Diagnostic value of Plain Abdominal Radiograph, Ultrasonography and Clinical impression of the surgeon in acute peritonitis (original) (raw)
Related papers
2021
Introduction: Acute generalized peritonitis is a life-threatening emergency. It is most often secondary to a perforation of the digestive organ and or to the spread of an intra-abdominal septic area. Methodology: We carried out a descriptive retrospective study lasting from January 1, 2018 to December 31, 2018 on the contribution of imaging in the management of acute generalized peritonitis general surgery department of the hospital Chinese-Guinean. Were included in our study, all records of patients with acute generalized peritonitis will be confirmed by imaging. We carried out an exhaustive recruitment of all complete files. Our variables were analyzed using the Epi-info 7.2 software. Result: Out of 578 hospitalized patients, peritonitis represented 8.8% of cases. We noted a male predominance with 60.8% and a Sex-ratio: M / F = 1.6 whose mean age was 41.9 ± 13.5 years; extremes ranging from 17 and 67 years with a modal class ≥ 30 years or 88.3%. Housewives were the most collected ...
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.
Clinicopathological Study of Perforation Peritonitis
Background: Peritonitis is defined as inflammation of the serosal membrane that lines the abdominal cavity and the organs contained therein. It is often caused by introduction of an infection into the otherwise sterile peritoneal environment through perforation of bowel. This study is an attempt to analyze perforation peritonitis according demography, clinical presentations, investigations, anatomical sites of perforation, complications and outcome of surgical management. Methods: 100 patients of perforation peritonitis visiting the surgery department in last two years, more than 12 years of age, were included. Demographic details, chief complaints, past, personal and family history, general physical and local examination, hematological and radiological investigations were performed. Type of surgical procedure, treatment modalities and details of complications were noted. Results: Mean age at the time of presentation was 36.68 years. Male female ratio was 6.14:1. Most common symptom was pain abdomen (100.00%) followed by vomiting (67%). 28% patients were diabetic and 20% hypertensive. 48.00% were dehydrated, 82.00% had tachycardia while 10.00% patients presented in shock. Most common cause of perforation peritonitis was peptic (44%) followed by appendicular (22%), enteric (15%), traumatic(13%), gall bladder (3%) and ischemic (3%) perforations. Most common site of perforation was duodenum (32%) followed by appendix (22%). Repair with omental patch was the most frequent procedure performed. 25% patients developed wound infection while 12% had chest infection. Septicaemia occurred in 10% cases and 5% patients eventually developed burst abdomen. Mortality rate was 15%. Conclusion: Perforation peritonitis is mostly seen in males during 3 rd and 4 th decade of life & present with pain abdomen, vomiting and distension. History of fever is one of the most useful clinical criteria to differentiate typhoid from other perforations. Peptic perforation is the most common cause followed by appendicular perforation. These cases are managed surgically. Patients may develop complications like wound and chest infection in the post operative period.
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.
Clinical presentation and diagnosis of colonic perforative peritonitis
2019
INTRODUCTION: Colonic perforative peritonitis (CPP) is a life-threatening surgical emergency where timely diagnosis is of ultimate impact on outcome. MATERIALS AND METHODS: For a five-year period (2014 – 2018), 62 patients with CPP were treated in First Clinic of Surgery in St. George University Hospital - Plovdiv. Males were 48 (77.42%) and females 14 (22.58%), with a ratio of 3.4:1. Patients’ age ranged from 14 to 92 years, with an average age of 71 years ± 2.4. Colonic perforative peritonitis was more common in patients over 80 years of age (n=21; 33.87%). The main causes of CPP were: perforated colon diverticulitis (n=19), perforated colon cancer (n=18), perforation in incarceration (n=9), sigmoid volvulus (n=6), mesenteric ischemia (n=5) and miscellaneous (n=5). There were 12 patients with local peritonitis (19.36%), with diffuse peritonitis - 21 patients (33.87%), and with total peritonitis - 29 patients (46.77%). The following surgical procedures were performed: Hartmann’s pr...
Post-Operative Peritonitis: Diagnostic Problems, Morbidity and Mortality in Developing Countries
Surgical Science, 2014
Goal: To study the diagnostic difficulties and post-operative morbidity and mortality of peritonitis. Patients and Methods: Retrospective study about the records of adult patients operated on between 1999 and 2013 whose diagnosis of post-operative peritonitis was made. Results: We achieved 23,573 lanterns and recorded 148 cases of postoperative peritonitis or 0.62%. The medium age was 37.1 ± 17.7 years and the sex ratio was 1.2. The delay between the initial intervention and reoperation was less than 5 days. Factors occurrence of postoperative peritonitis were those related to the initial surgery: septic context 70.8%, emergency surgery 81.1% under the seat mesocolic 25% and 20.3% initial surgical technique. The diagnosis was made preoperatively in 62.2% (n = 92). Ultrasound has found an effusion in 29.7% (n = 44). Cytobactériologic review identified germs in 85.1% (n = 126) and sterile in 12.9% of patients (n = 22). The most frequent etiologies were: 22.9% anastigmatic leak (n = 34), the phoenix abscess in 17.6% (n = 26), iatrogenic perforation 13.5% (n = 20) and digestive fistula 25% (n = 37). Other causes were the stoical necrosis 12.2% (n = 18) and evisceration 8.8% (n = 13). We performed a digestive stoma in 61% (n = 89), a closure of the abdomen bolsters in 8.8% (n = 13), a suture in iatrogenic perforation in 13.5% (n = 20) and washing with drainage in patients with phoenix abscess in 17.6% (n = 26). Morbidity was 22.3% and 53.4% mortality. Conclusion: The diagnosis of post-operative peritonitis is difficult in a developing country. Morbidity and mortality is high. Improved diagnostic tools are needed.
Surgical Management of Secondary Peritonitis Patients in a Tertiary Care Hospital
International Academic Research Journal of Surgery
Background: In the majority of general surgical units around the world, Secondary Peritonitis is the common surgical emergency and has high risk of morbidity and mortality. The present study was done to evaluate the surgical management among Secondary Peritonitis cases in a tertiary care Hospital. Material and Methods: This cross sectional study was conducted by Department of Surgery, IGMC, Shimla over a period of twelve months from January 2021 – December 2021 among patients with a diagnosis of secondary peritonitis after fulfilling the inclusion and exclusion criteria. Relevant information was collected and further analysed by using IBM SPSS Statistics. Results: A total of 250 individuals with a diagnosis of perforation peritonitis were assessed in the current study. Males made up 205 (82%) of the total while females made up 45 (18%). The patients' average age was 47.28 17.34 years, ranging from 18 to 87. In the study, 99 (39.6%) of the total patients were under the age of 40,...
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.
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