Hollow Viscus Perforation Research Articles

Spontaneous uterine perforation presenting as acute abdomen: a diagnostic challenge

Spontaneous uterine perforation resulting in generalized peritonitis in postmenopausal women is a very rare entity usually caused by pyometra and is associated with high morbidity and mortality. The clinical picture of uterine perforation secondary to pyometra are similar to hollow viscus perforation which makes preoperative diagnosis difficult. Definitive diagnosis can be made with laparotomy or laparoscopy. We report a case of 62 years old female patient who presented with acute generalized peritonitis with pneumoperitoneum having history of pigtail insertion right kidney for right non-functional kidney with gross hydronephrosis two days back, which was more complicating the clinical picture. This case report aims to alert surgeons to the possibility that uterine perforation secondary to pyometra also shows air under diaphragm apart from hollow viscus perforation.

Utility of Mannheim’s Peritonitis Index in Predicting Outcome of Peritonitis in Patients with Hollow Viscous Perforation

INTRODUCTION Peritonitis due to hollow viscous perforation is one of the common causes for emergency surgery requiring immediate surgical intervention. Scoring systems that provide objective descriptions of the patient’s conditions at specific points in the disease process aid our understanding of these problems. Hence this study is undertaken to study the effectiveness of Mannheim’s peritonitis index in predicting the outcome in peritonitis patient. MATERIAL AND METHODS This study was carried out in Department of Surgery of National Medical College and Teaching Hospital. A total of 44 patients with diagnosis of peritonitis due to hollow viscous perforation over period 2 years was included in this study. History and detailed clinical examination were performed as per the working proforma. Blood investigation was done. Data analysis was done using SPSS (Statistical Package for social sciences) version 25. RESULTS In this study 44 cases of peritonitis due to hollow viscous perforation were included. The mean age of patients was 38.16 ± 21.09 years. Abdominal pain and abdominal distension were most common presentation. MPI scoring system done in all patients depending on preoperative and intra-operative and patients were categorized into three categories, <21, 21 to 29, and >29 where 50% of patients had MPI less than 21, 25% of patient had MPI score 21-29 and 25% of patient had MPI score >29. CONCLUSION MPI scoring system is required to predict the outcome in peritonitis patients and whether the line of management taken is appro- priate or needs to be changed.

Effectiveness of Mannheim Peritonitis index in Predicting the Morbidity and Mortality of Patients with Hollow Viscous Perforation

Effectiveness of Mannheim Peritonitis index in Predicting the Morbidity and Mortality of Patients with Hollow Viscous Perforation

Role of Diagnostic Laparoscopy in the Evaluation of Blunt Injury to Abdomen in Hemodynamically Stable Patients

BACKGROUND
 In this study, we wanted to evaluate the role of diagnostic laparoscopy in the management of blunt injury to abdomen in hemodynamically stable patients.
 METHODS
 This was a hospital based prospective observational clinical case study conducted among 30 patients who presented with blunt trauma of abdomen to the Department of General Surgery, Kamineni Academy of Medical Sciences and Research Centre, L.B. Nagar, Hyderabad, from September 2019 to September 2021 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. The aim of the study is to assess the role of Diagnostic Laparoscopy in the management of Blunt Injury to Abdomen in Hemodynamically Stable patients. Objective of the study were to assess the incidence of Hollow Viscus Injury not detected by clinical or radiological assessment, incidence of persistent bleed and to assess the incidence of Mesentery injury not detected by clinical or radiological assessment.
 RESULTS
 The most common mode of injury was road traffic accidents (23 cases) 76.66 %, followed by fall from height (3 cases) 9.99 %. Then accidents and assaults which were (2 cases) 2.22 % each. Ongoing bleeding from solid organ injuries was seen intra-operatively in 3 cases (9.99 %). P value = 0.0237 was calculated using Fischer’s exact test and was found to be significant P < 0.05. Most common grade of liver injury was Grade 1- 37.75 % followed by grade 3 - 33.33 %, then grade 2 - 20.8 % and grade 4 - 8.33 %. Grade 1 and grade 2 splenic injuries were more common with 36.36 % (4 cases) each. Followed by grade 3 27.27 % (3 cases). Diagnostic laparoscopy ongoing bleed was noted in 9.99 % (3 cases), followed by mesenteric injury in 6.66 % (2 cases) and hollow viscous perforation in 3.33 % (1 case). Total of 6 therapeutic procedures were done after diagnostic laparoscopy. Out of which, 4 were carried out in laparoscopy (66.66 %) and two were converted from laparoscopy to laparotomy (33.33 %).
 CONCLUSIONS
 Diagnostic laparoscopy can be carried out in patients of blunt trauma of abdomen, who are hemodynamically stable without any increase in morbidity or mortality. It is a highly useful tool to detect injuries which could not be detected on CT scan. Laparoscopic surgery can be used both as a diagnostic and therapeutic modality. Laparoscopy helps in reducing the negative laparotomies and significant decrease in both morbidity and mortality. With advances in technology and increasing in expertise in laparoscopy, it can be concluded that diagnostic laparoscopy is a valuable modality in the diagnosis and management of patients with blunt trauma to abdomen.

