequency of Socio-Demographic Characteristics of Patients (n = 143)

Table 2: Frequency of Clinical Presentation of Surgical Emergencies

Table 3: Frequency of Types of Surgical Emergencies

Table 4: Frequency of Intraoperative Findings

Table 5: Frequency of Pathological Patterns

Table 6: Frequency of Patient Outcomes

Table 7: Association between Diagnosis and Gender

Table 8: Association between Age Group and Type of Emergency

The present study aimed to study the clinical profile and pathological patterns of surgical emergencies in a tertiary care hospital and we found that the majority of our patients were young adults, mostly male with the most common complaint being abdominal pain. Acute appendicitis was the most common surgical emergency, followed by intestinal obstruction and perforated viscus; inflammatory and infective were the most common pathological patterns. The results are similar to those of a number of recent regional and international studies.

A male predominance (60.1%) was found in the present study. In the case of gastrointestinal perforation, Belbase et al. (2022) reported a male-to-female ratio of 1.56:1 in a tertiary care hospital in Nepal, indicating a higher exposure of males to risk factors like delayed presentation and occupational factors of acute surgical conditions.[12] A large retrospective audit of secondary peritonitis in Pakistan showed the gender distribution was similar, with 77% of patients being male, further supporting the presence of comparable male dominance in emergency surgical admissions in South Asian populations.[13]

The present study demonstrated that the most common age group affected was 21–40 years. This is consistent with the results of a tertiary care study from Pakistan, which found that most acute abdomen cases were in the young adult population, especially those in their third and fourth decades of life.[14] Likewise, Belbase et al. (2022) reported a mean age of 46.5 years, which showed that gastrointestinal surgical emergencies are common during the economically productive age groups.[12]

The most common presenting symptom was abdominal pain, which occurred in 21.1% of the patients, followed by vomiting (18.9%), and abdominal distention (18.9%). This is compatible with the observations of various studies conducted in the area of acute abdomen, as in more than 90% of cases, there is abdominal pain as the main clinical symptom in the initial clinical suspicion of surgical emergencies.[15]

Acute appendicitis was found to be most prevalent surgical emergency in our study in terms of the distribution of disease. This result is consistent with the outcome of a large retrospective study performed in Turkey that showed, likewise, appendicitis to be the most common emergency surgical disease in adults, followed by cholecystitis and pancreatitis.[16] Likewise, another cohort study of appendicular perforation showed that appendicitis is still the most frequent general surgical emergency in the world and is the leading cause of acute abdomen that requires surgical intervention.[17] These uniform results support the problem of appendicitis as a major emergency surgical disease in the world.

The second and third most common emergencies in the present study were intestinal obstruction and perforated viscus, respectively. Similar observations have been made in a study from Nepal, which found that perforation and obstruction were a major proportion of laparotomies performed on patients who attend for emergency surgery, especially when they present late and/or have underlying infectious or peptic disease.[12] There were a large number of factors associated with the delay in presenting and limited access to early surgical care, which could be a possible explanation for the increased complications in similar resource-limited settings.

The present study also showed that the younger age group presented with appendicitis as the main diagnosis, whereas the older age group presented with perforation and ischemic pathology as the main diagnosis. This age-related variation has been shown in a cohort study of children and adults with appendicitis, who also demonstrated increased complication rates and perforation risk in the extremes of age, owing to the delay in diagnosis and atypical presentation.[18] In general, our findings revealed that there was a very low mortality rate with a high percentage of patients being discharged post-treatment. Favorable results have been seen in large cohorts of appendicitis; early surgery and better perioperative management have led to a mortality rate and complication rate of less than 5% in most tertiary care centres.[19]

To conclude, the results of the present study align with the national and international literature, thus supporting the fact that surgical emergencies are mainly in young males, with the most prevalent diagnosis being appendicitis. Access to care, delay in presentation and socioeconomic factors are important factors in shaping the spectrum of disease. The results indicated the importance of early diagnosis, the need for better emergency surgical infrastructure, and the need to raise public awareness to decrease the morbidity caused by delayed presentation.

Limitations

There were a number of limitations that should be taken into consideration when interpreting the results of this study. This was a single-center, retrospective study, and the findings may be subject to information bias due to the retrospective nature of the study. The findings might not be representative of the general population because patients who attend other healthcare facilities may have a different clinical profile due to different referral patterns. Furthermore, certain variables like time to presentation, pre-hospital treatment and long-term outcomes were difficult to evaluate completely, as there was a lack of or incomplete documentation. Nevertheless, the study offers significant insight into the actual spectrum of surgical emergencies in the real world in a tertiary care center.

