Mortality and Morbidity in operated patients with non-traumatic perforation peritonitis

Dr Vikas Kumar Malviya; Dr Shivam Diwan; Prof. Dr Shrikant Sharma; Dr Tarun Kumar Sainia

Volume : VIII, Issue : I, January - 2019

Mortality and Morbidity in operated patients with non-traumatic perforation peritonitis

Dr Vikas Kumar Malviya, Dr Shivam Diwan, Prof. Dr Shrikant Sharma, Dr Tarun Kumar Sainia

Abstract :

Introduction: Non Traumatic generalized peritonitis resulting from the perforation of a gastrointestinal tract is frequently encountered in India. Despite of overall improvement in diagnostic facilities, surgical modalities and treatment strategy, antimicrobial therapy and postoperative intensive care, this condition continues to be associated with high mortality and morbidity. Peritonitis usually presents as an acute abdomen and diagnosis is usually made on clinical examination with radiological finding of gas under diaphragm in plain X-ray abdomen erect view. Exploratory laparotomy is the only option for these patients. This study has been carried out to evaluate the pattern of mortality and morbidity associated with non-traumatic perforation peritonitis presented in L.N. medical college & J.K. hospital Bhopal. Material and Methods: This retrospective study was conducted in L.N. medical college & J.K. hospital Bhopal. A total of 100 operated cases of non-traumatic perforation peritonitis were included in the study. Case records of patients of non-traumatic perforation peritonitis who were admitted in surgical wards and operated, were obtained from medical record department and all the relevant information noted. Results: A total of 100 patients of non traumatic perforation peritonitis were included in this retrospective study with mean age of 37.5 years. 53% patients were below 50 years, but the mortality was more in patients with age more than 50 (12.7%) in comparison to below 50 years age group (9.4%). The male to female ratio was 3:1 (75 male and 25 female). Mortality in female patients was more (16%) in comparison to male (9.3%). Patients with lower socioeconomic status were most commonly admitted (67%) with perforation peritonitis and mortality was more in this group (11.9%). Most of the patients presented late to the hospital after the onset of symptoms. Only 4 patients were presented within 24 hours of onset of symptoms with 1 death. 36 patients presented between 2 to 3 days with 3 deaths. 54 patients presented 4 to 7 days after the onset of symptoms with 6 deaths. 6 patients were admitted after 7 days with 1 death only. Hypertension was most common medical illness (9) associated with patients of non-traumatic perforation peritonitis with mortality 55.5%. Other medical illness associated was diabetes (6) with mortality of 33.3% and tuberculosis (3) with mortality 33.3%. Most common systemic finding at the time of admission was tachycardia and dehydration, followed by oliguria and Septicemia shock. Most common local clinical findings were abdominal tenderness followed by guarding, rigidity and absent or diminished bowel sound. Total patient admitted with peptic perforation was 35 and 4 patient died with this diagnosis (mortality 11.4%). 56 patients with ileal perforation peritonitis were admitted and 6 patients were died of typhoid and tubercular ileal perforation peritonitis (mortality 10.7%). Only 1 patient out of 9 patients was died of appendicular perforation peritonitis (mortality 11.1). No patient with colonic perforation peritonitis was admitted in our study. Most common procedure in peptic perforation and ileal perforation was primary closure and appendicectomy in case of appendicular perforation. Other procedures which were performed in ileal perforation were resection anastomosis and loop ileostomy. Overall morbidity and mortality recorded in this study were 52% and 11% respectively. Conclusion : Non traumatic Perforation peritonitis in India is a very common emergency presented to hospitals and has a different statistic as compared to the western countries. Mortality in these patients varies according to age, sex, socioeconomic status, days of presentation, etiology of perforation and different operative treatment. Morbidity is still high despite of better treatment strategy. Better primary health care services and health education definitely will help to reduce mortality and morbidity. Early exploratory laparotomy, postoperative intensive care under oad spectrum antibiotics is imperative for good outcomes minimizing morbidity and mortality.