A study of acute peritonitis: evaluation of its mortality and morbidity

Abstract

INTRODUCTIONAcute peritonitis remains an important cause of morbidity and mortality in emergency surgery. The contributory causes are delay in seeking the surgical advice, infection, toxemia, old age, associated illnesses and post-operative complications. 1Despite of the progress in antimicrobial agents, intensive care treatment, the present mortality due to diffuse suppurative peritonitis from 10-20 % continue to be unacceptably high. The outcome of an abdominal infection depends on complex interaction of many different factors and the success obtained with the early onset of specific therapeutics. 3 ABSTRACTBackground: Acute peritonitis remains an important cause of morbidity and mortality in emergency surgery. The contributory causes are delay in seeking the surgical advice, infection, toxemia, old age, associated illnesses and postoperative complications. The objective of this study was to evaluate the mortality and morbidity in cases of acute peritonitis and to evaluate the factors affecting the outcome of peritonitis. Methods: This is a prospective, non-randomized study of 120 cases which were treated as surgical emergencies for acute peritonitis during July 2009 to July 2011 at S. V. S. Hospital, Mahabubnagar. Thorough clinical examination was done. Clinical symptoms and signs namely pain abdomen, distension, vomiting, tenderness, guarding, rigidity, absent bowel sounds; obliteration of liver dullness formed the criteria for suspicion of peritonitis. Plain x-ray abdomen and ultra sound abdomen were done to confirm the diagnosis. Results: A total of 120 patients were studied out of which 28 died giving a mortality rate of 23.33%. Patient's age ranged from 10-82 years with a mean age of 39.57 years. Maximum deaths were seen in the age group of 50-64 years. Among the studied cases majority were males i.e. 100 males compared to only 20 females. But the death rates were found to be almost similar among both the sexes. i.e. 24% in males compared to almost similar i.e. 20% in females. From the above table, it is seen that survival was 100% if the exudates was clear. As the exudates consistency deteriorated, the survival rate decreased and the mortality rate increased. Most common cause of peritonitis in the study was DU perforation 40%. Mortality rate was found to be very high in case of peritonitis caused by gangrenous bowel (46.15%) followed by trauma in 37.5% of cases. Conclusions: A total of 120 cases were studied. Mortality was 23.33% and morbidity was 51%. Out of the variables studied Age >50 years was significant. Pre-op duration of >24 hours was significant. Nature of peritoneal fluid was also significant. Female sex was not found to be significant. Early diagnosis and intervention is the best way to prevent mortality and morbidity in peritonitis.

Predictors of 30-Day In-Hospital Mortality in Patients Undergoing Urgent Abdominal Surgery Due to Acute Peritonitis Complicated with Sepsis

“…However, this number might vary and depends on the indications, specific patient characteristics, and health system factors [13,22]. Acute peritonitis remains an important cause of morbidity and mortality in emergency abdominal surgery [23]. Mortality in intra-abdominal sepsis ranges from 28% to 47% [22,24,25].…”

Management of postoperative complications in patients with acute peritonitis

“…An important component of the treatment of acute peritonitis is the ability to prognose adequately the possibility of postoperative complications, which allows to use appropriate preventive measures [1][2][3][4][5][6][7]. For the case, mentioned above, numerous methods, based on the account of various parameters [8][9][10][11][12], are developed.…”

“…As a result, APACHE, SAPS, SOFA and other scales [8][9][10][11][12][13][14][15][16] which allow estimating the severity of the patients and the possibility of death are suggested for predicting the effects of treatment. Mannheim peritonitis index (MPI) [5] is acknowledged in many countries, but its only function is determination of the peritonitis severity. It is clear, that with the increasing of peritonitis severity and the patients condition, the probability of postoperative complications increases, but mentioned above methods do not allow differentiating the risk of separate postoperative complications [17][18][19][20].…”

Two-stage prognosis of postoperative complications in patients with acute peritonitis

“…An important component of the treatment of acute peritonitis is the ability to prognose adequately the possibility of postoperative complications, which allows to use appropriate preventive measures (1,2,3). For the case, mentioned above, numerous methods, based on the account of various parameters (4,5,6,7), are developed. But none of them is fully accepted, due to several reasons, including a large number of parameters that determine the complexity of use, low informative methods based on a small number of criteria etc.…”

“…As a result, APACHE, SAPS, SOFA and other scales Ref (8,9) which allow to estimate the severity of the patients and possibility of death are suggested for predicting the effects of treatment. Mannheim peritonitis index (MPI) (5) is acknowledged in many countries, but its only function is determination of the peritonitis severity. It is clear, that with the increasing of peritonitis severity and the patients condition, the probability of postoperative complications increases, but mentioned above methods do not allow to differentiate the risk of separate postoperative complications.…”