A 3 Year Prospective Study of 1400 Cases of Perforation Peritonitis: Asiaas Largest Single Centre Study

Abstract

Aims Objectives Intestinal Perforations are most common surgical emergencies seen worldwide Despite improvement in diagnosis antibiotics surgical treatments and intensive care support it is still an important cause of mortality in surgical patients This study was done to know the spectrum of etiology clinical presentation management and treatment outcomes of patients admitted with perforation peritonitis in our hospital Methods A prospective study was done over a period of 3 years from January 2011 to December 2013 in SMS medical college and hospital Jaipur Rajasthan which included 1400 patients diagnosed with perforation peritonitis All patients admitted with perforation of gastrointestinal tract were included in this study All cases of primary peritonitis and anastamotic leaks were excluded from this study Results Total of 1400 cases were included with 74 28 being males The time taken for resuscitation diagnosis and preparation of patient for surgery was less than 12 hours in 83 4 of cases Most common symptom with which patient presented was abdominal pain 99 followed by nausea 92 vomiting 85 abdominal distension 71 fever 64 and altered bowel habit 42 12 patients were in shock Most common site of perforation noted was duodenum 35 8 followed by ileum 27 6 Gastroduodenal perforations were mainly caused by Acid peptic disease 93 Jejunal by blunt trauma abdomen 96 ileal by typhoid 64 and tuberculosis 31 and colonic by malignancy 77 Primary repair was done in 49 6 cases 11 cases required resection and anastomosis 21 required resection without anastomosis and Appendicectomy was done in 18 4 cases Overall mortality was 7 2 Conclusion In contrast to western literature where lower gastrointestinal tract perforations predominate upper gastrointestinal tract perforations constitute the majority of cases in India with APD typhoid and tuberculosis being the commonest causes