Cause Of Peritonitis Research Articles

Clinical study of perforative peritonitis and the role of mannheim peritonitis index in predicting its mortality

Background: A scoring system which can compare patient populations and severity of illness, objectively predict mortality, morbidity and can help to evaluate the treatment strategy is the dire need for evaluative research of intensive care. Methods: The study is done after obtaining a detailed history, complete general physical examination and systemic examination. The patients are subjected to relevant investigations like X-ray erect abdomen, CXR, USG and routine investigations like Hb, TC, urea, creatinine, serum electrolytes. Results: The study was conducted in a population of 50 patients who had been diagnosed as having peritonitis secondary to hollow viscous perforation. It was observed that perforated appendix was most common cause of peritonitis in our study accounting for 26 percent of the cases. Conclusions: Despite advancements in the realm of medical science, the management of patients with peritonitis continues to be demanding. In our study it was found that appendicular perforation was the most common cause followed by gastro duodenal perforation.

English

Treatment of Peptic Ulcer Disease in major hospitals is now limited to managing their complications like perforations of stomach or duodenum. This is also a common cause of peritonitis and remains a challenge to the surgeon. Diagnosis is based on clinical parameters like pain in the abdomen, shock, abdominal guarding/rigidity and abdominal distension. The diagnosis is confirmed by ultrasound examination of the abdomen, x-ray abdomen in erect posture. The predisposing factors include the age, smoking, alcohol intake, steroids and NSAIDs usage. The risk factors of mortality are presence of shock and pre-existing medical conditions and time of arrival to the casualty. The mortality and morbidity may be predicted using different scoring systems like ASA scoring and Boey’s scoring. AIM To analyze the different risk factors, clinical features and surgical treatment options of Acute Peptic Ulcer perforation in patients attending a Tertiary Hospital. To evaluate the prognostic factors causing death and complications in this condition. MATERIALS AND METHODS One hundred and sixty five patients attending with signs and symptoms of Acute Perforation of Peptic Ulcer were included. Males were predominantly affected than females with a 1.94:1 ratio. The median duration of illness was 9.64 days. History of smoking in 93.5%, NSAIDs in 78%, alcohol intake in 93.8% and steroids in 84% of the patients was present. Previous history of peptic ulcer disease was reported in 90% of the patients. Gastric ulcers were more common than with duodenal ulcer with a ratio of 1.32:1. The mortality rate was 6.66%. Among the complications wound infection was highest with 26% followed by paralytic ileus 23%. ASA and Boey’s scoring showed statistical significance in predicting the mortality with a P value of 0.00003. RESULTS The incidence of APPU was 0.35% of the total 46080 emergency surgical patients in a 4-year period. The incidence was high among the manual laborers and in urban populations. The potential risk factors with statistical significance with P value below 0.05 were age, smoking, intake of alcohol, high BUN and serum creatinine levels and time lapse before undertaking definitive treatment. CONCLUSIONS Acute perforation of the peptic ulcer is a common clinical entity in this part of the state of Telangana affecting both the sexes. Simple closure with omental patch followed by treatment of the peptic ulcer disease limits the mortality and morbidity as reported from this center. The ASA and the Boey’s scoring helps in assessing the risk factors for post-operative mortality and morbidity.

Pasteurella species peritoneal dialysis-associated peritonitis: Household pets as a risk factor.

Pasteurella species are Gram-negative coccobacilli that are a part of the normal oropharyngeal flora of numerous domestic animals. They have been recognized as a rare but significant cause of peritonitis in patients undergoing peritoneal dialysis (PD). A consensus about management strategies for PD-associated peritonitis caused by Pasteurella species currently does not exist. The microbiological database serving the Manitoba Renal Program was searched from 1997 to 2013 for cases of Pasteurella species PD-associated peritonitis, and charts were reviewed. PubMed was searched for case reports and data were abstracted. Seven new local cases and 30 previously reported cases were analyzed. This infection is clinically similar to other forms of PD peritonitis, with household pet exposure appearing to be the strongest risk factor. Cats are the most commonly implicated pet. Direct contact between the pet and the equipment was commonly reported (25 of 37 patients) but was not necessary for infection to develop. The mean duration of treatment was 15 days. Complication rates were low, with only 11% of patients requiring PD catheter removal. There was no mortality reported. Pasteurella species are a rare cause of PD-associated peritonitis that can be successfully treated with a two-week course of intraperitoneal antibiotics with a high likelihood of catheter salvage.

