Abstract
Introduction: Acute peritonitis by perforation is the most common type and almost 80% cases results from necrosis of digestive conduit, such as typhoid fever, duodenal ulcer perforation, tubercular perforation and mesenteric ischemia secondary to the intestinal obstruction. So it is very important to seek urgent evaluation and treatment that can prevent fatal complications. This prospective study was conducted at tertiary care center to know the range of perforation in terms of etiology, presentation ,site of perforation, treatment options, postoperative complications and mortality so that we can improve its outcome in this region.
Methods: This was a prospective study conducted by the department of general surgery from September 2017 to March 2018. 39 consecutive patients of perforation peritonitis admitted to surgical emergency were included in this study. All patients were resuscitated and underwent emergency exploratory laparotomy. On laparotomy, cause of perforation was identified and managed accordingly.
Results: The mean age of patients was 34.9 years (range 15-75 years).The majority of patients were male (76%). Perforated duodenal ulcer due to acid-peptic disease and small bowel perforation due to typhoid were the most common cause of perforation peritonitis. Tubercular perforation was second most common cause of small bowel perforation. Post- operative complications included wound infection (31%), anastomotic leak (8%),burst abdomen (13%) ,Pneumonia( 25%),septicemia (8%),Acute renal failure (6%) and abdominal collection in (9%) .
Conclusion: Peritonitis due to perforation is still a terrible and alarming condition encounter to general surgeon in emergency. Early arrival of patients to hospital and adequate Resuscitation before surgery improves outcome of disease. Avoidance of extensive emergency surgery contributes to low mortality.
Keywords: Perforation peritonitis, Exploratory laparotomy, outcome.
References
- Wittmann DH, Walker AP, Condon RE. Peritonitis, intra-abdominal infection, and intra-abdominal abscess. In Schwartz SI, Shires GT, Spencer FC, editors. Principles of surgery.6th New York:McGraw-Hill;1994.p.1449-84.
- Wittmann DH, Shein M, Condon RE, etal. Management of secondary peritonitis .Ann Surg 1996;224(1):10-7.
- Shein M .Saadia R. Peritonitis: contamination and infection, principles of treatment. In: Schein M, Rogers P, editors. Schein’s common sense emergency abdominal surgery.2nd NewYork: Springer; 2005.p.95-101.
- Wittmann DH. Intra-abdominal infections: pathophysiology and treatment. NewYork: Marcel Dekker Publisher; 1991.p.8-75.
- Adesunkanmi AK, Badmus TA, Fadiora FO, Agbakwuru EA (2005) Generalized peritonitis secondary to typhoid ileal perforation: Assessment of severity using modified APACHE II score. Indian J Surg 67:29–33
- Adesunkanmi ARK, Badmus TA, Ogundoyin OO (2003) Causes and determinants of outcome of intestinal perforations in a semiurban African community. Surg Pract 7(4):116–123
- Agarwall N, Saha S, Srivastava A, Chumber S, Dhar A, Garg S(2007) Peritonitis 10 years experience in a single surgical unit. Trop Gastroenterol 28(3):117–120
- Malangoni MA, Inui T (2006) Peritonitis the western experience. World J Emerg Surg 1:25
- Gupta S, Kaushik R (2006) Peritonitis—the Eastern experience. World J Emerg Surg 1:13
- Noon GP, Beall AC, Jorden GL: clinical evaluation of peritoneal irrigation with antibiotic solution. Surgery 1967,67:73.
- Siu WT, Leong HT, Law BK, Chau CH, Li AC, Fung KH, Tai YP,Li MK (2002) Laproscopic repair for perforated peptic ulcer. Arandomized controlled trial. Ann Surg 235(3):313–319
- Jhobta RS, Attri AK, Kaushik R, Sharma R, Jhobta A (2006)Spectrum of perforation peritonitis in India—review of 504 consecutive cases. World J Emerg Surg 1:26
- Veliyev NA, Merrell RC (2004) Differe-ntiated approach to surgical treatment of patients with perforatred duodenal ulcer. Chirurgia(Bucur) 99(2):119–123
- Koninger J, Bottinger P, Redeeke J, Butters M (2004) LaproscopicRepair of perforated gastroduodenal ulcer by running suture. Langenbecks Arch Surg 389(1):11–16
- Ohene-Yeboah M, Togbe B (2006) Perforated gastric and duodenalulcers in an urban African population. West Afr J Med 25(3):205–211
- Erdman Seward: Hyper plastic tuberculosis of the intestine. Ann Surg 1920, 71(5):637-644.
- Collado C, Stirnemann J, Ganne N, Trinchet JC, Cruaud P, BarratC, Benichou J, Lhote F, Malbec D, Martin A, Prevot S, Fain O(2005) Gastrointestinal tuberculosis: 17 cases collected in 4 hospitals in the northeastern suburb of Paris. Gastroenterol Clin Boil 9(4):419–424
- Ramachandran CS, Agarwal S, Dip DG, Arora V (2004) Laproscopic surgical management of perforative peritonitis in entericfever: a preliminary study. SurgLaproscEndoscPercutanTech14(3):122–124
- Oheneh-yeboah M (2007) Postoperative complications after surgery for typhoid illeal perforation in adults in Kumasi. West AfrJMed 26(1):32–36
- Ozman MM, Zulfikaroglu B, Kece C, Aslar AK, Ozalp N, Koc M(2002)Factors influencing mortality in spontaneous gastric tumor perforations. J Inter Med Res 30(2):180–184
- Capoor MR, Nair D, Chintamani MS, Khanna A, Bhatnagar D(2008) Role of Enteric fever in ileal perforation. Indian J MedMicrobiol 26:54–57
- Shinkawa H, Yasuhara H, Naka S, Yanagie H, Nojiri T, FuruyaY,Arikiand K, Niwa H (2003) Factors afecting the early mortality ofpatients with non traumatic colorectal perforation. Surg Today33:13–17.
Corresponding Author
Dr Prem Prakash
Associate Professor, Department of General Surgery
Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna
Mob. No. +91- 8544413217, Fax No. 0612-2297225, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i4.77
