Online ISSN: 2515-8260

Keywords : peritonitis


Use Of Mannheim Peritonitis Index Screening System, In Predictingthe Outcome In Patients With Peritonitis At Sharda Hospital

Mridula Kashyap, Mudasir Ahmad, Ayaz Ahmad Bhat, Suresh Kalyanasundar .

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 1, Pages 3517-3525

Background: Peritonitis is inflammation of peritoneum and peritoneal cavity caused by localized or generalized infection.
Primary peritonitis results from bacterial, chlamydial, fungal, or mycobacterial infection in absence of perforation or inflammation of GI or GU tract. Secondary peritonitis occurs in the setting of GI or GU perforation or inflammation with common causes including acute appendicitis, colonic diverticulitis, and pelvic inflammatory disease.
Methods: This is an observational prospective cross sectional study including 73 patients presenting to surgical emergency with features of peritonitis. Patient’s information were collected both on hospitalization and after surgical exploration; severity of peritonitis was evaluated using the MPI. According to MPI score patients were divided in appropriate groups(<21,21-27,>27) and analyzed accordingly. The statistical analysis used chi-square test, Kolmogorov-Smirnov test, Kruskal Wallis test& ANOVA test.
Result: In groups <21, 21‑27 and > 27 points according to MPI mortality was 0%, 10.53% and 76% respectively. age > 50 was largely associated with increased mortality. There has been a significant correlation between the MPI score and organ failure, Hospital stay.
Conclusion: MPI scoring system is a simple and effective tool for assessing this group of patients, and can be used as a guiding tool to decide on the management of the patient after the definitive procedure is done.Increasing scores are associated with poorer prognosis, needs intensive management and hence it should be used routinely in clinical practice

Prospective observational assessment of the aetiopathological profile of on small bowel perforation and its management

Dr. Alishala Lingam, Dr. Talluri Suresh Babu, Dr. Talla Srinivas

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 1, Pages 3583-3589

The objective of the study was to study the various causes, incidences and clinical features of small bowel perforations and various surgical procedures and it’s the outcome.
Methods: The present study was conducted in the Department of General Surgery for the period of 2 years and all the patients of small bowel perforation of both sexes and of different ages was included. 50 patients were included in the study. The protocol was reviewed and approved by the ethics committees of this institution. Patients were included after taking their informed consent for the study.
Results: In the present study, majority of the patients (36%) were of age group 36-45 followed by (28%) 26-36 age groups. There were 40 (80%) males as compared to females 10 (20%). In this study, 35 cases (70%) of perforation were due to peptic ulcers. Next order cases due to trauma consist of 10 cases (20%). Tubercular perforation was seen in 2 patients (4%), and due to Crohn’s disease, only 1 case was found. Typhoid perforation was seen in 1 case. Malignant perforation was in 1 case (2%) which was found to be gastrointestinal stromal tumours after histopathological examination. In this study, free peritoneal fluid was found in 43 cases (86%). Free gas in the peritoneal cavity was found in 40 cases (80%) due to third space fluid collection and escape of bowel gas into the peritoneum, respectively. Mesenteric lymphadenitis and thickened omentum were found in 2 cases (4%) due to tuberculosis and malignancy.
Conclusion: Duodenal perforation is the most common cause of small intestinal peforation. Smoking and consumption of alcohol & NSAIDS are the most important risk factors for small bowel perforation. Patients mainly presented with abdominal pain and distension with features of peritonitis. X-ray abdomen suggested of pneumoperitoneum in most of the patients. Resuscitation followed by closure of perforation with omental patch was the most common management procedure done.

