Background: The present study was carried out to evaluate the ASA Grading and Duration of stay among Secondary Peritonitis cases and its association with outcome in a tertiary care Hospital. Material and Methods: This study was a longitudinal, prospective study in which all patients presenting to the Department of Surgery, IGMC, Shimla over a period of twelve months from January 2021 – December 2021 and with a diagnosis of secondary peritonitis after fulfilling the inclusion and exclusion criteria were recruited. Relevant information was collected and further analysed by using IBM SPSS Statistics. Results: In the present study a total of 250 patients with diagnosis of perforation peritonitis were evaluated. Among the total Males were 205 (82%) and Females were 45 (18%). Mean age of the patients was 47.28±17.34 years with range from 18 to 87 years. Among the total, 99(39.6%) patients were age less than 40 years while 151(60.4%) patients were aged > 40 years. Among the total, 32(12.80%) were expired while 218(87.20%) were discharged after treatment. Among the total, 114(45.60%) patients were in grade 1 according American Society of Anesthesiologists (ASA) scoring system, 107 (42.80%) were in grade 2, 22(8.80%) were in grade 3 and 7(2.80%) were in grade 4. Among the total 32 patients who were expired, 2(6.3%) were in grade 1, 19(59.4%) were in grade 2, 9(28.1%) were in grade 3 and 2(6.3%) were in grade 4 while among the total 218 patients who were discharged, 112(51.4%) were in grade 1, 88(40.4%) were in grade 2, 13(6.0%) were in grade 3 and 5(2.3%) were in grade 4 according American Society of Anesthesiologists (ASA) scoring system. There was found significant association between ASA Grading and mortality. The mean duration of hospital stay among study participants was 8.99±6.07 days with range 1 to 40 days. The mean duration of hospital stay among 32 expired patients was 9.19± 8.26 days while among 218 discharged patients was 8.96±5.70 days. There was no significant association between duration of hospital stay and mortality. Conclusion: The present study concluded that most of patients of secondary peritonitis were in grade 1 of American Society of Anesthesiologists (ASA) scoring system old and there was significant association of mortality with ASA Grading but not with duration of stay in hospital.
Background: Peritonitis still poses major problem for surgeons as far as morbidity and mortality is concerned. The aim of this study is to evaluate the Socio-demographic characteristics and its association with outcome in Secondary Peritonitis cases in a tertiary care Hospital. Material and Methods: This study was a longitudinal, prospective study in which all patients presenting to the Department of Surgery, IGMC, Shimla over a period of twelve months from January 2022 – December 2022 and with a diagnosis of secondary peritonitis after fulfilling the inclusion and exclusion criteria were recruited. Relevant information was collected and further analysed by using IBM SPSS Statistics. Results: In this study, a total of 250 patients with diagnosis of perforation peritonitis were evaluated. Among the total Males were 205 (82%) and Females were 45 (18%). Mean age of the patients was 47.28±17.34 years with range from 18 to 87 years. Among the total, 99 (39.6%) patients were age less than 40 years while 151 (60.4%) patients were aged > 40 years. Among the total, 32 (12.80%) were expired while 218 (87.20%) were discharged after treatment. Among the total 205 males, 19 (9.3%) were expired and 186 (90.7%) were discharged while among total 45 females 13 (28.9%) were expired and 32 (71.1%) were discharged. There was significant difference in mortality among males and females. Mean age of 32 expired patients was 59.16±13.32 years while mean age of 218 discharged patients was 45.49± 16.96 years. There was significant difference in mortality according to age. Among the total 205 Males mean BMI was 21.93±3.00 while among the total 45 females mean BMI was 20.68±2.46. Among the total 32 expired patients mean BMI was 22.69±3.54 while among the total 218 discharged patients mean BMI was 21.76 ±2.80. There was no significant difference in mortality according to BMI. Conclusion: In the present study maximum patients of secondary peritonitis were males and less than 40 years old. There was significant association of mortality with gender and age group.