Microbiological Aspects of Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis: A Monocentric Five Years Follow up Study

Peritonitis is a serious complication of continuous ambulatory peritoneal dialysis (CAPD). CAPD peritonitis usually occurs due to contamination by bacteria from the skin or the environment of the inserted catheter. The aim of this study was to analyze data about microbial cause of peritonitis in patients on CAPD monitored at University Clinical Centre of Republic of Srpska, Bosnia and Herzegovina in five years period, from October 2010 till October 2015. In the five-year period 69 samples of peritoneal dialysate were examined. The most common isolates were Gram +ve bacteria: Staphylococcus aureus in 9 cases (32.1%), coagulase-negative Staphylococcus 5 (17.6%) and the Gram -ve bacteria Escherichia coli 4 (14.2%) and Enterobacter 3 (10.7%). In one case Candida spp. (3.6%) was isolated. All the Gram positive isolates were sensitive to ciprofloxacin and vancomicin. Among Staphylococcus spp. there were no methicillin resistant strains. The findings of culture of peritoneal dialysate is important for the proper choice of antimicrobial therapy. The use of systemic vancomycin and ciprofloxacin administration is a simple and efficient first-line protocol antibiotic therapy for PD peritonitis.

Closed suction drainage for treatment of septic peritonitis of confirmed gastrointestinal origin in 20 dogs.

To determine survival rate in dogs with septic peritonitis of confirmed gastrointestinal origin treated with closed suction drainage. Retrospective case series. Dogs (n = 20) with septic peritonitis. Medical records (2007-2010) of dogs with septic peritonitis of confirmed gastrointestinal origin treated by closed suction drainage were reviewed. Information on signalment, clinicopathologic abnormalities, underlying cause, surgical procedure performed, postoperative management, complications, and outcome was obtained. Dehiscence of a previous anastomosis was the most common source of contamination (80%). Drains remained in place, collecting fluid produced within the abdomen, for a median of 6 days (range, 2-11 days). Eighteen dogs received nutritional support, and 14 received plasma transfusions. Seventeen dogs (85%) survived to discharge. Closed suction drainage together with resolution of the underlying cause of peritonitis and appropriate postoperative management is an effective technique for treatment of septic peritonitis of confirmed gastrointestinal origin in dogs.

Evaluation of the Mannheim’s Peritonitis Index in Predicting Mortality in Patients with Perforative Peritonitis

Aim: To study the applicability of the Mannheim's peritonitis index in predicting mortality in patients with perforative peritonitis. Methods: A total of 50 patients diagnosed as perforative peritonitis based on history, clinical examination, and plain skiagram abdomen erect antero-posterior view were studied. The Mannheim's peritonitis index was calculated at first laparotomy. Results: Overall post-operative mortality rate was 10%. Middle age population (35-55 years) was predominantly affected (48%) with male preponderance (75%). Peptic ulcer perforation was the most common cause of peritonitis. Malignant perforation of hollow viscus accounted for only 4% of cases. Mean MPI Score of survivors was 22.04, and that of non survivors was 33.2. Mortality rate was highest in patients with high MPI Score. Conclusion: Mannheim's peritonitis index is easy to use, with all variables easily available at first laparotomy, with reproducible results and is a reliable predictor of mortality.

