Prognostic factors in perforative peritonitis: an observational study

Abstract

Background: Perforative peritonitis is the most common surgical emergency in India that requires prompt and optimum surgical attention. Despite advances in surgical techniques, antimicrobial therapy and intensive care support, management of peritonitis continues to be highly demanding, difficult and complex. This study was aimed to identify factors in patients with peritonitis which have a significant bearing on morbidity and mortality. Methods: The study was a single center, prospective observational study conducted in Lokmanya Tilak Municipal Hospital, Sion, Mumbai. 50 patients with perforative peritonitis presented to the emergency were included in our study. Detailed history & clinical examination performed, routine blood investigation were done followed by the use of appropriate diagnostic procedures such as X-ray erect abdomen, with additional help of abdominal ultrasound and abdominal CT scan. Different parameters were studied and analyzed. Results: 50 patients studied with age range 18-60 years with mean age of presentation 36.80 years and mortality rate was 16%. Majority of cases were male 88%. Tuberculosis was the most common co-morbidity (16%), most common site of perforation was gastroduodenal perforation (61%) [duodenum (48.9%) gastric (12.8%)] with peptic ulcer as the most common histopathology. We found most of the patients having no growth in peritoneal contamination followed by E. coli (34%) highly sensitive to amikacin. Most common complication was wound infection. We found delayed presentation >24 hrs, blood pressure /=24/min, number of perforation, size of perforation >/=1 cm, site of perforation, amount of contamination >1000 ml and Mannheim’s peritonitis index were the prognostic factors associated with morbidity. We could not find association between older age, sex, creatinine and hemoglobin but they were associated morbidity. Conclusions: The late admission to the hospital a very important cause of adverse outcome, leads to deterioration of patients. Tachycardia, tachypnea, hypotension, anemia, renal failure and septicemia, amount of contamination, size and number of perforations are the factors significantly predicting death (each significant at 5%). Thus, if patients having above mentioned symptoms could be detected early and prompt treatment could be provided accordingly; mortality can be reduced.