Descriptive study of non-traumatic perforative peritonitis at a tertiary care hospital

Dr. Somashekhar L Samagandi, Dr. SB Rajashekar, Dr. Gurubasavana Gouda Yale, Dr. Vishwajith K

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 2155-2160

Introduction: Peritonitis is defined as inflammation of the serosal membrane that lines abdominal cavity and organs contained therein. Secondary peritonitis caused due to non-traumatic hollow viscous perforation is a common occurrence in this country which requires emergency surgical intervention. In our prospective study we tried to find out the incidence of perforative peritonitis which presented to our tertiary care hospital with respect to age and gender, relative frequency of anatomical site of perforation, their causes, presentation, treatment and outcome.
Methods: The study has been based on the analysis of 98 cases of non-traumatic perforated peritonitis patients admitted to our tertiary hospital, during the study period with prior inclusion criteria.
Each patient was examined thoroughly, after taking a detailed history and social demographic factors were noted. Cases were admitted as emergency and relevant immediate investigations were done. The diagnosis was made with history, clinical features and radiology to support the diagnosis.
Out of 98 cases, 92 underwent emergency laparotomy, at laparotomy the site of perforation, its pathological conditions, the amount of peritoneal contamination were noted. Perforation site specific operative procedures were done. In post-operative period, patients were closely monitored and complications were managed appropriately.
Results: Out of 98 cases 84(85.7%) were males. 25(32.7%) of the patients were in a age group of 21-30 years. Majority (35.7%) of the cases presented after 24-48 hours to our hospital. Pain abdomen was the most consistent symptom present in all the cases. Smoking (43.12%) and NSAIDs(21.4%) were the most important risk factors. Duodenum was the most common site of perforation (43.9%) followed by ileal (24.5%) and gastric (21.4%). In postoperative period 34.3% of patients had some form of complication and death occurred in 8 patients (8.16%).
Conclusion: Non-traumatic perforative peritonitis is more common in young age group (21-30 years) with male preponderance and is more common in rural population. Smoking and NSAIDs are the most common causative factors although it is multifactorial. Peptic ulcer disease is the most common cause of perforation. Delayed presentation to the hospital is the most common cause of morbidity and mortality

EFFICACY OF MANNHEIM PERITONITIS INDEX (MPI) SCORE IN PATIENTS WITH PERFORATION PERITONITIS IN A TERTIARY CARE SETUP

Ankit Meena, Rajveer Singh, Minaxi Sharma, Manish Bhadoo, Deepak Sethi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1778-1784

Introduction: Peritonitis is an inflammatory or suppurative response of the peritoneal lining to direct irritation. Surgical treatment for perforation peritonitis is highly demanding and very complex. The combination of improved surgical technique, antimicrobial therapy, and intensive care support has improved the outcome of such case. A scoring system which can compare patient populations and severity of illness, objectively to evaluate the treatment strategy is the required for evaluative research of intensive care. The present study was undertaken to evaluate the efficacy of Mannheim Peritonitis Index (MPI) score in patients with perforation peritonitis.
Materials and Methods: The present prospective study was carried among 50 patients ofperitonitis.  Using history, clinical examination and lab values risk factors found in MPI were classified according to values indicated and individual variable scores were added to establish MPI score. The cases were grouped into three: those below 21 points, between 21-29 points, and those above 29points. The data was analyzed, each variable in the MPI score along with other patient variables was analyzed using chi square analysis with various outcomes that were noted in the study. P value
Results: Around 80% of high risk group (MPI > 29) required more than 5 days of ICU stay. High risk group (MPI>29) has more complications than intermediate(MPI 21 TO 29) and low risk group.(MPI <21).Most common complication found in this study is Surgical site infection. Up to 60% patients with score >29 developed surgical site infection in post operative period which was about 42% in patients with score 21 -29 and about 19% in patients with score 29 and only one (7%) required inotropes with score 29. 40% patients with score >29 developed multi organ dysfunction. All the patients who developed MODS died. Thus, development of MODS post operatively is bad predictor of mortality.
Conclusion: Among the various variables of the scoring system duration of pain, organ failure on presentation and presence of feculent exudates these factorshad a significant hand in predicting the eventual outcome of thepatient.