A Giant Gastrojejunal Trichobezoar: About A Case

A gastric bezoar is a foreign materiel occur in the stomach & can be extended through duodenum, jejunum and colon. Trichobezoar, is an underdiagnosed entity, has to be considered in children and adolescents (especially females suffering from trichotillomania and trichophagia). The disease is usually underdiagnosed so showed by threatening complications: occlusion, bleeding of perforation. The present report concerns a 19-year-old girl presenting with abdominal pain. On the abdominal exam an acute peritonitis which rapidly evolved to septic shock and an emegercy laparomy was performed, by supraumbilical laparaotomy and anterior gastrotomy objictived peritonitis jejunal perforation caused by large gastrojejunal trichobezoar. Acute peritonitis following hollow viscus perforation caused by tichobezoars is an therapeutic emergency in order to avoid visceral spillage, peritonitis & mortality.

Typhoid Ileal Perforation: Comparative Study of Ileostomy Versus Primary Repair and associated Morbidity and Mortality

Objectives: To study the result of primary repair with ileostomy in cases of typhoid ileal perforation.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Department of Surgery, Jinnah Postgraduate Medical Center, Karachi Pakistan, from May 2019 to Jun 2020
 Methodology: Participants who were operated on for typhoid ileal perforation were included, while patients who presented with a hollow viscus perforation other than ileal perforation were excluded from the study. Peritoneal lavage and exploration were performed. All per-operative findings were documented. In addition, the socio-demographic and clinical parameters, including the postoperative complications and morbidity/mortality, were documented.
 Results: Out of the 73 individuals with ileal perforation included in this research, 52 underwent primary repair, whereas 21 underwent ileostomy. Patients who had undergone ileostomy had a higher morbidity (61.90%) and mortality (19.00%) rate than patients in the Primary Repair Group. In addition, patients in the ileostomy Group had significantly higher rates of wound dehiscence and infection, electrolyte imbalance, and weight loss than patients in the Primary Repair Group.
 Conclusion: The current study indicates that primary repair is an ideal procedure for typhoid ileal perforation compared to an ileostomy.

Assessment of severity of peritonitis due to hollow viscous perforation- using APACHE II score

