Severe secondary peritonitis following gastrointestinal tract perforation (original) (raw)
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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.
Study on Factors Effecting Outcome of Abdominal Emergencies Presenting With Peritonitis
BACKGROUND: Peritonitis is defined as,inflammation of peritoneum. Despite the surgical treatment, sophisticated intensive care units, broad spectrum antibiotics and a better understanding of pathophysiology, the mortality rates of peritonitis are still high and its treatment had been a challenge.Hence management continued to be a highly challenging task demanding proper knowledge, experiences, continued care and close monitoring.The outcome of an abdominal infection depends on the complex interaction of many different factors and the success obtained with the early institution of specific therapeutic procedures. It also depends upon the exact recognition of the seriousness of the diseases and an accurate assessment and classification of the patient's risk. PATIENTS AND METHODS: This is a study of 121 patients who presented with peritonitis to Tertiary care teaching hospital between august 2014 to july 2016 who subsequently underwent surgical intervention. All these patients have been thoroughly assessed both preoperatively and postoperatively. Mortality was documented with in first week after surgery. RESULTS: In our study the incidence of male sex was 73% while that of female sex was 27%, giving a male female ratio of 2.7:1. 21 patients died (overall mortality 17.3%). In males the mortality was 16% while in the females 21%. 34 patients had evidence of organ failure out of which 16 patients died (mortality 47%). Out of 62 patients with a pre-operative duration of greater than 24hr, 21 died thus resulting in mortality 34%. 5 patients there was presence of malignancy of which 2 patients died (mortality 40%). The mortality in the colonic origin of sepsis was 60% while in the latter 13%. CONCLUSION: Hence elderly age, female sex, presence of organ failure, pre operative duration more than 24 hours, presence of malignancy and colonic origin of sepsis are recognised as high risk factors. Presence of these factors should be identified , and patients should be categorised as high risk and should be provided intensive care.
International Surgery Journal, 2017
Background: Gastrointestinal tract perforation is one of the common surgical emergency all over the world. Menekse et al devised POMPP score (predictive score of mortality in perforated peptic ulcer) to predict the morbidity and mortality in peptic ulcer perforation. The objective of this study was to assess the validity of POMPP score in peptic ulcer perforation and to assess its usefulness in gastrointestinal perforation due to causes other than the peptic ulcer.Methods: Fifty consecutive cases, who had undergone exploratory laparotomy for gastrointestinal perforation peritonitis, were included in the study. “These patients were assessed at the time of admission on the basis of Age >65 years, BUN >45mg/dl (Blood Urea Nitrogen) and Albumin <1.5g/L and a score of 1 point each had been given”. The total score was compared with the outcome of the disease in relation with mortality.Results: In our study, 42% of gastrointestinal perforation were due to peptic ulcer, 22 % due to...
Journal of Natural Science, Biology and Medicine, 2015
Aims: We aimed to validate Mannheim peritonitis index (MPI) for prediction of outcome in patients with perforation peritonitis. Materials and Methods: A prospective study involving 100 subjects operated for perforation peritonitis over the period of 2 years was designed. Postevaluation of predesigned performa, MPI score was calculated and analyzed for each patient with death being the main outcome measure. The MPI scores were divided into three categories; scores <15 (category 1), 16-25 (category 2), and >25 (category 3). Results: Our study consisted of 82 males and 18 females (male:female ratio 4.56:1), with the mean patients age of 37.96 ± 17.49 years. 47, 26, and 27 cases belonged to MPI score categories 1, 2, and 3, respectively. The most common origin of sepsis was ileal with small intestine dominating the source of perforation. When the individual parameters of MPI score were assessed against the mortality only, age >50 years (P = 0.015), organ failure (P = 0.0001), noncolonic origin of sepsis (P = 0.002), and generalized peritonitis (P = 0.0001) significantly associated with mortality. The sensitivity of MPI was 92% with a specificity of 78% in receiver operating characteristic curves. Conclusion: MPI is an effective tool for prediction of mortality in cases of perforation peritonitis.
IOSR Journals , 2019
Background: perforation peritonitis still leading cause of morbidity and mortality in the present era of modern surgery. The objective of study was to evaluate pathophysiology and its outcomes associated with perforation peritonitis. Methods: This prospective observational study was conducted in the A total of 60 patients were enrolled in these studies. Results: A total of 60 patients of perforation peritonitis were included in the study with 40% of patients belong to age group of 31 to 40 years. The most common etiology was Peptic ulcer disease (37%), enteric perforation (30%) and Tubercular (16%). Conclusions: most of the patients of perforation peritonitis required aggressive resuscitation, correction of electrolyte imbalance and early surgical intervention.
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
Preoperative predictors of mortality in adult patients with perforation peritonitis
Indian Journal of Critical Care Medicine, 2011
Introduction: There is paucity of data from India regarding the etiology, prognostic indicators, morbidity, and mortality patterns of perforation peritonitis. The objective of our study was to evaluate the predictors of mortality, preoperatively, for risk stratification of the patients and institution of an early goal-directed therapy. Materials and Methods: Eighty-four consecutive patients presenting with perforation peritonitis, in the age group of 14-70 years scheduled for emergency laparotomy were studied prospectively. The parameters studied were age and sex of the patients, associated co-morbidities, duration of symptoms, delay in initiating surgical intervention, and preoperative biochemical parameters such as hemoglobin, random blood sugar, blood urea, serum creatinine, pH, base excess, and serum lactate levels. In-hospital mortality was taken as the outcome. Results: We encountered a mortality of 17.8% in our study. Multiple linear (enter) regression identified the age, duration of symptoms, preoperative blood sugar levels, blood urea, serum creatinine levels, Mannheim Peritonitis Index, and the delay in instituting surgical intervention as independent predictors of mortality. Hyperlactatemia, acidosis and base excess were not found to be associated with mortality. Conclusion: Routine biochemical investigations, delay in presentation, and surgical intervention are good predictors of mortality. Recognizing such patients early may help the anesthesiologists in risk stratification and in providing an early goal-directed therapy.
International Surgery Journal
Background: Secondary peritonitis carries high mortality and morbidity. Many scoring systems have been designed to assess its severity. This study was undertaken to compare the Mannheim peritonitis index (MPI) and revised multiple organ failure score (Revised MOFS) in predicting the mortality and morbidity.Methods: A prospective observational study was undertaken in adults operated for gastrointestinal perforation. Clinical and biochemical parameters as required for MPI and Revised MOFS were recorded. Each of the scores were divided under four categories; MPI <14, 14-21, 22-29 and >29; Revised MOFS 0, 1, 2 and >2. Data was compared for predicting mortality and morbidity. P-value, ROC curve and 95% CI were used as statistical tools.Results: Two thirds of 120 patients studied presented after 48 hours. MPI score of <14, 14-21, 21-29 and >29 had mortality of 0%, 2.2%, 27.2% and 50% respectively. ROC curve showed highest sensitivity and specificity of 79% and 70% respectiv...
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.