Background: The present study was carried out to evaluate the serum lactate, pH and procalcitonin level as a prognostic indicator for mortality among secondary peritonitis patients. Material and Methods: This cross sectional study was conducted by Department of Surgery, IGMC, Shimla over a period of twelve months from January 2021 – December 2021 among patients with a diagnosis of secondary peritonitis after fulfilling the inclusion and exclusion criteria. Relevant information was collected and further analysed by using IBM SPSS Statistics. Results: A total of 250 individuals with a diagnosis of perforation peritonitis were assessed. Of the total, 32 (12.80%) passed away while 218 (87.20%) were discharged. Mean Pre (AL1), Postoperative (AL24) lactate level and Absolute lactate clearance (AL1 - AL24) was 2.48±1.42 and 1.74±1.52 and 0.74 mmol/L respectively. There was significant difference in the AL1 and AL24. Mean AL1 in expired patients was 3.78±2.24 mmol/L while among discharged patients it was 2.29 ±1.15 mmol/L and its increased level was significantly associated with mortality. The mean AL24 in expired patients was 3.67±3.18 mmol/L while among discharged patients it was 1.45 ±0.76 mmol/L and its increased level was significantly associated with mortality. The mean AL1 - AL24 in expired patients was 0.11±2.79 mmol/L while among discharged patients it was 0.84 ±1.1- mmol/L and its decreased level was significantly associated with mortality. Mean Pre (pH1), Postoperative (pH24) pH level and Procalcitonin was 7.33±0.10 and 7.35±0.11 and 0.88±0.80 ng/ml respectively. Mean pH1 in expired patients was 7.16±0.09 while among discharged patients it was 7.36 ±0.08 and its decreased level was significantly associated with mortality. The mean pH24 in expired patients was 7.17±0.13 mmol/L while among discharged patients it was 7.38 ±0.07 and its decreased level was significantly associated with mortality. The mean Procalcitonin level in expired patients was 2.58 ±1.26 ng/ml while among discharged patients it was 0.63 ±0.18 ng/ml and its increased level was significantly associated with mortality. Conclusion: The study concluded that increased Pre (AL1), Postoperative (AL24) lactate and Procalcitonin level while decreased Absolute lactate clearance (AL1 - AL24) , Pre (pH1) and Postoperative (pH24) pH level was significantly associated with mortality.
Secondary peritonitis is the most common form that follows an intra-peritoneal source usually from perforation of hollow viscera. Acute generalized peritonitis due to underlying hollow viscous perforation is a critical & life-threatening condition. It is a common surgical emergency in most of the general surgical units across the world. It is often associated with significant morbidity and mortality. In the present study Perforation peritonitis is associated with 12.8% mortality. Initial lactate, postoperative (24 hours) lactate is significant variables for mortality with critical values up to 3.78 mmol/L and 3.67 mmol/L respectively. Initial lactate, postoperative (24 hours) lactate values up to 2.29 mmol/L and 1.45 mmol/L respectively were reported in case of survivors. The lactate value of more than 2.5 mmol/L ascertained to have 64 % mortality. Initial pH, postoperative (24 hours) pH are significant variables for mortality with critical value of 7.16 and 7.17 respectively. Initial pH, postoperative (24 hours) pH value of 7.36 and 7.38 respectively were reported in case of survivors. Procalcitonin values of more than 2.58 ng/ml (normal range 0.01-0.05 ng/ml) ascertained to have 56.25 % mortality.
The self-insertion of sewing needles into the urethra is an unusual emergency faced by a urologist. The most common cause for self-insertion of urethral foreign bodies is unknown however autoerotism/psychological impairment has been implicated. Because of guilt and embarrassment, patients usually do not take medical advice unless he is symptomatic. A 24-year male inserted a sewing needle through the urethra for autoerotic stimulation which has impacted at proximal bulbar urethra and piercing the post wall of the urethra towards the rectum. The needle was successfully removed by cystoscope assistance with difficulty after grasping with forceps. Follow-up after cystourethroscopy is important for diagnosing urethral stricture. The main objective of this case reports that foreign bodies inserted especially in the urethra can migrate. Milking of a needle is contraindicated as it may pierce the urethra and migrate to adjacent structures. Removal of these needles under cystoscopy guidance is mandatory.
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