: Acute widespread peritonitis caused by a perforated hollow viscus is a potentially fatal illness. It's a common surgical emergency in many developing-country general surgical departments, and it's often associated with substantial morbidity and mortality. Grading the severity of acute peritonitis has greatly aided decision-making and improved the therapeutic success in the management of critically ill patients. Empirically based risk assessment for major clinical events has proven to be tremendously valuable in evaluating new medicines, monitoring resource utilisation, and improving care quality. A hospital based prospective observational study was conducted on patients operated on emergency basis for hollow viscus perforation admitted to the hospital, the study was conducted from OCT 2014 – SEP 2016 at Kamineni institute Medical sciences & hospital, Narketpally, Telengana. A series of 100 cases was compiled for this study during this period. The accuracy in outcome prediction of APACHE–II system was assessed by means of receiver operating characteristic curve and Pearson correlation coefficient. The Analytical data obtained was compared and discussed with the data available in the literature. A total of 100 patients were studied. Out of which there were 86(86%) survivors and 14(14%) non-survivors. Mean APACHE–II score of the study population was 9.80 with a range of 1-30. The predicted death rate for the study population was 16% and observed death rate was 14%. Mean APACHE–II score in survivors was 8.03 where as in non-survivors it was 20.64. The area under the curve using receiver operating characteristic curve analysis was found to be 0.985. The association between the APACHE-II score and the predicted death rate was flawless, with r = 0.99 and P0.001. In patients with peritonitis caused by hollow viscus perforation, an APACHE-II score of 11-20 was found to be a stronger predictor of mortality risk. In patient groups with APACHE-II scores of 0-10 and scores > 20, predicted death did not match observed mortality. APACHI-II scoring system can be used for assessment of group out come in patients with peritonitis due to hollow viscus perforation. However, it does not provide sufficient confidence for outcome prediction in individual patient.

The Role of the Mannheim Peritonitis Index for Predicting Outcomes in Patients With Perforation Peritonitis in a Rural Hospital in India.

Introduction Acute secondary peritonitis due to hollow viscus perforation is a life-threatening surgical condition with significant morbidity and mortality, depending on the severity with outcomes that differ in the Western and developing world. Various scoring systems have been developed to assess the severity and its relation to morbidity and mortality. We conducted this study to evaluate the role of the Mannheim peritonitis index (MPI) in predicting outcomes in perforation peritonitis patients in a rural hospital in India. Materials and methods A prospective study of 50 patients with hollow viscus perforation with secondary peritonitispresented to the emergency department, Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, from 2016 to 2020. Each operated patient was scored according to the MPI to predictmortality. Results The majority of the patients were discharged uneventfully and about 16% (8/50) of the patients expired. The patients with an MPI score of more than 29 had maximum mortality of 62.5%. Mortality was seen in 37.5% of the patients with MPI scores between 21 and 29, whereas no mortality was recorded in patients with an MPI score of 21. Higher mortality was associated with age greater than 50 years (p=0.007), the presence of malignancy (p=0.013), colonic perforation (p=0.014), and fecal contamination (p=0.004). There was no significant correlation with gender (p=0.81), the presence of organ failure (p=1.6), delayed presentation, i.e., preoperative duration >24 hours (p=0.17), and the presence of diffuse peritonitis (p=0.25). Conclusion MPI is a specific, easily reproducible, and less cumbersome scoring method for predicting mortality in patients with hollow viscus perforation (secondary) peritonitis with minimal laboratory investigations. Higher scores correlate with a poorer prognosis and need intensive management, making use of MPI in clinical practice relevant and beneficial, especially in resource-poor settings.

A Prospective Study of Clinicoradiological Scores in Predicting risk of Strangulation in Bowel Obstruction

Introduction: Acute intestinal obstruction is one of the common surgical emergencies leading to variable amount of morbidity and mortality. Strangulation is the most important factor in influencing the outcome and it is critical to accurately and promptly identify the existence of intestinal strangulation. The objective of the study was to assess the clinicoradiological scores in predicting risk of strangulation in bowel obstruction.
 Methods: A prospective study of 50 patients with clinical diagnosis of acute intestinal obstruction attending General Surgery department of Government Mohan Kumaramangalam Medical College and Hospital, Salem during January 2021 and September 2022.
 Results: Most of the study population is between 51 – 60 years with mean age of 55 years with male predominance. Mean time between admission and surgery is 6 hours. All patients had previous history of surgery, with appendicectomy being most common followed by hollow viscous perforation. Of the 50 patients in the study 19 patients underwent resection. Pain > 4 days, Guarding, Total leucocyte count > 10000/mm3, CRP > 75mg/dl, reduced contrast enhancement in CECT is frequently found in strangulated obstruction. On comparing with Schwenter score, of 36 patients who scored 0 -3, 5 patients underwent resection whereas all 14 patients who scored > 4 underwent resection.
 Conclusions: A combination of clinical, laboratory and radiological parameters helps in earlier prediction of risk of ischaemia in acute intestinal obstruction and timely intervention.

