Abstract
Introduction
Peritonitis caused by hollow viscous perforation continues to be one of the most challenging conditions confronted by a surgeon. It is one of the frequently encountered surgical emergencies in tropical countries like India and most of the times it affects young males in the productive phase of their life1,2,3,4.
Peritonitis following perforation of the gastrointestinal tract remains an important problem in the field of abdominal surgery. The clinical symptoms of peritonitis vary depending largely on the site of perforation as the contents and / or bacterial flora are not uniform throughout the gastrointestinal tract and thus the therapy for peritonitis should always been based on such facts. By now it has been established that the spectrum of etiology of perforation in Indian subcontinent differs from its western counterpart2. Majority of the patients present late, with purulent peritonitis and septicemia5. Surgical treatment of perforation peritonitis is highly demanding and very complex, combination of improved surgical technique, anti microbial therapy and intensive care support has improved the outcome of such cases6.
Although, a number of advancements have been made in surgical techniques, antimicrobial therapy and intensive care support yet management of peritonitis continues to be highly demanding, difficult and complex. Consecutively, the prognosis of patients with perforation peritonitis and intra-abdominal infections is generally poor7. Perforation peritonitis might be responsible for multi organ failure, thus increasing the severity of morbidity and mortality8.
Interestingly, there has been seen to be differences in the location of perforation in different geographical regions across the world. In eastern countries such as India and Pakistan, the proximal part of the gastrointestinal tract (GIT) is affected more commonly2 whereas in western population distal gut perforation is more common. Overall, duodenum is the most common site of perforation9.
References
- Dorairajan LN, Gupta S, Deo SV, Chumber S, Sharma LK. Perotinitis in India: A decade experience. Tropical Gastroenterol. 1995;16:33–8.
- Sharma L, Gupta S, Soin AS, Sikora S, Kapoor V. Genaralised peritonitis in India - tropical spectrum. Jpn J Surg. 1991;21:272–7.
- Jhobta RS, Attri AK, Kaushik R, Sharma R, Jhobta A. Spectrum of perforation peritonitis in India: A review of 504 consecutive cases. World J Emerg Surg. 2006;1:26.
- Gupta S, Kaushik R. Peritonitis: The eastern experience. World J Emerg Surg. 2006;1:13.
- Ersumo T, W/MESKEL y, Kotisso B: Perforated peptic ulcer in Tikur Anbessa Hospital; a review of 74 cases. Ethiop Med J 2005, 43(1):9-13.
- Bosscha K, van Vroonhoven TJ, Werken C van der: Surgical management of severe secondary peritonitis. Br J Surg 1999, 86(11):1371-7.
- Rangaswamy P, Rubby SA, Prasanna CM. Clinical study of perforative peritonitis and the role of mannheim peritonitis index in predicting its mortality. Int Surg J. 2016 Nov;3(4):2016-2021.
- Bohnen J, Boulenger M, Mackin JL. Prognosis in generalized peritonitis, relation to cause and risk factors. Arch Surg. 1983;118:285-90.
- Melangoni MA, Inui T. Peritonitis: The western experience. World J Emerg Surg. 2006;1:25.
- Sharma S, Singh S, Makkar N, Kumar A, Sandhu MS. Assessment of Severity of Peritonitis Using Mannheim Peritonitis Index. Nigerian Journal of Surgery : Official Publication of the Nigerian Surgical Research Society. 2016;22(2):118-122.
- Irvin TT. Mortality and perforated peptic ulcer: a case for risk stratification in elderly patients. Br J Surg. 1989;76:215–18.
- Moller MH, Engebjerg MC, Adamsen S, Bendix J, Thomsen RW. The Peptic Ulcer Perforation (PULP) score: a predictor of mortality following peptic ulcer perforation. A cohort study. Acta anaesthesiologica Scandinavica. 2012;56(5):655–62.
- Moller MH, Adamsen S, Thomsen RW, Moller AM. Preoperative prognostic factors for mortality in peptic ulcer perforation – a systematic review. Scand J Gastroenterol. 2010;45:785–805.
- Moller MH, Shah K, Bendix J, Jensen AG, Zimmermann-Nielsen E, Adamsen S, Moller AM. Risk factors in patients surgically treated for peptic ulcer perforation. Scand J Gastroenterol. 2009;44:145–52.
- Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Critical Care Medicine. 1981:9.
- Boey J, Choi SKY, Alagaratnam TT, Poon A. Risk stratification in perforated duodenal ulcers. Ann Surg. 1987;205:22–6.
- Bion J. Outcome in Intensive care. BMJ. 1993;307:953-54.
- Linder MM, Wacha H, Feldmann U, Wesch G, Streifensand RA, Gundlach E. [The Mannheim peritonitis index. An instrument for the intraoperative prognosis of peritonitis] Chirurg. 1987;58(2):84–92.
- Bosscha K, Reijnders K, Hulstaert PF, Algra A, van der Werken C. Prognostic scoring systems to predict outcome of peritonistis and inta- abdominal sepsis. Br J Surg. 1997; 84(11):1532-34.
- Kumar P, Singh K, Kumar A. A comparative study between Mannheim peritonitis index and APACHE II in predicting the outcome in patients of peritonitis due to hollow viscous perforation. Int Surg J. 2017 Feb;4(2):690-696.
Corresponding Author
Mushtaq Ali
Asst. Prof. Era Medical College, Sarfarazganj, Lucknow, India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v7i3.87