Evaluation of the Mannheim's Peritonitis Index in Predicting Mortality in Patients with Perforative Peritonitis

<p><strong>Aim:</strong> To study the applicability of the Mannheim's peritonitis index in predicting mortality in patients with perforative peritonitis.</p><p><strong>Methods:</strong> A total of 50 patients diagnosed as perforative peritonitis based on history, clinical examination, and plain skiagram abdomen erect antero-posterior view were studied. The Mannheim's peritonitis index was calculated at first laparotomy.</p><p><strong>Results:</strong> Overall post-operative mortality rate was 10%. Middle age population (35-55 years) was predominantly affected (48%) with male preponderance (75%). Peptic ulcer perforation was the most common cause of peritonitis. Malignant perforation of hollow viscus accounted for only 4% of cases. Mean MPI Score of survivors was 22.04, and that of non survivors was 33.2. Mortality rate was highest in patients with high MPI Score.</p><p><strong>Conclusion:</strong> Mannheim's peritonitis index is easy to use, with all variables easily available at first laparotomy, with reproducible results and is a reliable predictor of mortality.</p>

Implementation of a continuous quality improvement program reduces the occurrence of peritonitis in PD

Objective: To investigate the causes of peritonitis in patients with peritoneal dialysis (PD) using continuous quality improvement (CQI) to develop effective interventions and reduce the occurrence of peritonitis. Methods: A quality control team consisting of 10 members, including the department head, four nephrologists and four nurses, all specialized in PD care, and the head nurse, was established at the Peritoneal Dialysis Center of the Third Xiangya Hospital of Central South University. All patients with peritonitis occurring between 1 July 2010 and 31 December 2011 (pre-CQI period) were analyzed and compared with data obtained between January 2012 (implementation of CQI) and March 2013 to investigate possible causes of peritonitis and to develop corresponding interventions. Fishbone analysis, including laboratory parameters, was carried out monthly. Results: Gastrointestinal tract dysfunction, nonstandard procedures and malnutrition were found to be the top three risk factors for peritonitis. Gastrointestinal tract dysfunction was the likely cause of peritonitis in 42.8% of the subjects before CQI and 36.0% after CQI (p < 0.05). Nonstandard procedures were the cause of peritonitis in 33.3% of the subjects before CQI and 24.0% after CQI (p < 0.05). The overall incidence of peritonitis reduced from once every 40.1 patient months before the CQI to once every 70.8 patient months after CQI (p < 0.05). The incidence of Gram-positive bacteria peritonitis reduced from once every 96.9 patients per month before CQI to once every 209.1 patient months after CQI (p < 0.05), whereas the incidence of Gram-negative bacteria peritonitis reduced from once every 234.2 patient months before CQI to once every 292.8 patient months after CQI. Conclusion: CQI can effectively reduce the occurrence of PD-related peritonitis.

Isolated Meckel’s diverticulum perforation as a sequel to blunt abdominal trauma: a case report

IntroductionMeckel’s diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Its infrequent occurrence is mirrored by the paucity of large series of data on it in the literature. Hemorrhage, obstruction and inflammation are the three main categories of complications resulting from Meckel’s diverticulum. Perforation of Meckel’s diverticulum following blunt abdominal injury is very rare indeed. We present what we believe to be the first case to be published from Africa.Case presentationA 29-year-old Nigerian Igbo man presented with progressively worsening abdominal pain following a road traffic accident. He was a front-seat passenger traveling without a seat belt. On physical examination his abdomen was distended with guarding and rigidity. A provisional diagnosis of peritonitis secondary to perforation of intestinal viscus was made. Our patient had an emergency laparotomy, where a perforated Meckel’s diverticulum was discovered. A segmental resection of his ileum and reanastomosis were done. He had postoperative surgical site infection, but was asymptomatic for three months of follow-up.ConclusionPerforation of Meckel’s diverticulum is rarely suspected as a cause of peritonitis following blunt abdominal injury. This case indicates the need to be aware of the possibility to limit morbidity associated with delayed management of such a perforation.

Peritonitis caused by Bifidobacterium longum: Case report and literature review

Bifidobacterium spp. rarely causes human infections. We report a case of a 42-year-old man with a history of pancolonic diverticulosis, who suffered a purulent peritonitis caused by Bifidobacterium longum secondary to intestinal perforation. Clinical outcome was good after urgent surgery and antibiotic treatment with imipenem and amoxicillin/clavulanic acid. Our case shows that Bifidobacterium spp. should be considered as a cause of peritonitis, especially in patients with risk of intestinal perforation. The review of the literature shows that these organisms can cause a wide spectrum of severe infections, especially in patients with underlying diseases. Infections caused by Bifidobacterium spp. may be overlooked or underreported since it may be considered normal microbiota.