A RARE PRESENTATION OF MASSIVE PNEUMOPERITONEUM FOLLOWING INGESTION OF LIQUID NITROGEN SNACK WITHOUT IDENTIFIABLE GASTROINTESTINAL PERFORATION

A 26 year old male patient presented with abdominal distension following ingestion of liquid nitrogen and was diagnosed to have massive pneumoperitoneum both clinically and radiologically. Patient underwent emergency laparotomy in search of perforation, the stomach, Intestines was examined and no hollow viscous perforation was found. All abdominal contents were normal, no tissue necrosis or haemorrhage, no free uid or bleeding was found in the abdomen. Two abdominal drains were placed in the lesser sac and the pelvis and abdomen were closed. The patient was stable post operatively and tolerated oral feeds and discharged on 7th post operative day. Our study revealed that despite of having massive pneumoperitoneum, site of perforation cannot be identied

A clinical observational study of intestinal stoma and their complication from a tertiary care center in India

Background: The present study is designed to deal with an indication of various stoma surgery, type of stoma formed, and various ju=of General surgery, RG Kar Medical College and hospital, Kolkata, from June 2020 to May 2021 The study includes patients 12 years and <65 years of populations All data were collected in a prospective manner with a questionnaire and analyzed. Aims and Objectives: The aim of the study was to study various type of stoma and their indication and to identify the various complication encountered that occurs after the construction of intestinal stomas to assess the ways in which these complication can be minimized and managed in a better way. Materials and Methods: This was a prospective and observational study conducted in the Department of General Surgery, R.G.KAR Medical College and Hospital both the emergency and elective department. The study was approved by the Institutional Ethics Committee. Results: From the study, it was observed that among the study population, most were male 32 (80%) than female 8 (20%). There were two peak age group found to undergo stoma surgery most of which is 31–40 years consisting of 25 (27.5%) and 51–60 years consisting of 25 (27.5%). Most of the stoma surgery was found to be done in emergency 31 (77.5%) than in elective 9 (22.5%) setting. The most common cause of stoma formation was found to be hollow viscous perforation 12 (30%). Among the type of stoma ileostomy is more common than colostomy. Loop stoma formations are more common than end stoma and double barrel stoma. The most common complication following stoma surgery was found to be skin excoriation 30%. Conclusion: Stoma surgery was associated with a high rate of complication irrespective of the surgical expertise, surgical setup, and per operative planning resulting in higher morbidity. With meticulous dissection, post-operative stoma care, early detection, and management of complications, also patient education helps to achieve good outcomes following stoma surgery.

Fluid balance following laparotomy for hollow viscus perforation: A study of morbidity and mortality

Fluid balance following laparotomy for hollow viscus perforation: A study of morbidity and mortality

Mannheim Peritonitis Index in Predicting the Morbidity and Mortality in Patients with Peritonitis due to Hollow Viscus Perforation - A Prospective Study

Mannheim Peritonitis Index in Predicting the Morbidity and Mortality in Patients with Peritonitis due to Hollow Viscus Perforation - A Prospective Study

