DOI: http://dx.doi.org/10.18203/2349-2902.isj20201535

Role of peritoneal drainage in moribund patients of perforation peritonitis

Sakshi Jaiswal, Subhash Chandra Sharma

Abstract


Background: Objective of the present study was to evaluate applicability of primary peritoneal drainage under local anesthesia in moribund patients as pre-laparotomy support when laparotomy under general anesthesia could not be done. Also to assess outcome in terms of survival, patients needing definitive surgery and complications associated with the procedure on immediate and follow up basis.

Methods: We conducted this study in Teerthanker Mahaveer Medical College, Moradabad, UP, India from October 18 to October 2019. 71 patients were admitted as cases of perforation peritonitis in moribund condition, demographic data of all patients was noted, peritoneal drainage under local anesthesia in flanks was done and variable amount of fluid was drained in different patients, simple parameters were taken in to consideration in pre and post drainage phase. We also noted the complications after the definitive surgery.

Results: Out of 71 patients, admitted in late and in very critical state, 61 patients improved after drainage and resuscitative procedures, although in ASA grade 3 and 4 they underwent surgical treatment and we were able to save their lives. 13 patients expired after definitive surgery inspite of best efforts.

Conclusions: Peritoneal drainage under local anesthesia in late reporting and critical patients, not only improves general condition but makes patients better to undergo further surgery, and can prove to be life saver. It being a simple procedure can easily be done at even PHC level, before patient is referred or shifted to higher centre for further management.


Keywords


Perforation peritonitis, Drainage, Moribund patients

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References


Malangoni MA, Rosen MJ. Acute abdomen, Townsend: Sabiston Textbook of Surgery, first South Asia edition. Elsevier; 2016.

Dorairajan LN, Gupta S, Deo SVS, Chumber S, Sharma L. Peritonitis in India-A decades experience. Trop Gastroenterol. 1995;16(1):33-8.

Sharma L, Gupta S, Soin AS, Sikora S, Kapoor V. Generalized peritonitis in India. The Tropical Spectrum. Japan J Surg. 1991;21(3):272-7.

Ahmad MM, Wani M, Dar HM, Thakur SA, Wani HA, Mir IN. Spectrum of perforation peritonitis in Kashmir: a prospective study at our tertiary care centre. Int Surg J. 2015;2(3):381-4.

Nusree R. Conservative management of perforated peptic ulcer. Thai J Surg. 2005;26:5-8.

Robledo FA, Luque-de-León E, Suárez R, Sánchez P, de-la-Fuente M, Vargas A, et al. Open versus closed management of the abdomen in the surgical treatment of severe secondary peritonitis: a randomized clinical trial. Surg Infect (Larchmt). 2007;8:63-72.

Noetzel W. The operative treatment of diffuse purulent peritonitis. Negotiations of the German Society of Surgeons. 1908;34:638-707.

Kirchner M. Treatment of acute purulent free abdominal arthritis. Langenb Arch Chir. 1926;142:253-67

Taylor H. Perforated acute and chronic peptic ulcer; conservative treatment. Lancet. 1956;270:397.

Taylor H. The non-surgical treatment of perforated peptic ulcer. Gastroenterology. 1957;33:353-68.

Donovan A, Berne T, Donovan J. Perforated duodenal ulcer: an alternative therapeutic plan. Arch Surg. 1998;133:1166-71

Ein SH, Marshall DG, Gervan D. Peritoneal drainage under local anesthesia for perforations from necrotizing enterocolitis. J Pediatr Surg. 1977;12:963-7.

Leppäniemi AK. Laparostomy: why and when? Leppäniemi Crit Care. 2010;14:216.