Generalized Secondary Peritonitis in a Teaching Hospital: a Clinical Profile

Abstract

Inflammation of the peritoneum and peritoneal cavity, usually caused by a localized or generalized infection, is called peritonitis. The common causes of secondary peritonitis are peptic ulcer perforation, acute appendicitis, colonic diverticulitis, and PID. The present study aimed to determine the etiology, clinical presentation, and treatment outcome and identify the factors responsible for the poor outcome in the patients with generalized secondary peritonitis at Department of Surgery, Dr. RPGMC Kangra at Tanda, HP, India. The study enrolled 153 patients admitted to the surgery department with a diagnosis of acute generalized secondary peritonitis within a period of 1 year from December 2016 to November 2017. After admission, detailed history was recorded. The data regarding possible etiology, duration of symptoms, clinical presentation, diagnostic procedures, surgery performed, comorbidities, postoperative morbidity, and mortality was recorded. The age of patients ranged from 12 years to 90 years with a mean age of 42.75 years. Male/female ratio in our study was 6.29:1. Pain abdomen, fever, abdominal distension, abdominal guarding, and rigidity were the major signs and symptoms in our study. Of the patients, 65.36% presented after 24 h of onset of symptoms. Of the patients, 13.76% were having comorbidities, where respiratory disease was the most common one. Pneumoperitoneum on erect chest X-ray was found in 88.23% of the patients. Peptic ulcer disease was the commonest etiology of secondary peritonitis followed by enteric fever-associated perforation. Exploratory laparotomy and omental patch closure (Cellan jones and Modified Graham) were the most common surgery done. Postoperative morbidity was seen in 20.9% of our patients. We observed that the complication rate was higher in patients with enteric perforation (33.3%), followed by peptic ulcer disease, in 19.5% cases. To conclude, secondary peritonitis in India continues to have different spectrum as compared with Western countries with peptic ulcer disease as the most common etiology. Omental patch repair may be the preferred procedure for peptic ulcer perforation as it is technically easy and has better results. A prompt diagnosis, aggressive resuscitation, and timely surgical intervention are life-saving for all patients with generalized secondary peritonitis.