Idiopathic Gastric Fundal Perforation in a Young Male

Gastric perforation is a life-threatening condition encountered in surgical emergency. Common conditions that cause gastric perforation requiring emergency exploration include peptic ulcers, trauma, iatrogenic injuries and corrosive burns. Gastroduodenal region is the most common site of perforation but perforation in fundus of stomach is unusual. Acute Gastric Dilation (AGD) is a rarely encountered condition that leads to vascular compromise of stomach wall causing ischaemia and necrosis. Hereby reporting the case of a 26-year-old male, who presented with complaint of abdominal pain following heavy meal. Erect skiagram of chest was diagnostic of hollow viscous perforation peritonitis and the patient underwent emergency exploratory laparotomy. A perforation was noted over the posterior aspect of fundus of dilated stomach. Gastric fundectomy and feeding jejunostomy was done. The surgeon should be aware of such cases of AGD, with fundal perforation for active and appropriate management.

Mannheim Peritonitis Index as a Predictor of Post-operative Complications, Mortality and Duration of Hospital Stay in Patients with Peritonitis due to Hollow Viscus Perforation: A Prospective Cohort Study

Introduction: Peritonitis due to hollow viscus perforation is a common surgical emergency and can be life-threatening. Patients who undergo surgery for peritonitis require extensive counselling to fully understand the nature of the disease, the need for surgery, post-operative complications and the duration of hospital stay. Hence, scoring systems are necessary to determine the severity of the disease to provide sufficient prognostic data. Aim: To evaluate the Mannheim Peritonitis Index (MPI) scoring system as a predictor of post-operative complications, mortality and duration of hospital stay in patients with peritonitis due to hollow viscus perforation. Materials and Methods: The prospective cohort study was carried out in 50 diagnosed cases of perforation peritonitis admitted at the centre during the study period from November 2017 to October 2018. MPI was calculated for each patient, following which they were stratified into three risk groups- 1, 2 and 3 with scores of ≤20, 21-29 and ≥30, respectively. Post- operative complications, mortality, and duration of hospital stay were analysed. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) software 24.0. Results: Out of 50 patients included, 36 were male and 14 were female with a mean age of 41.14 years. A total of eight patients suffered mortality. The incidence of mortality in risk Group-1 was 0 out of 29 patients (0%), risk Group-2 was 3 out of 13 patients (23.1%) and risk Group-3 was 5 out of 8 patients (62.5%), respectively and hence MPI was a useful indicator of prediction of mortality in perforation peritonitis patients. The risk factors which had a higher significance in predicting mortality were found to be, organ failure at presentation and the nature of intra-peritoneal exudate with a p-value of 0.029 and <0.001, respectively. In 29 patients, there were no complications and 13 patients had a single complication, 8 patients had multiple complications. The incidence of multiple post-operative complications in a patient in risk Group-1, 2 and 3 were 1 (12.5%), 2 (25%) and 5 (62.5%) patients, respectively. The number of complications in a patient increased as the MPI score increases. Dispersion of duration of hospital stay in discharged patients according to MPI score using Pearsons’s correlation, showed statistical significance with the value of r being 0.6214, the p-value being 0.000011. The duration of hospital stay of patients who were discharged, increased as the MPI score increased. Conclusion: MPI was effective in predicting post-operative complications, mortality and duration of hospital stay in patients with peritonitis due to hollow viscus perforation and hence can be used as an effective tool to facilitate counseling and educate the patient and relatives regarding the expected course of the disease in that particular patient.

