Perforation peritonitis: a clinical study regarding etiology, clinical presentation and management strategies

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 Shyam Shah Medical College and Sanjay Gandhi Memorial Hospital Rewa (M.P.) India.Methods: The study was a prospective observational study conducted from July 2018 to June 2019 in the Department of General Surgery, S. S. Medical College and Sanjay Gandhi Memorial Hospital Rewa (M.P.). A total of 280 patients with perforation peritonitis were included in the study and underwent exploratory laparotomy.Results: Out of 280 patients, there were 234 males (83.57%) and 46 females (16.43%). Most common affected age group was 21 to 30 years (19.64%). Doudenal perforation was the most common type (35%), which were mainly due to Acid peptic disease (48.92%) followed by Jejunal and Ileal perforations (34.95%). In our study, a variety of operative procedures were performed depending on the patients general condition, peritoneal contamination, site of perforation, gut viability, and surgeon’s decision. Wound infection was the most common complication (29.64%). Mortality rate was 7.5% (21 patients).Conclusions: Perforation is diagnosed on clinical grounds immediately as patient reaches emergency department, time lost due to delayed hospitalization affects the outcome of standard surgical procedure. Selection of appropriate surgical procedure and postoperative care is helpful in early and uneventful recovery.