Peritonitis caused by Ewingella americana in a patient with peritoneal dialysis: a case report

IntroductionPeritonitis can happen in patients undergoing continuous ambulatory peritoneal dialysis. It is commonly caused by Staphylococcus aureus, which is the basis of the empiric choice of antibiotics. Here we report a case that was caused by Ewingella americana and thus required different considerations of treatment.Case presentationA 76-year-old Chinese woman underwent continuous ambulatory peritoneal dialysis after the diagnosis of chronic renal failure. She presented with generalized abdominal pain after the start of continuous ambulatory peritoneal dialysis for 10 consecutive months. The pathogen was identified as Ewingella americana by microbiological examination and its susceptibility to antibiotics was partly different from the common pathogens causing peritonitis. The change of antibiotic treatment from vancomycin to amikacin accelerated her recovery.ConclusionIt should be noted that peritonitis can be caused by E. americana. Our report may add to the known causes of peritonitis in a hospital environment. With respect to the empiric choice of antibiotics to treat peritonitis under the condition of continuous ambulatory peritoneal dialysis, it is worth noting that E. americana has a different susceptibility to the spectrum of antibiotics and its corresponding therapy should be taken into consideration.

Chronic peritonitis in adult cattle

Primary peritonitis is generally caused by haematogenous spread, but is uncommon in cattle. Peritonitis more commonly results from compromise to the gut wall which allows toxins, and following perforation gut contents, to leak into the peritoneal cavity. Other causes of peritonitis include traumatic perforation of the reticulum and uterus. The ability of the omentum to envelope perforated gut and leaked contents is remarkable which masks clinical signs making diagnosis difficult. Fibrinous adhesions to hepatic abscesses at the capsular surface are not uncommon and again prove difficult to diagnose and are rarely reported.

Ascite urinaire, uropéritoine et péritonite urinaire chez l’enfant : conduite diagnostique et thérapeutique à propos de neuf observations à Madagascar

To evaluate the frequency of urinary peritonitis in children and to highlight its terms of management in a country with limited resources. We retrospectively observed nine case reports of urinary peritonitis collected in surgical reanimation service at the CHU of Antananarivo, from 1st January 2009 to 31 December 2012. Urinary peritonitis accounts 0.5% of all pediatric abdominal emergencies and 5% of pediatric urological emergencies collected in our service during study period. Three etiologies were traumatic bladder rupture, one bladder iatrogenic rupture, four secondary to obstructive uropathy and one other after cystolithotomy. We found a new case of posttraumatic transverse rupture of the bladder neck. Among obstructive uropathy observed, there were two cases of posterior urethral valves and two cases of ureteralpelvic junction obstruction. Clinical expression was dominated by fever, with abdominal distention and defense. In majority of cases, etiological diagnosis was made intraoperatively. The surgical treatment by laparotomy was performed under cover of systemic antibiotic therapy. Evolution was complicated with sepsis in three cases and acute renal failure in both cases. Surgical follow-up without complication were observed in four cases. A child has died to septic shock and multivisceral failure. Unlike urinary ascites resulting a transperitoneal extravasation of urine, uroperitoneum was a fistula between adominal cavity and content of the urinary tract. Urinary ascites was a rare cause of peritonitis. In contrast, uroperitoneum caused peritonitis quickly. Urinary peritonitis was a rare entity but severe prognosis in children. In majority of cases, etiological diagnosis was made intraoperatively.

