Analysing prognostic factors among patients with perforative peritonitis

Authors

  • Pradeep M. Wagh Department of General Surgery, District Hospital, Nashik, Maharashtra, India
  • Samadhan Patil Department of General Surgery, District Hospital, Nashik, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20211809

Keywords:

Perforative peritonitis, Surgical outcome, Etiology, Complication, Mortality

Abstract

Background: The mortality of perforation peritonitis is highly dependent on early approach to the hospital, quick diagnosis and prompt surgical treatment as it correlates with the duration and degree of peritoneal contamination, the patient's age, the general health of the patient and the nature of the underlying aetiology. The present study was done to assess the role of various prognostic factors which have a bearing on the final outcome of the patients.

Methods: This prospective observational cross-sectional study was conducted in the at a tertiary level hospital in Maharashtra, in which 47 patients who presented a surgical emergency of perforation peritonitis and underwent an exploratory laparotomy were included. We compared different variables between patients who survived and those who died.

Results: High mortality was also found in patients who presented after 24 hours of developing symptoms. Ileal perforation was significantly more common among dead patients (50%) as compared to patients who survived (20%), p-value<0.05. There were significantly higher proportion of patients who had shock on day 1 who died (67%) as compared to those who survived (12%), p-value<0.05. Also, the group of patients who died, had significantly higher MPI (p-value<0.01), higher proportion of patients with multiple perforations (p-value<0.05), larger perforations (p-value<0.01) and contamination more than 1000 ml (p-value<0.05).  

Conclusions: High mortality was observed in patients who presented late, had ileal perforations, multiple and large perforation and developed shock on day one.

References

Meena LN, Jain S, Bajiya P. Gastrointestinal perforation peritonitis in India: A study of 442 cases. Saudi Surgical Journal. 2017;5(3):116.

Jain NK, Jain MG, Maini S, Khobragade V. A study of clinical profile and management of perforation peritonitis in a tertiary health centre located in Central India. International Surgery Journal. 2017;4(3):981-7.

Ramakrishnan K, Salinas RC. Peptic ulcer disease. Am Fam Physician. 2007;76(7):1005-12.

Vagholkar KR. Therapeutic options in perforation peritonitis. Hospital Today. 2011;6(5):277-81.

Linder MM, Wacha H, Feldmann U, Wesch G, Streifensand RA, Gundlach E. The Mannheim peritonitis index. An instrument for the intraoperative prognosis of peritonitis. Chirurg. 1987;58(2):84-92.

Budamala S, Penugonda A, Prakash GV, Ramaniah NV, Muralikrishna K, Gopikrishna B. Evaluation of various prognostic factors in perforative peritonitis management. JEBMH 2015;2(38):6027-35.

Stanley KE. Prognostic factors for survival in patients with inoperable lung cancer. J Natl Cancer Inst. 1980;65(1):25-32.

Kumar PC, Kharalkar V, Raghavendra B. A Clinical Study of Management of Perforative Peritonitis and Its Surgical Outcome. International J Contemporary Surg. 2019;7(2):125-31.

Kamble RS, Singh M, Jaiswal Y. Prognostic factors in perforative peritonitis: an observational study. Int Surg J. 2016;3:1082-92.

Singh SJ, Thangjam D, Singh TAK, Singh NS. To study prognostic factors inperforative peritonitis and evaluating the outcome of patients with perforation peritonitis using Mannheim Peritonitis Index. Indian J Res. 2020;9(3):40-3.

Downloads

Published

2021-04-28

Issue

Section

Original Research Articles