Clinicopathological Study of Perforation Peritonitis (original) (raw)
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International Surgery Journal, 2019
Generalized peritonitis as a result of gastrointestinal perforation is a common surgical emergency in India .1 In spite of advances in perioperative care, antimicrobial therapy, and intensive care support, perforation peritonitis still has high morbidity and mortality. 2,3 Perforation is defined as an abnormal opening in a hollow organ or viscus. It is derived from the Latin perforatus, meaning "to bore through." The spectrum of etiology of perforation is different between developing and developed countries, and there is a paucity of data from India regarding its etiology, prognostic indicators, morbidity, and mortality patterns. 4-6 The signs and symptoms of almost all cases of perforation peritonitis are typical and clinical diagnosis of peritonitis can be made in all patients. X-ray chest and abdomen, ultrasound whole abdomen and CT scan are the investigations that can confirm the diagnosis. Peritonitis usually presents as an acute abdomen. Local findings include generalised abdominal tenderness, guarding, rigidity, abdominal distension, decreased bowel sounds. Systemic findings include fever with chills or rigor, restlessness, tachycardia, tachypnea, dehydration, ABSTRACT 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
PERFORATIVE PERITONITIS: CONTINUING SURGICAL CHALLENGE.(PROSPECTIVE STUDY OF 50 CASES)
International Journal of Medical Reviews and Case Reports, 2022
Background: Perforative peritonitis poses a significant diagnostic and therapeutic challenge to the attending surgeon. Delay in diagnosis followed by sub-optimal treatment may lead to many complications, thereby increasing both morbidity and mortality. This is by virtue of various factors which affect the prognosis. Hence the need arises to identify these prognostic factors. Aims and Objectives: To study the various etiological factors of perforative peritonitis and to identify prognostic factors and comorbid conditions which influence the outcome in perforative peritonitis. Materials and Methods: 50 patients with an established diagnosis of perforative peritonitis due to various aetiologies confirmed by clinical and radiological investigations were included in the study and studied prospectively. On admission to the hospital, various haematological and radiological investigations were conducted to confirm the diagnosis. Patients subsequently underwent surgical intervention. Postoperative recovery and outcomes assessed. Results were tabulated and statistically analysed. Results: The mean age of patients in the study was 36.5 ±5 years. Patients who presented in an advanced stage developed complications. The majority of patients were males. The interval between the onset of symptoms and operative intervention was directly related to postoperative complications. Pneumoperitoneum was the most common x-ray finding, followed by dilated bowel loops with free fluid in the peritoneal cavity as the most common ultrasonography finding. Tachycardia and oliguria, which were markers of the severity of the disease process, were associated with an increased rate of complications. Peptic ulcer perforation was the most common, followed by perforations caused by infective aetiology. Perforations caused by infective aetiology had a higher rate of complication. Primary closure of the perforation was the most commonly performed procedure. Significant abdominal contamination found intraoperatively contributed to a negative outcome, as were comorbid conditions, which also increased the complication rate significantly. Conclusion: Delayed intervention after the onset of symptoms, tachycardia, oliguria and comorbidities are associated with a higher complication rate. Radiological investigations help in confirming the diagnosis. Infective aetiology of the perforation and extensive peritoneal contamination was associated with higher complication rates. Prompt and aggressive resuscitation on admission, optimum antibiotic administration, and early meticulous surgical intervention can reduce morbidity and mortality to a bare minimum.
PERFORATION PERITONITIS: A CASE STUDY.
Peritonitis is an emergency health condition that is life-threatening and requires urgent surgery. here we presented a case of perforation peritonitis for a 21 years old male. The patient suffered severe abdominal pain constant vomiting of what he eat, not bloody diarrhoea and he had moderate fever. Abdomen examination showed peritonitis. And the CT.abdomen examination showed a presence of peritonitis and few air pocket in rectosigmoid region and posterior to pancrease which mean that patient had peritonitis with pneumoperitoneum. The patient underwent surgery and stayed in the hospital for 7 days during which the patient\\\'s health improved and became healthy.
