Perforation peritonitis: a clinical study regarding etiology, clinical presentation and management strategies
DOI:
https://doi.org/10.18203/2349-2902.isj20195412Keywords:
Perforation peritonitis, Clinical study, Exploratory laparotomyAbstract
Background: Generalized peritonitis as a result of gastrointestinal perforation is a common surgical emergency in India. The present study was conducted to understand the spectrum of perforation peritonitis in terms of etiology, clinical presentation, site of perforation, surgical treatment, postoperative complications, and mortality encountered at Shyam Shah Medical College and Sanjay Gandhi Memorial Hospital Rewa (M.P.) India.
Methods: The study was a prospective observational study conducted from July 2018 to June 2019 in the Department of General Surgery, S. S. Medical College and Sanjay Gandhi Memorial Hospital Rewa (M.P.). A total of 280 patients with perforation peritonitis were included in the study and underwent exploratory laparotomy.
Results: Out of 280 patients, there were 234 males (83.57%) and 46 females (16.43%). Most common affected age group was 21 to 30 years (19.64%). Doudenal perforation was the most common type (35%), which were mainly due to Acid peptic disease (48.92%) followed by Jejunal and Ileal perforations (34.95%). In our study, a variety of operative procedures were performed depending on the patients general condition, peritoneal contamination, site of perforation, gut viability, and surgeon’s decision. Wound infection was the most common complication (29.64%). Mortality rate was 7.5% (21 patients).
Conclusions: Perforation is diagnosed on clinical grounds immediately as patient reaches emergency department, time lost due to delayed hospitalization affects the outcome of standard surgical procedure. Selection of appropriate surgical procedure and postoperative care is helpful in early and uneventful recovery.
References
Ramakrishnan K, Salinas RC. Peptic ulcer disease. Am Fam Physician. 2007;76:1005-12.
Agarwal N, Saha S, Srivastava A, Chumber S, Dhar A, Garg S. Peritonitis: 10 years’ experience in a single surgical unit. Trop Gastroenterol. 2007;28:117-20.
Gupta S, Kaushik R. Peritonitis- The Eastern experience. World J Emerg Surg. 2006;1:13.
Dorairajan LN, Gupta S, Deo SV, Chumber S, Sharma LK. Peritonitis in India – A decade’s experience. Trop Gastroenterol. 1995;16:33-8.
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.
Sharma L, Gupta S, Soin AS, Sikora S, Kapoor V. Generalized peritonitis in India – The tropical spectrum. Jpn J Surg. 1991;21:272-7.
Doherty GM, Editor. Current diagnosis and treatment, Surgery. 13th edition. New York: The McGraw-Hill Companies, Inc.; 2010: 464-468.
Malangoni MA, Inui T. Peritonitis – the Western experience. World J Emerg Surg. 2006;1:25.
Agarwall N, Saha N, Srivastava A, Chumber S, Dhar A, Garg S. Peritonitis 10 years experience in a simple surgical unit. Trop Gastroenterol. 2007;28(3):117–20.
Afridi SP, Malik F, Ur-Rahman S, Shamim S, Samo KA. Spectrum of perforation peritonitis in Pakistan: ses Eastern experience. World J Emerg Surg. 2008;3:31.
Ghooi AM, Punjwani S. Acute abdominal emergencies: Clinical overview. Ind J Surg. 1978;140:182-9.
Chalya P, Mabula JB, Koy M, Mchembe MD, Jaka HM, Kabangila R, et al. Clinical profile and outcome of surgical treatment of perforated peptic ulcers in Northwestern Tanzania: A tertiary hospital experience, World J Emerg Surg. 2011;6:31.
Goud VS, Babu NV, Kumar PB. Comparative Study of Closure of Duodenal Perforations with Omental Plugging Versus Graham’s Patch. Int J Sci Stud. 2016;4(8):138-42.