Perforation peritonitis: a clinical profile and management

Perforative peritonitis is the most common surgical emergency in general surgical practice[2]. The Indian aetiological spectrum of perforation continues to differ from that of the Western world and there is the paucity of data regarding its aetiology, prognostic indicators, morbidity and mortality pattern. In the majority of cases, delayed presentation to the hospital occurs with well-established generalized peritonitis and varying degree of septicaemia.
This descriptive cross-sectional study was conducted at Dr D. Y. Patil Medical College from 2017 to 2019 with a sample size of 30 patients. All details of the patients including clinical history, examination findings, laboratory and radiological investigations, intra-operative findings, and post-operative complications were studied.
Perforation peritonitis had a male: female ratio of 3.29:1; and was more commonly seen between the age group of 21-30 years, whereas peptic ulcer perforation had a bimodal distribution (21-30 years and 51-60 years). Appendicular perforation was seen in the younger age group. Small bowel perforation commonly occured after 3rd decade of life. Descending order of perforation sites: duodenum and stomach, appendix, ileum, jejunum, colon and gall bladder. Commonest aetiology was peptic ulcer perforation, followed by appendicitis and enteric fever. Majority of patients presented after 48 hours, in the stage of established generalised peritonitis.
The diagnosis was possible by pneumoperitoneum on X-ray abdomen standing in 70% and only a few needed CT for diagnosis. Laparotomy followed by primary closure of perforation with or without live omental patch was the commonest procedure. Appendicectomy was done in appendicular perforation whereas occasionally, resection anastomosis of involved small bowel segment was required. Proximal diversion was not routinely necessary; only if there are severe contraindications to a primary RA. E. coli was the most common peritoneal contaminating organism followed by Klebsiella and Proteus mirabilis. The post-operative complication rate was 53.3% (wound infection 30%) and the mortality rate was 3.3%.