2014
Aims & Objectives: Intestinal Perforations are most common surgical emergencies seen worldwide. Despite improvement in diagnosis, antibiotics, surgical treatments and intensive care support, it is still an important cause of mortality in surgical patients. This study was done to know the spectrum of etiology, clinical presentation, management and treatment outcomes of patients admitted with perforation peritonitis in our hospital. Methods: A prospective study was done over a period of 3 years from January 2011 to December 2013 in SMS medical college and hospital, Jaipur, Rajasthan which included 1400 patients diagnosed with perforation peritonitis. All patients admitted with perforation of gastrointestinal tract were included in this study. All cases of primary peritonitis and anastamotic leaks were excluded from this study. Results: Total of 1400 cases were included with 74.28% being males. The time taken for resuscitation, diagnosis and preparation of patient for surgery was less ...
Prognostic factors in perforative peritonitis: an observational study
International Surgery Journal, 2016
Peritonitis due to hollow visceral perforation is commonly encountered in surgical practice. It is defined as inflammation of the serosal membrane that lines the abdominal cavity and the organs contained therein. 1 Peritonitis is often caused by introduction of an infection into the otherwise sterile environment through perforation of bowel or introduction of a chemically irritating material, such as gastric acid from a perforated ulcer. The different modes of presentation of cases may be misleading to the diagnosis of its origin. In contrast to western countries where lower gastro-intestinal tract ABSTRACT Background: Perforative peritonitis is the most common surgical emergency in India that requires prompt and optimum surgical attention. Despite advances in surgical techniques, antimicrobial therapy and intensive care support, management of peritonitis continues to be highly demanding, difficult and complex. This study was aimed to identify factors in patients with peritonitis which have a significant bearing on morbidity and mortality. Methods: The study was a single center, prospective observational study conducted in Lokmanya Tilak Municipal Hospital, Sion, Mumbai. 50 patients with perforative peritonitis presented to the emergency were included in our study. Detailed history & clinical examination performed, routine blood investigation were done followed by the use of appropriate diagnostic procedures such as X-ray erect abdomen, with additional help of abdominal ultrasound and abdominal CT scan. Different parameters were studied and analyzed. Results: 50 patients studied with age range 18-60 years with mean age of presentation 36.80 years and mortality rate was 16%. Majority of cases were male 88%. Tuberculosis was the most common co-morbidity (16%), most common site of perforation was gastroduodenal perforation (61%) [duodenum (48.9%) gastric (12.8%)] with peptic ulcer as the most common histopathology. We found most of the patients having no growth in peritoneal contamination followed by E. coli (34%) highly sensitive to amikacin. Most common complication was wound infection. We found delayed presentation >24 hrs, blood pressure <90 mmHg, respiratory rate >/=24/min, number of perforation, size of perforation >/=1 cm, site of perforation, amount of contamination >1000 ml and Mannheim's peritonitis index were the prognostic factors associated with morbidity. We could not find association between older age, sex, creatinine and hemoglobin but they were associated morbidity. Conclusions: The late admission to the hospital a very important cause of adverse outcome, leads to deterioration of patients. Tachycardia, tachypnea, hypotension, anemia, renal failure and septicemia, amount of contamination, size and number of perforations are the factors significantly predicting death (each significant at 5%). Thus, if patients having above mentioned symptoms could be detected early and prompt treatment could be provided accordingly; mortality can be reduced.
Surgical Science, 2020
Introduction: Appendicular peritonitis is a complication of acute appendicitis characterized by the spread of the infectious process in the peritoneal cavity thus achieving wide spread or localized purulent peritonitis; it's a medico-surgical emergency. Our objectives are to determine the frequency, describe the clinical, therapeutic and prognostic aspects of peritonitis by appendicular perforations. Patients-Method: This was a 24-month retro, prospective, descriptive study from January 1, 2018 to December 31, 2019; conducted in the Bougouni Reference Health Center Surgery Unit. All patients of appendicular peritonitis at the Bougouni Reference Health Centre were included. Results: During the study period, 68 cases of generalized acute peritonitis including 30 appendicular peritonitis cases were collected. Appendicular peritonitis accounted for 44.1% of surgical procedures. Males accounted for 71.0% with a sex ratio of 1.2 at risk of men, the average age was 26.07 years. Abdominal pain and vomiting were the reasons for consultation in 86.7% and 76.7% of cases. Physical examination was used in most cases to make the diagnosis. X-ray of the abdomen without preparation, and abdominal ultrasound were performed systematically. Surgical treatment consisted of an appendectomy with peritoneal toilet followed by drainage. The average length of hospitalization was 8.8 days with extremes of 1-44 days. Hospital mortality was 3.3%; morbidity and high mortality were related to delayed consultation. Conclusion: Appendicular generalized acute peritonitis is a medical-surgical emergency with a high mortality rate associated with delayed management.
