Study of factors that help in assessing the outcome of perforative peritonitis
Keywords:Perforative peritonitis, Scoring systems, Mortality
Background: Perforative peritonitis is one of surgical emergency associated with increased morbidity and mortality. The current study aims to evaluate etiological factors of the disease and to assess the effectiveness of Mannheim peritonitis index (MPI) and sepsis score of Elebute and Stoner to predict the outcome.
Methods: This is a prospective hospital based study conducted in our hospital from June 2016 to July 2018 involving a total of 50 patients with perforative peritonitis. Prognostic factors and the validity of scoring systems were analyzed.
Results: Male preponderance was seen in the study (90%). Mortality rate was higher in older patients compared to younger. Mortality rate was more in females (40%). Mortality rate was more in patients with ileal perforation (45%). Delay of >72 hours of presentation was associated with a mortality of 79%. Mortality increased exponentially with MPI score more than 26 (28% mortality) and with sepsis score >20 was 76%.
Conclusions: Age over 50, longer duration of perforation, presence of shock on day one, extent of peritoneal contamination and associated medical illness adversely affect prognosis. Enteric and duodenal perforations carry a higher mortality. Both MPI and sepsis score accurately predicted mortality and morbidity rates.
Bone RG. Sepsis, SIRS and MODS: The New Definition. Proceedings of Sepsis/SIRS; 21-22 February, 1995; Washington, DC.
Nachiappan M, Litake MM. Scoring Systems for Outcome Prediction of Patients with Perforation Peritonitis. J Clin Diagn Res. 2016;10(3):1-5.
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.
Elebute EA, Stoner HB. The grading of sepsis. Br J Surg. 1983;70(1):29-31.
Wach H, Linder MM, Feldman U, Wesch G, Gundlach E, Steifens RA. Mannheim peritonitis index - prediction of risk of death from peritonitis; construction of a statistic and validation of an empirically based index. Theoretical Surgery. 1987;1:169-77.
Sharma S, Singh S, Makkar N, Kumar A, Sandhu MS. Assessment of Severity of Peritonitis Using Mannheim Peritonitis Index. Niger J Surg. 2016;22(2):118-22.
Tripathi MD, Nagar AM, Srivastava RD, Partap VK. Peritonitis- study of factors contributing to mortality. Indian J Surg. 1993;55:342–9.
Dandapat MC, Mukherjee LM, Mishra SB, Howlader PC. Gastrointestinal perforations. Indian J Surg. 1991;53(5):189-93.
Svanes C, Lie RT, Svanes K, Lie SA, Søreide O. Adverse effects of delayed treatment for perforated peptic ulcer. Ann. Surg. 1994;220(2):168-75.
Bobin AN, Klochkov ND, Bogomolova NV. Complications and the proximate causes of death in typhoid. Voen Med Zh. 1993;(1):49-52.
Billing A, Frohlich D, Schildberg FW. Prediction of outcome using the Mannheim Peritonitis Index in 2003 patients. Peritonitis study group. Br J Surg. 1994;81(2):209-13.
Dominioni L, Dionigi R, Zanello M, Monico R, Cremaschi R, Dionigi R, et al. Sepsis score and acute-phase protein response as predictors of outcome in septic surgical patients. Arch Surg. 1987;122:141-6.