DOI: http://dx.doi.org/10.18203/2349-2902.isj20194036

Peritonitis secondary to non-traumatic small and large bowel perforation

Syed O. Ilyas, Saeed A. Sheikh, Muhammad D. Muneeb, Mahmood A. Makhdoomi, Erum Naz, Sajila Bano, Ashraf A. Elsyed

Abstract


Background: The objective of the study was to determine the outcome of secondary peritonitis in non-traumatic small and large bowel perforation in a secondary care hospital in the region of Ha’il, Kingdom of Saudi Arabia (KSA).

Methods: This prospective study was conducted in a surgical unit of King Khalid Hospital, Ha’il Kingdom of Saudi Arabia, from 01 October 2013 to 30th June 2014. 30 patients were admitted through emergency room (ER). Every patient was enquired a detailed history about abdominal distension, abdominal pain, fever, constipation, vomiting, and gut motility. Clinical examination of the patient was done. Baseline investigations along with chest radiograph posterio-anterior (PA) view, abdominal radiograph with erect and supine views and ultrasound whole abdomen were included. All patients landed in the ER with peritonitis due to gastrointestinal perforation, regardless of their sex and age, were included. Peritonitis of primary cause or due to trauma, corrosive ingestion and anastomosis leak were excluded. Follow up of all the patients was done. Data was analyzed through SPSS software 16.

Results: Out of 30 patients, 23 (76.66%) were male and 7 (23.33%) were female. Mean age 36.28±2.3 years. 80% presented with abdominal pain. Pneumoperitoneum on chest X-Ray was found in 21 (70%) patients. Duodenal perforation was the most common reason of peritonitis in 14 patients (46.66%). Surgical site wound infection is the commonest complication in 16 patients (53.33%).

Conclusions: In conclusion, the outcome of secondary peritonitis in our Eastern population is perforation of the upper gastrointestinal tract and small bowel as the documented common cause, and wound infection as the commonest complication. 


Keywords


Peritonitis, Perforation, Small bowel, Large bowel, Wound infection

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References


Ramakrishnan K, Salinas RC. Peptic Ulcer disease. Am Fam Physician. 2007;1(7697):1005-12.

Afridi SP, Malik F, Shafiq Ur-Rahman, Shamim S, Samo KA. Spectrum of perforation peritonitis in Pakistan: 300 cases Eastern Experience. World J Emergency Surg. 2008;3:31:1-5.

Turnage RH. Abdominal wall, umbilicus, peritoneum, mesenteries omentum and retroperitoneum. In: Sabiston DC, JR eds. Textbook of Surgery. The biological basis of modern surgical practice. 17th ed. Philadelphia: W.B. Saunders Co 2004: 1137-1197.

van Ruler O, Boermeester MA. Surgical treatment of secondary peritonitis: A continuing problem. Die chirurgische Therapie der sekundären Peritonitis. Ein weiter andauerndes Problem. Chirurg. 2016;88(Suppl 1):1–6.

Wani RA, Parry FQ, Bhat NA, Wani MA, Bhat TH, Farzana F. Non traumatic terminal ileal perforation. World J Emerh Surg. 2006;1:7-12.

Waris M, Cheema MA. Different presentation of abdominal tuberculosis at Mayo Sir Ganga Ram Hospital Lahore. Ann. 2000:6(1):68-72.

Ross JT, Matthay MA, Harris HW. Secondary peritonitis: principles of diagnosis and intervention. BMJ. 2018;361:k1407.

Launey Y, Duteurtre B, Larmet R, Nesseler N, Tawa A, Mallédant Y, et al. Risk factors for mortality in postoperative peritonitis in critically ill patients. World J Crit Care Med. 2017;6(1):48–55.

Thompson J, Russell RCG, Williams NS. The peritoneum, omentum, mesentery and retroperitoneal space. In: Bailey & Love’s Short Practice of Surgery 25th ed. London; Arnold, 2009: 1133-1152.

Cuschieri A, Giles SR, Moosa AR. Patient undergoing emergency surgical operations In: Essential surgical practice 4th ed. Oxford Butterworths — Heineinann; 2000: 393-413.

Wong PN, Lo KY, Tong GMW, Chan SF, Lo MW, Mak SK, Wong AKM. Treatment of fungal peritonitis with a combination of intravenous amphotericin b and oral flucytosine, and delayed catheter replacement in continuous ambulatory peritoneal dialysis. Peritoneal Dialysis Int. 2008;28(2):155–2.

Sartelli M, Catena F, Abu-Zidan FM, Ansaloni L, Biffl WL, Boermeester MA, et al. Management of intra-abdominal infections: recommendations by the WSES 2016 consensus conference. World J Emerg Surg. 2017;12:22.

Dhaigude BD, Shree S, Shah P, Francis M, Patel K, Metta V. Post-operative wound complications following emergency and elective abdominal surgeries. Int Surg J. 2017;5(1):232-7.

Wabwire B, Saidi H. Stratified Outcome Evaluation of Peritonitis. Ann African Surg. 2014;11(2).

Lopez N, Kobayashi L, Coimbra R. A Comprehensive review of abdominal infections. World J Emerg Surg. 2011;6:7.

Holzheimer RG. Management of secondary peritonitis. In: Holzheimer RG, Mannick JA, editors. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt; 2001.

Gupta S, Kaushik R, Sharma R. The management of large perforations of duodenal ulcers. BioMed Central Surg. 2005;5:1-9.

Mandava N, Kumar S, Walter F. Perforated colorectal carcinomas. Am J Surg. 1996;172:236-8.

Verma H, Pandey S, Sheoran KD, Marwah S. Surgical audit of patients with ileal perforations requiring ileostomy in a Tertiary Care Hospital in India. Surg Res Pract. 2015;2015.

Malik SA, Azad M, Ahmed Z, Qureshi A, Ahmed MN. Presentation and management of gastro duodenal perforations in the era of NSAIDS. JK Practitioner. 2011;16(1&2):14-6.

Singh R, Kumar N, Bhattacharya A, Vajifdar H.Preoperative predictors of mortality in adult patients with perforation peritonitis. Indian J Crit Care Med. 2011;15(3)157-63.

Jhobta RS, Attri AK, Kaushik R, Sharma R, Jhobta A. Spectrum of perforation peritonitis in India-review of 504 consecutive cases. World J Emerg Surg. 2006;1:26-30.

Miller RE. The radiologic evaluation of intraperitoneal gas (pneumoperitoneaum). CRC Crit Rev Radiol Sci. 1973;4:61-84.

Søreide K, Thorsen K, Harrison EM, et al. Perforated peptic ulcer. Lancet. 2015;386(10000):1288–98.

Malangoni MA, Inui T. Peritonitis the western experience. World J Emerg Surg. 2006;1:25-9.