Role of laparoscopy in peritonitis

Laparoscopy has gained clinical acceptance in many subspecialties in the last decade. The conventional open surgery for peritonitis carries significant morbidity and mortality. The present study was done to extend and evaluate benefits of minimally invasive surgery in this subset of patients. This was a prospective study spanning over a period of four years. All those patients diagnosed as having peritonitis on clinical assessment and preoperative investigations and those who were stable enough haemodynamically were included in this study. After initial resuscitation for few hours, they underwent diagnostic and therapeutic laparoscopy to identify the cause of peritonitis and to confirm the pathology. All cases were done under general anesthesia, using three standard ports at appropriate sites according to pathology. Patients were treated by different procedures either laparoscopically or with laparoscopic assistance after diagnosis. Operative and post operative data was collected and analyzed. Ninety two cases of peritonitis underwent diagnostic and therapeutic laparoscopy. Mean age of patient was 46.5 years. 24 patients were diagnosed as perforated duodenal, in 14 (58.3%) patients laparoscopic suture repair was done and in 8 (33.3%) small upper midline incision was given and perforation was repaired. Out of 32 patients having perforated appendix, 25 (78.1%) patients laparoscopic appendectomy was done while in 7 (21.8%) perforation was dealt by laparoscopic assistance. Out of 14 patients of ileal perforation 6 (42.8%) with minimal contamination laparoscopic suture was applied, while in 8 (57.1%), perforated loop was brought out by making small window and perforation was closed. All 22 patients with pelvic sepsis needed only aspiration of pus and peritoneal lavage. Only one patient died post operatively and 2 (2.1%) patients developed fistula. 6 (6.5%) patients developed port site infection. Laparoscopic management is feasible, safe and effective surgical option for patients with peritonitis due to different abdominal emergencies in properly selected cases with higher diagnostic yield and a faster postoperative recovery.

Efficacy of a synthetic antimicrobial peptidomimetic versus vancomycin in a Staphylococcus epidermidis device-related murine peritonitis model

Biofilm-forming Staphylococcus epidermidis is a prevalent cause of peritonitis during peritoneal dialysis. We compared the efficacy of a synthetic antimicrobial peptidomimetic (Ltx21) versus vancomycin in a murine model mimicking a device-related peritonitis. Silicone implants, pre-colonized with an S. epidermidis biofilm, were inserted into the peritoneal cavity of BALB/c mice. Three groups (36 mice in each) with pre-colonized implants received intraperitoneal treatment with Ltx21, vancomycin or placebo. Mice were euthanized on day 3 (n = 12), day 6 (n = 12) or day 8 (n = 12) post-implantation. Controls were mice with sterile implants (n = 18) and mice without surgery (n = 6). Bacterial reductions in cfu were analysed from implants and peritoneal fluid (PF). Inflammatory responses in serum and PF were measured. Vancomycin resulted in a stronger reduction in cfu counts, both on pre-colonized implants and in PF, compared with Ltx21 and placebo. Complete bacterial clearance of the implants was not achieved in any of the groups. The implants pre-colonized with S. epidermidis 1457 resulted in a low-grade peritonitis. We observed, only on day 6, a significant increase in the PF leucocyte count in the group with pre-colonized implants compared with the group with sterile implants (P = 0.0364). Treatment with vancomycin or Ltx21 was not sufficient to achieve complete bacterial clearance of implants, underlining the difficulties of treating such infections. The low-grade infection may attenuate the inflammatory response and contribute to impaired bacterial clearance.

Diagnostic value of lactoferrin ascitic fluid levels in spontaneous bacterial peritonitis

IntroductionSpontaneous bacterial peritonitis (SBP) is a clinical syndrome in which ascitic fluid becomes infected in the absence of a recognizable cause of peritonitis. The diagnostic criterion for SBP is a polymorphonuclear cell (PMN) count greater than or equal to 250 cells/ml in the ascitic flui

Isolation of Anaerobic Bacteria from the Peritoneal Fluid of Patient who has Unstrangulated Umbilical Hernia

