Abstract
Perforative Peritonitis still remains a disease with higher mortality and morbidity rates in rural population of India. The aim of this study was to evaluate the efficacy of Mannheim Prognostic Index in predicting the clinical outcomes in patients with Perforative Peritonitis.
Material and Methods:Prospective cohort study carried out over a period of 2 years on patients presenting with Perforative peritonitis. MPI score was calculated on admission for all patients and they were followed up till discharge or death and results were analysed.
Results:A total of 100 patients were analysed with a mortality rate of 17%. MPI score ≥30 was significantly associated with Mortality, while a score of 21-29 was associated with 15.20% mortality. Age ≥ 50 yrs, female sex, organ failure, duration of symptoms ≥ 24 hrs pre operatively, origin of sepsis from colorectal perforations, fecal and purulent nature of peritonitis were found to be independent risk factors for statistically significant risk of post operative complications.
Conclusion:MPI is a valid and reliable predictor for pos operative mortality and morbidity in patients with perforative peritonitis.
Keywords- MPI- Mannheim Peritonitis Index, MOFS- Multi Organ Dysfunction Syndrome, APACHE- Acute Physiology And Chronic Health Evaluation.
References
1. P.S. Barie, L.J. Hydo, E. Fisher, Development of multiple organ dysfunction syndrome in critically ill patients with perforated viscous. Predictive value of APACHE severity scoring, Arch. Surg. 131 (1996) 37-43.
2. J.M. Bohnen, R.A. Mustard, S.E. Oxholm, B.D. Schouten, APACHE II score and abdominal sepsis. A prospective study, Arch. Surg. 123 (1988) 225-229.
3. Tushar Dani, Prof. L. Ramachandra, Rajesh Nair, Digvijoy Sharma. Evaluation of Prognosis in patients’ with perforation peritonitis using Mannheim’s Peritonitis Index. International Journal of Scientific and Research Publications, Volume 5, Issue 5, May 2015.
4. Ersumo T, W/Meskel Y, Kotisso B. Perforated peptic ulcer in Tikur Anbessa Hospital; a review of 74 cases. Ethiop Med J 2005;43:913.
5. Billing A, Fröhlich D, Schildberg FW. Prediction of outcome using the Mannheim peritonitis index in 2003 patients. Br J Surg 1994;81:20913.
6. Linder MM, Wacha H. The Mannheim peritonitis index. An instrument for the intra operative prognosis of peritonitis. Chirurg,1987, Feb ; 58 (2) 84-92.
7. S.V. Kulkarni, A.S. Naik, N. Subramanian, APACHE-II scoring system in perforative peritonitis, Am. J. Surg. 94 (2007) 549-552.
8. F. Pacelli, G.B. Doglietto, S. Alfieri, E. Piccioni, A. Sgadari, D. Gui, F. Crucitti, Prognosis in intra-abdominal infections. Multivariate analysis on 604 patients, Arch. Surg. 131 (1996) 641-645.
9. K. Bosscha, K. Reijnders, P.F. Hulstaert, A. Algra, C. van der Werken, Prognostic scoring systems to predict outcome in peritonitis and intra-abdominal sepsis, Br. J. Surg. 84 (1997) 1532-1534.
10. S. Biondo, E. Ramos, D. Fraccalvieri, E. Kreisler, J.M. Ragu_e, E. Jaurrieta, Comparative study of left colonic peritonitis severity score and Mannheim peritonitis index, Br. J. Surg. 93 (2006) 616-622.
11. K.K. Tan, S.L. Bang, R. Sim, Surgery for small bowel perforation in an Asian population: predictors of morbidity and mortality, J. Gastrointest. Surg. 14 (2010) 493-499.
12. H. Sawayama, S. Tomiyasu, K. Kanemitsu, T. Matsumoto, H. Tanaka, H. Baba, Colonic perforation due to colorectal cancer: predicting postoperative organ failure with a preoperative scoring system and selecting the optimal surgical method based on the prognosis, Surg. Today 42 (2012) 1082-1087.
13. J.T. Mäkelä, H. Kiviniemi, S. Laitinen, Prognostic factors of perforated sigmoid diverticulitis in the elderly, Dig. Surg. 22 (2005) 100-106.
DOI: http://dx.doi.org/10.18535/jmscr/v4i2.04