Clinical Study of non-traumatic causes and management of generalized peritonitis

Background: Peritonitis refers to an inflammatory response of the peritoneum in the abdominal cavity in terms of activation of local mediator cascades by different stimuli. Therefore, bacterial, viral and chemical agents may cause inflammation of the peritoneal layer. Secondary peritonitis is usually due to spillage of gastrointestinal or genitourinary microorganisms into the peritoneal cavity as a result of loss of integrity of the mucosal barrier. Methods: Cross sectional observational study was performed. All patients admitted and treated for perforation secondary to non-traumatic hollow viscus perforation in surgical units of Department of General Surgery, Government Medical College, Nalgonda, Telangana, India, during the period of October 2019 - September 2021. A detailed history was taken and all the patients were subjected to thorough clinical examination. Patients subjected to laparotomy are followed in post-operative period to know the complications, morbidity and mortality rates. General condition at the time of admission was monitored by noting presenting complaints, pulse, BP, respiratory rate, hydration status. Operative findings were recorded. Necessary surgical intervention done is recorded; post operatively patients will be followed up for any complications. Each case will be studied as per the proforma. Results: The most common age group was 40- 60yrs (53.3%) in the present study. Major etiological factor noted is gastric perforation and next is appendicular perforation& duodenal ulcer perforation. In this study pain abdomen was the predominant symptom and was presented in all cases (100%). In this study guarding/rigidity was seen in all cases (100%). Most of the cases had a mean duration of 10-19days of hospital stay. Mortality rate was found to be 16.6%. Conclusion: In our study, youngest age of small intestine perforation was 23years and oldest was 80 years. Most cases had a duration of hospital stay of 10- 19 days. Main presenting complaint was pain abdomen, vomiting, fever and distension of abdomen. Risk factors for perforations were smoking, tobacco, alcohol and NSAIDs.

Perforation peritonitis: as a spectrum

Background: Peritonitis due to hollow viscus perforation is one of the frequent cause of patient presenting as acute abdomen in clinical practice. The cause of this perforation can be traumatic perforation or an underlying diseased viscus.Methos: The study was conducted in Sir J J group of hospitals, Mumbai between January 2021 to June 2021. A total of 50 cases with peritonitis due to gastrointestinal tract perforation were studied. The patient were studied on the basis of clinical presentation, radiological findings, cause and site of perforation, treatment given, postoperative complication and mortality.Results: Perforated duodenal ulcer (32%) and illeal perforation (24%) were most common in our study which is in contrast to the pattern seen in western part of the world. Perforations due to malignancy were the least commonly seen.Conclusions: As indicated on our study the spectrum of perforation peritonitis in India continues to be different from its western counterpart with duodenal ulcer perforation, perforating appendicitis, typhoid perforation and tubercular perforation being the major causes of generalized peritonitis.

Ileal Perforation by Ingested Fishbone

Hollow viscus perforation is one of the most frequent causes of acute gastrointestinal symptoms, but these are rare due to foreign body (FB) ingestion. The majority of ingested FBs that reach the stomach pass uneventfully through the gastrointestinal tract. Hollow viscus perforation following a FB ingestion frequently occurs at the ileum. Fishbones are often ingested by older population, and only a small number of patients can recall an event of swallowing an FB. Here, we present a case of ileal perforation caused by ingesting a fishbone in a 60-year-old man who recovered successfully after receiving emergency surgical treatment.

S3489 The Uncommon Acute Abdomen: Enteropathy-Associated T-Cell Lymphoma Revealed by Jejunal Perforation