Aim: In cases of ventral hernia, in the presence of complications such as strangulation, a variety of intestinal bacteria can penetrate to peritoneal fluid and can cause peritonitis. However, these infections are rare in unstrangulated hernia cases. In this case report, it is emphasized that anaerobic bacteria and other bacteria can be isolated from patients with unstrangulated umbilical hernia to be cause of peritonitis. Case report: The 94-year-old female patient with unstrangulated ventral hernia was operated on as an emergency. The liquid that has accumulated in the hernia sac was taken for Gram stain and culture. Five ml peritoneal fluid was inoculated in the BACTEC plus Anaerobic F (Becton Dickinson-Maryland, USA) bottle. In addition, the fluid sample was inoculated on blood agar and EMB (eosin methylene blue) agar medium for aerobic isolation, and was inoculated on Schaedler agar medium (Oxoid, Hampshire, United Kingdom) for anaerobic isolation, and they was incubated at 37°C. Isolated facultative anaerobic bacteria were identified by using conventional methods; anaerobic bacterium was identified by using conventional methods, the API 20 a panels and An-Ident Discs tests. In the microbiological examination by Gram stain, no microorganism was observed. E. coli and Enterococcus spp. were identified as facultative anaerobic bacteria, and B. fragilis as anaerobic bacterium. After surgery of the patient, ceftriaxone and metronidazole were ordered. According to the culture results, ciprofloxacin was replaced by ceftriaxone in the treatment and the patient was discharged by healing. Conclusion: In patients with unstrangulated ventral hernia, anaerobic bacteria and other bacteria may be cause of peritonitis due to penetration of intestinal flora to peritoneal fluid.

Mycobacterium fortuitum Peritonitis in a Patient on Continuous Ambulatory Peritoneal Dialysis (CAPD): A Case Report

Mycobacterium fortuitum, an environmental organism, is capable of producing a variety of clinical infections such as cutaneous infections, abscesses and nosocomial infections. Rarely, it has been a documented as a cause of peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD). Continuous Ambulatory Peritoneal dialysis (CAPD) is one of the treatment options which are used for patients with end-stage renal disease (ESRD). Although peritonitis rates have declined in parallel with advances in peritoneal dialysis (PD) technology, peritonitis remains a leading complication of CAPD and it is the major cause for transfer to other methods of dialysis. We are reporting a case of M. fortuitum peritonitis in a patient who was undergoing CAPD, which was successfully treated. This case emphasizes the importance of mycobacterial cultures in patients with CAPD-associated peritonitis, whose routine cultures may yield no organisms.

A Prospective Study of Factors Influencing Wound Dehiscence after Midline Laparotomy

Aim: To evaluate the factors influencing fascial wound dehiscence after midline laparotomy in the patients of perforation peritonitis with an emphasis on measurement of “intra-abdominal” pressure (IAP) and fascial transforming growth factor-beta (TGF-beta). Methods: Hundred eligible adult patients with the diagnosis of perforation peritonitis who underwent emergency exploratory laparotomy were prospectively recruited. Forty five patients who developed midline abdominal wound dehiscence were compared with 55 patients without dehiscence. Results: The variables that were significantly associated with wound dehiscence include anemia, hypo proteinemia, duration of surgery, prolonged postoperative ileus, wound infection and postoperative pulmonary infection. Age, gender, jaundice, cause of peritonitis, wound contamination and types of surgery were non significant variables. The mean IAP value in the patients with dehiscence was significantly higher than “non-dehiscence” group (p = 0.000). The patients with wound dehiscence strongly expressed TGF-beta on the day of burst. Conclusion: The patients of peritonitis undergoing prolonged surgery in the presence of risk factors like anemia, hypo proteinemia, postoperative ileus, wound infection and postoperative pulmonary infection have high risk of abdominal wound dehiscence.

A Case Report ofMycobacterium abscessusPeritonitis in a Patient on Continuous Ambulatory Peritoneal Dialysis

Mycobacterium is an uncommon cause of peritonitis in patients receiving peritoneal dialysis (PD), and the incidence of nontuberculous mycobacterium (NTM) peritonitis is even rarer since the majority of mycobacterial peritonitis cases are caused by Mycobacterium tuberculosis. However, NTM peritonitis has been known to result in a high mortality rate with delayed diagnosis and treatment. In this study, we report a case of Mycobacterium abscessus peritonitis in a 52year-old male under continuous ambulatory peritoneal dialysis (CAPD). (Ann Clin Microbiol 2013;16:101-104)