Aetiological Pattern of Gastrointestinal Perforations: A Prospective Observational Study
2021
Introduction: Peritonitis secondary to gastrointestinal perforation is one of the commonest surgical emergencies encountered all over the world. This study was done to highlight the spectrum of perforation peritonitis encountered in surgery unit of Dhaka Medical College Hospital. Method: It was observational prospective of 100 cases of perforation peritonitis treated in our hospital. All cases of perforative peritonitis whether spontaneous, infective or neoplastic pathology were included in this study. Results: The maximum numbers of patients were in age group between 31 to 40 years (39 %) with mean age 35 years. Male female ratio was 9:1. The most common aetiology of perforation peritonitis was peptic ulcer disease (73%) followed by enteric fever (12%), appendicitis (10%), tuberculosis (3%) and malignancy (2%). The most common sites of perforation were in descending order of frequency first part of the duodenum (65%), terminal ileum (12%), appendix (10%), gastric antrum (9%), jejun...
2017
Perforation peritonitis is one of the most common surgical emergencies all over the world. The aetiology of peritonitis in tropical countries differs from western studies and is still a common cause of death, if timely medical or surgical intervention is not done. This study was done to know the spectrum of peritonitis in our setup at National Institute of Medical Sciences Medical College And Hospital, Jaipur. The study was a cross sectional hospital based research comprising fifty cases of perforation peritonitis and was done over a span of one year. It was noted that peptic ulcer (60%) is the most common cause followed by typhoid ulcers (20%). Abdominal pain (100%) with vomiting (98%) was the chief complain. Diagnosis is easy with typical clinical features and gas under the diaphragm in abdominal radiograph (94%). Early surgery is life saving with delay in surgical management leads to increased morbidity and mortality. Suture site infection and respiratory complications are the mo...
A Clinical study on Perforation Peritonitis patients to assess its Morbidity & Mortality
Peritonitis is defined as an inflammation of the serosal membrane that lines the abdominal cavity and the organs contained in it. Its a life threatening condition having significant morbidity and mortality. Diagnosis is based on clinical background, Plain X-ray abdomen, Ultrasound and CT scan with Local and systemic findings. Our prospective observational study was carried out on such patients admitted in Department of Surgery from 1 st Dec 2015 to 31 st of March 2017 to assess disease's morbidity & mortality. A total of 51 patients were in this study. Our study concluded that delay in presentation, hypotension at time of admission, hypoalbumenia, site of perforation and type of operative procedure performed are significant factors affecting the morbidity and mortality in case of perforation peritonitis Simple repair is the recommended procedure in most of the cases, but more definite resection and anastasmosis can be justified in patient with favourable outcome. In gross peritoneal contamination, stoma formation should be procedure of choice
A Prospective Study of Gastrointestinal perforations Leading to Acute Peritonitis
Introduction : Perforation is defined as an abnormal opening in any organ or viscous. Perforation of hollow viscous is one of the common surgical emergency in India ..Chronic alcoholism, Smoking, chronic use of Non steroid anti-inflammatory drugs (NSAIDS) are major risk factors for perforations Materials and methods : This study was hospital based prospective study conducted from September 2016 to January 2018. A total number of 171 cases were included in our study. The details of age, sex, anatomical location of perforation, signs and symptoms, complications and etiology were analyzed. Results: In our study, out of 171 patients, 133 were males (77.78%). 20 to 40 years of age group are most susceptible for perforation (47.37%). Gastro-duodenal perforation (48.54%) followed by appendicular (33.92%) perforation is the most common. Pain abdomen is universal symptom and tenderness is universal sign in our study (100%). Chronic alcoholism and peptic ulcer disease is most commonly associated with gastric and duodenal perforation. Delayed presentation >48 hours associated with co-morbidities are leading causes of septicemia and death. Conclusion: Early diagnosis along with appropriate preoperative management followed by the required surgical procedure decides the outcome of patients. As and when post operative complications arise they should be treated with utmost care