Introduction: Long-standing Celiac disease that is untreated or refractory to gluten-free diet can have dire consequences. Among these, Enteropathy-associated T-cell Lymphoma (EATL) is a rare form of non-Hodgkin’s intestinal lymphoma that carries a poor prognosis with high mortality. This neoplasm can manifest as complicated small bowel disease such as obstruction or perforation. We present a patient with Celiac Disease presenting with an acute abdomen found to have jejunal perforation due to EATL. Case Description/Methods: A 51-year-old male with history of biopsy-confirmed Celiac Disease (CD) presented for severe abdominal pain. Vital signs were stable and laboratory findings showed leukocytosis and lactic acidosis. Abdominal CT revealed closed loop obstruction and pneumatosis with hollow viscus perforation. He was taken to the OR for urgent exploratory laparotomy where purulent fluid and a perforation in the mid-jejunum was discovered. Subsequent jejunal resection with primary anastomosis was performed. Post-operative course was complicated by ileus and urinary retention but ultimately made full recovery. Biopsy of the resected jejunum revealed malignant lymphoid infiltrate in a background of mild villous blunting, increased intraepithelial lymphocytes, ulceration, perforation, and acute serositis consistent with EATL. Follow-up endoscopy was consistent with known CD, but otherwise unremarkable. T-cell receptor rearrangement study and bone marrow biopsy were negative. He was initiated on BV-CHP chemotherapy and achieved complete remission after 6 cycles. After induction, he opted for consolidation (BEAM) chemotherapy followed by autologous bone marrow transplant. Unfortunately, this treatment course was complicated by septic shock with multi-organ failure and ultimately decision was made for comfort care. (Figure) Discussion: Strict gluten-free diet (GFD) is the primary prevention of EATL in CD. Non-compliance to GFD has been shown to significantly increase risk of developing EATL. Small bowel perforation is a rare, but well-documented complication of EATL that must be recognized in CD patients presenting with acute abdomen. Current treatment of EATL with chemotherapy and autologous bone marrow transplant has shown promising improvement in survival rates and reduced mortality rate. For CD patients, strict adherence to GFD with close clinical monitoring is of utmost importance to improve quality of life, minimize progression of EATL, and prevent necessity of risky advanced interventions as highlighted in our case.Figure 1.: Axial view of Abdominal CT showing perforation of small bowel.

S1366 Impact of Hospital Teaching Status on Mortality and Procedural Complications of Percutaneous Paracentesis in the United States