The study shows that surgical emergencies are a substantial and varied problem in tertiary care and the commonest surgical emergencies were due to acute appendicitis, intestinal obstruction and perforated viscus, most of whom were young male patients. The underlying patterns were mainly inflammatory and infective pathologies and showed the significance of early diagnosis and timely surgical intervention. The results indicate an ongoing trend of delayed presentation, especially among patients from rural areas, which underscores the importance of increasing public awareness, enhancing emergency surgical services, and optimizing referral processes. Timely and good surgical care in a well-equipped tertiary care hospital was associated with good outcomes in most of the patients, highlighting the importance of structured emergency surgical care in minimizing morbidity and mortality.

1. Abbas, A., et al., Routine pediatric surgical emergencies: incidence, morbidity, and mortality during the 1st 8000 days of life—a narrative review. World Journal of Surgery, 2023. 47(12): p. 3419-3428.
2. Courtney, M., et al., Critical Care and Emergency Surgery, in Higher FRCS. 2023, CRC Press. p. 36-61.
3. Hirani, R., et al., Strategies to reduce hospital length of stay: evidence and challenges. Medicina, 2025. 61(5): p. 922.
4. Alsabri, M., et al., Bridging the gap: Lessons from low-resource pediatric emergency medicine for high-resource settings. Current emergency and hospital medicine reports, 2025. 13(1): p. 10.
5. Moparthi, K.P., et al., Acute care surgery: navigating recent developments, protocols, and challenges in the comprehensive management of surgical emergencies. Cureus, 2024. 16(1).
6. Miclau, T., et al., Trauma systems: a global comparison. OTA International, 2025. 8(3S): p. e376.
7. Alattar, Z. and N. Keric, Evaluation of abdominal emergencies. Surgical Clinics, 2023. 103(6): p. 1043-1059.
8. Aziz, Z., H. Naseer, and A. Altaf, Challenges in access to new therapeutic agents: marginalized patients with cancer in Pakistan and the need for new guidelines. JCO global oncology, 2022. 8: p. e2100132.
9. Li, D., Emergency surgical conditions in geriatric patients: current research landscape. International Journal of Emergency Medicine, 2025. 18(1): p. 269.
10. Shinde, V., et al., Clinical and epidemiological profile of patients presenting with acute abdomen to the emergency department of a tertiary care hospital. Cureus, 2024. 16(8): p. e67017.
11. Raheel, M., et al., Identifying the Patterns: Prevalence and Management of Trauma and Surgical Emergencies in a Tertiary Care Hospital in Peshawar. Cureus, 2025. 17(6).
12. Belbase, N.P., et al., Spectrum of Gastrointestinal Perforations in a Tertiary Care Hospital of Central Nepal: An Analytical cross-sectional study. Journal of Society of Surgeons of Nepal, 2022. 25(2): p. 58-62.
13. Memon, A.A., et al., An audit of secondary peritonitis at a tertiary care university hospital of Sindh, Pakistan. World journal of emergency surgery, 2012. 7(1): p. 6.
14. Saif, N., et al., Causes Of Acute Abdomen Diagnosed Through Gray-Scale Ultrasonography in Adults at A Tertiary Care Hospital, Lahore: Gray-Scale Ultrasonography in the Diagnosis of Acute Abdomen. Pakistan Journal of Health Sciences, 2025: p. 26-31.
15. Ali, M.Z. and V.K. Maddu, Comparative analysis of clinical, radiological and operative findings in acute abdomen. Int Surg J, 2019. 6(3): p. 806-11.
16. Hamamci, E.O., et al., Can the Modified Systemic Inflammation Score Predict Complicated Appendicitis? Age (years), 2023. 39(16.28): p. 35.07-13.7.
17. Potey, K., et al., Study of outcomes of perforated appendicitis in adults: a prospective cohort study. Annals of medicine and surgery, 2023. 85(4): p. 694-700.
18. Castro, P., et al., Presurgical time and associated factors as predictors of acute perforated appendicitis: a prospective cohort study in a teaching pediatric hospital in Colombia. BMC pediatrics, 2022. 22(1): p. 49.
19. Strohäker, J.K., et al., Intraoperative bacterial cultures fail to reliably predict the bacterial spectrum encountered during infectious complications after appendicitis. Updates in Surgery, 2024. 76(1): p. 147-154.