Analysing prognostic factors among patients with perforative peritonitis

Background: The mortality of perforation peritonitis is highly dependent on early approach to the hospital, quick diagnosis and prompt surgical treatment as it correlates with the duration and degree of peritoneal contamination, the patient's age, the general health of the patient and the nature of the underlying aetiology. The present study was done to assess the role of various prognostic factors which have a bearing on the final outcome of the patients.Methods: This prospective observational cross-sectional study was conducted in the at a tertiary level hospital in Maharashtra, in which 47 patients who presented a surgical emergency of perforation peritonitis and underwent an exploratory laparotomy were included. We compared different variables between patients who survived and those who died. Results: High mortality was also found in patients who presented after 24 hours of developing symptoms. Ileal perforation was significantly more common among dead patients (50%) as compared to patients who survived (20%), p-value<0.05. There were significantly higher proportion of patients who had shock on day 1 who died (67%) as compared to those who survived (12%), p-value<0.05. Also, the group of patients who died, had significantly higher MPI (p-value<0.01), higher proportion of patients with multiple perforations (p-value<0.05), larger perforations (p-value<0.01) and contamination more than 1000 ml (p-value<0.05). Conclusions: High mortality was observed in patients who presented late, had ileal perforations, multiple and large perforation and developed shock on day one.

Aetiological Pattern of Gastrointestinal Perforations: A Prospective Observational Study

Introduction: Peritonitis secondary to gastrointestinal perforation is one of the commonest surgical emergencies encountered all over the world. This study was done to highlight the spectrum of perforation peritonitis encountered in surgery unit of Dhaka Medical College Hospital. Method: It was observational prospective of 100 cases of perforation peritonitis treated in our hospital. All cases of perforative peritonitis whether spontaneous, infective or neoplastic pathology were included in this study. Results: The maximum numbers of patients were in age group between 31 to 40 years (39 %) with mean age 35 years. Male female ratio was 9:1. The most common aetiology of perforation peritonitis was peptic ulcer disease (73%) followed by enteric fever (12%), appendicitis (10%), tuberculosis (3%) and malignancy (2%). The most common sites of perforation were in descending order of frequency - first part of the duodenum (65%), terminal ileum (12%), appendix (10%), gastric antrum (9%), jejunum (3%) and rectum (1%). Abdominal pain (100%) and vomiting (81%) were the most common symptoms while tachycardia (96%), muscle guard and rigidity (100%) were the common signs. Approximately 15-20% presented late with features of shock. Mortality rate was 2% and was significantly high in patients coming hospital late. Conclusion: Gastrointestinal perforations are one of the most common surgical emergencies. Duodenal perforations are most common. Ileal perforations secondary to enteric fever have highest morbidity. Early recognition and timely appropriate intervention is very important in reducing morbidity and mortality. J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 106-109

Tubular Ileal Duplication Causing Perforative Peritonitis in an Adult: A Rare Presentation

Background Enteric duplication cysts are a rare congenital abnormality that present more commonly in children than adults. Clinical presentation varies from vague abdominal pain, abdominal lump, iron deficiency anemia to intestinal obstruction due to intussusception or mass effect. We report a tubular ileal duplication in an adult male presenting with an acute abdomen due to perforative peritonitis. Case A 20-year-old male presented to the emergency department with complains of right lower abdominal pain. On clinical examination and ultrasound scan patient was suspected to have a complicated acute appendicitis (rupture). However, a computed tomography scan was suggestive of perforation in the distal ileum. Emergency exploratory laparotomy revealed a perforated isolated ileal tubular duplication.

A CLINICAL STUDY AND OUTCOME OF PERFORATIVE PERITONITIS IN A RURAL BASED TEACHING HOSPITAL

Background Peritonitis due to perforation of gastro intestinal tract one of the commonest surgical emergencies all over the world and the most common surgical emergency in India. Aims and objectives to evaluate role of clinical assessment and usefulness of basic investigations in diagnosis and follow-up, to evaluate incidence of wound infection, wound dehiscence in post-operative period, to assess mortality upto1 month of post-operative period. Methods All consenting patients above 18 years treated with symptoms and signs of perforative peritonitis in Burdwan Medical College and Hospital from March 2018 to August 2019 were included in this institution based, interventional, prospective, non-randomised, analytical study. Results We found that 40(80.0%) patients had gas under diaphragm in Chest X-ray report. It was found that 9(18.0%) patients had acute appendicitis, 1(2.0%) patient had appendicular perforation and 40(80.0%) patients had perforative peritonitis. We found that 30(60.0%) patients had chest infection. 10(20.0%) patients had wound infection.6 (12.0%) patients had wound dehiscence. Conclusion Early recognition of symptoms and referral is very important in reducing mortality and morbidity.

An observational study on peritoneal fluid bacteriology in cases of gastrointestinal perforations, antibiotic management and outcome in tertiary care center

Background: Perforative peritonitis is one of the most common surgical emergencies in India. Perforation of the intestines results in the potential for bacterial contamination resulting in peritonitis.Methods: A total of 65 patients (January 2018 to Dec 2018) who presented with features of perforative peritonitis admitted to various surgical units of PES institute of medical sciences, Kuppam were included in this study. The following study was conducted to analyze bacteriology of peritoneal fluid, to assess antibiotic sensitivity pattern, to assess its impact on morbidity, mortality pattern in these cases.Results: Males outnumbered females with a ratio of 4.9:1. The most common site of perforation was pre-pyloric part of stomach (35.3%), followed by an appendix (33.8%). Peritoneal fluid was negative for culture (21.5%) in the majority of cases. Culture was positive for E. coli in 27.6% of cases and Klebsiella in 18.4% of cases, respectively. Majority of the isolated strains were sensitive to cephalosporins, quinolones, aminoglycosides. Most common postoperative complications were wound infection, respiratory complications, death.Conclusions: Studies have shown that delay in management and treatment will affect the prognosis. Empiric antimicrobial therapy is initiated and changed accordingly with peritoneal fluid culture sensitivity reports. This may reduce the incidence of postoperative complications, morbidity, and mortality.