Abstract
ObjectivePeritonitis is the most common life threatening surgical emergency, which requires urgent surgical intervention and is a significant cause of morbidity and mortality. The objective of this study was to highlight the frequency of secondary peritonitis and to analyze the site and causes of perforation, in our tertiary care setup.MethodsA retrospective analysis of 311 patients of secondary peritonitis was done from July 2008 to June 2010 at Liaquat University Hospital Jamshoro, Hyderabad, Sindh, Pakistan. All cases found to have peritonitis as a result of perforation of any part of gastrointestinal tract at the time of surgery were included in the study. All cases with either primary peritonitis or that due to anastomotic dehiscence were excluded.ResultsA total of 311 patients were studied. Most of the patients were males (77%) and (89%) were in the third and fourth decades of life. Majority of the patients presented with pain (97%) associated with bowel symptoms. Most common site of perforation was small bowel (ileal 59%, jujenal 2%). In this series, most common risk factor of perforation was typhoid (43%). Ileostomy was the most commonly performed procedure. Overall morbidity was 48.5% and mortality was 17%.ConclusionConsidering the relatively higher rate of typhoid perforation quoted in this study, it is vital that typhoid fever ought to be eliminated by improved sanitation and immunizing programmes, otherwise surgeons will be confronted with its complications.
Highlights
Generalized peritonitis is a common surgical emergency in developing countries [1]
This study aims to identify the causes, bacteriology and outcomes of different surgical methods for secondary peritonitis at Liaquat University Hospital
Material and methods This retrospective study was conducted in Surgical Emergency Unit-I, Liaquat University Hospital, Hyderabad, Sindh, Pakistan over a period of two years from July 2008 to June 2010
Summary
Generalized peritonitis is a common surgical emergency in developing countries [1]. Despite advances in surgical techniques, good antimicrobial therapy and intensive care support, it carries high morbidity and mortality while its management remains difficult and complex [2]. Peritonitis can be classified as primary, secondary or tertiary, depending upon the source of microbial contamination. Primary peritonitis is secondary to extraperitoneal sources, the infection spreading mainly through haematogenous dissemination without visceral perforation. On the other hand, is caused by resident flora of the gastrointestinal or urogenital tracts, the organisms reaching peritoneum secondary to a mechanical break.
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