Introduction: Numerous previous studies investigated the impact of medical training settings on outcomes of hospitalized patients. Percutaneous paracentesis is frequently a bed-side procedure that is commonly performed by healthcare providers in training. However, impact of teaching hospital status on outcomes of percutaneous paracentesis to the best of our knowledge have never been studied before. Methods: Hospitalized patients who underwent percutaneous paracentesis were identified from the National Inpatient Sample database 2016 to 2019 across United States teaching and non-teaching hospitals. Univariate and Multivariate logistic regression analysis was performed to determine the risk difference in mortality, postprocedural outcomes and healthcare resources utilization in the studied groups. Multivariate logistic analysis was performed using STATA software and results were adjusted for patient and hospital characteristics and comorbidities. Results: Among 1,031,485 admitted adults’ patients who underwent percutaneous paracentesis, 791,700 (76.8%) subjects were managed at US teaching hospitals, while 239,785 (23.2%) were admitted to non-teaching hospitals (Figure). Patients baseline comorbidities are listed in Table. Inpatient mortality rates (Figure) were significantly higher in individual undergoing paracentesis at US teaching hospitals (aOR 1.29, 95% CI 1.23 - 1.35, p< 0.001) compared to non-teaching hospitals. Similarly, higher risk of procedural complications including hemoperitoneum (aOR 1.90, 95% CI 1.65 – 2.20, p< 0.001), hollow viscus perforation (aOR 1.97, 95% CI 1.54 - 2.51, p< 0.001) and vessel injury/laceration (aOR 15.3, 95% CI 2.12 - 110.2, p=0.007) were noticed in study group when compared to controls. Furthermore, hospital teaching status was associated with prolonged mean length of stay (9.33 days vs 7.42 days, adjusted mean difference (aMD) 1.81, 95% CI 1.68 - 1.94, p< 0.001) and increased charge of care (106,014$ vs 80,493$, aMD 24,926$, 95% CI 21,617$ – 28,235$, p < 0.001). Conclusion: Hospitalized patients undergoing paracentesis in US teaching hospitals have increased risk of mortality, postprocedural complications, prolonged length of stay and increased charge of care when compared to non-teaching hospitals. As the first study to answer this question, further studies are needed to confirm our findings and the relationship impact of new trainees involved in the care of ascites patients on the outcomes of those undergoing paracentesis. Table 1. - Baseline characteristics and comorbidities of patients managed with percutaneous paracentesis in US teaching and non-teaching hospitals Paracentesis %, NO. Teaching %, NO. Non-teaching %, NO. P-value (100,0) 1,031,485 (76.8) 791,700 (23.2) 239,785 Patient’s characteristics Age, mean years 59.3 59.0 60.6 < 0.001 Female 43.8 (451790) 43.9 (347556) 43.3 (103827) 0.028 Racial distribution White 66.0 (680780) 64.23 (508509) 72.15 (173005) < 0.001 Black 12.6 (129967) 13.8 (109255) 8.70 (20861) < 0.001 Hispanic 14.4 (148534) 14.7 (116380) 13.3 (31891) < 0.001 Others 2.75 (28366) 2.88 (22801) 2.32 (5563) < 0.001 Insurance type Medicaid 46.1 (475515) 45.2 (357848) 49.2 (117974) < 0.001 Medicare 23.6 (243430) 23.9 (189216) 22.8 (54671) < 0.001 Private 24.9 (256840) 25.7 (203467) 22.3 (53472) < 0.001 Uninsured 5.33 (54978) 5.20 (41168) 5.75 (13788) < 0.001 Charlson comorbidity index score 1 9.47 (97682) 9.09 (71966) 10.7 (25657) < 0.001 2 7.89 (81384) 7.71 (61040) 8.47 (20310) < 0.001 ≥3 75.2 (775677) 75.6 (598525) 74.0 (177441) < 0.001 Median annual income, us$ 1–43,999 31.0 (319760) 30.8 (243844) 31.7 (76012) < 0.001 44,000–55,999 26.0 (268186) 25.1 (198717) 28.9 (69298) < 0.001 56,000–73,999 23.9 (246525) 24.1 (190800) 23.0 (55151) < 0.001 ≥74,000 19.1 (197014) 20.0 (158340) 16.3 (39085) < 0.001 Hospital characteristics Hospital region Northeast 18.5 (190825) 20.7 (163882) 11.2 (26856) < 0.001 Midwest 21.7 (223832) 22.8 (180508) 18.2 (43641) < 0.001 South 38.0 (391964) 36.0 (285012) 44.6 (106944) < 0.001 West 21.8 (224864) 20.5 (162299) 26.0 (62344) < 0.001 Hospital bed size Small 15.8 (162975) 17.5 (138548) 10.3 (24698) < 0.001 Medium 27.4 (282627) 27.0 (213759) 28.5 (68339) < 0.001 Large 56.8 (585883) 55.5 (439394) 61.2 (146748) < 0.001 Comorbidities Hypertension 27.7 (285721) 27.6 (218509) 28.1 (67380) 0.066 Diabetes mellitus 31.8 (328012) 31.5 (249386) 32.9 (78889) < 0.001 Smoking history 39.9 (411563) 39.6 (313513) 40.9 (98072) 0.001 Hyperlipidemia 22.9 (236210) 22.7 (179716) 23.3 (55870) 0.039 Obesity 12.1 (124810) 12.1 (95796) 12.2 (29254) 0.745 Chronic kidney disease 28.1 (289847) 27.8 (220093) 29.1 (69777) < 0.001 Coronary artery disease 15.4 (158849) 15.1 (119547) 16.5 (39565) < 0.001 Peripheral vascular disease 1.87 (19289) 1.80 (14251) 2.30 (5515) < 0.001 Chronic obstructive lung disease 13.5 (139250) 12.7 (100546) 16.3 (39085) < 0.001 Human immunodeficiency virus 0.60 (6189) 0.70 (5542) 0.40 (959) < 0.001 Congestive heart failure 19.0 (195982) 18.8 (148840) 20.0 (47957) < 0.001 Nephrotic syndrome 0.20 (2063) 0.22 (1742) 0.15 (360) 0.002 Chronic liver disease 66.0 (680780) 65.2 (516188) 68.7 (164732) < 0.001 Malignancy 12.5 (128936) 12.8 (101338) 11.6 (27815) < 0.001 Pancreatitis 4.11 (42394) 4.10 (32460) 3.90 (9352) 0.028 Figure 1.: Flow diagram of study sample.