Spectrum of gastrointestinal perforation peritonitis in 462 consecutive patients in tertiary care institute of North India
DOI:
https://doi.org/10.18203/2349-2902.isj20213982Keywords:
Perforation peritonitis, Small intestine, PepticAbstract
Background: Gastrointestinal perforation is one of the common surgical emergencies in developing countries. The diagnosis is mainly clinical and is aided by radiological investigations. This study was designed to highlight the spectrum of hollow viscus perforation peritonitis in terms of etiology, clinical presentations, site of perforation, surgical treatment, postoperative complications, and mortality.
Methods: The study was a hospital‑based observational study and included 462 patients of perforation peritonitis (diffuse or localized) who were studied retrospectively in terms of cause, site of perforation, surgical treatment, complications, and mortality. Only those patients who underwent exploratory laparotomy for management of perforation peritonitis were included.
Results: Overall stomach was the most common site of perforation (33%). Ileum (26%) was the second common site of perforation. Duodenal perforations were seen in 88 (19%) cases whereas appendicular perforations were seen in 46 (10%) cases. Colonic perforations were least common. Acid peptic disease was the most common etiology of stomach perforations. Enteric fever (63%) was the most common etiology of jejuno-ileal perforation. Other causes include tuberculosis (23%), trauma (8%), malignancy (3%) and idiopathic in rest. Males were six times more commonly affected than females. Peak incidence was noted in the 2nd and 3rd decades of life.
Conclusions: Spectrum of perforation peritonitis cases in developing world is different from developed countries The Western literature suggests that foreign body, ischemia, radiotherapy, diverticula, and Crohn’s disease are the main causes of perforations. In contrast to this, infection is the most common cause for perforations in developing countries.
References
Meena LN, Jain S, Bajiya P. Gastrointestinal perforation peritonitis in India: A study of 442 cases. Saudi Surg J. 2017;5:116-21.
Wang YR, Richter JE, Dempsey DT. Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1993 to 2006. Ann Surg. 2010;251:51-8.
Seth S, Agrawal KK. Small bowel perforations: Review of 33 cases. Med J DY Patil Univ. 2016;9:186-9.
Singh JP, Steward MJ, Booth TC, Mukhtar H, Murray D. Evolution of imaging for abdominal perforation. Ann R Coll Surg Engl. 2010;92:182-8.
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.
Afridi SP, Malik F, Ur‑Rahman S, Shamim S, Samo KA. Spectrum of perforation peritonitis in Pakistan: 300 cases Eastern experience. World J Emerg Surg. 2008;3:31.
Bhattacharjee HK, Misra MC, Kumar S, Bansal VK. Duodenal perforation following blunt abdominal trauma. J Emerg Trauma Shock. 2011;4:514-7.
Ugurlu MM, Asoglu O, Potter DD, Barnes SA, Harmsen WS, Donohue JH. Adenocarcinomas of the jejunum and ileum: A 25-year experience. J Gastrointest Surg. 2005;9:1182-8.
Gupta SK, Gupta R, Singh G, Gupta S. Perforation peritonitis: A two year experience. JK Sci 2010;12:141-4.
Rajesh V, Chandra SS, Smile SR. Risk factors predicting operative mortality in perforated peptic ulcer disease. Trop Gastroenterol. 2003;24(3):148-50.
Ramakrishnaiah VP, Chandrakasan C, Dharanipragadha K, Sistla S, Krishnamachari S. Community acquired secondary bacterial peritonitis in a tertiary hospital of South India: An audit with special reference to peritoneal fluid culture. Trop Gastroenterol. 2012;33:275-81.
Chalya PL, Mabula JB, Koy M, Kataraihya JB, Jaka H, Mshana SE. Typhoid intestinal perforations at a University teaching hospital in Northwestern Tanzania: A surgical experience of 104 cases in a resource-limited setting. World J Emerg Surg. 2012;7:4.
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.
Jain BK, Arora H, Srivastava UK, Mohanty D, Garg PK. Insight into the management of non‑traumatic perforation of the small intestine. J Infect Dev Ctries. 2010;4:650-4.
