A study on clinical profile of patients with peritonitis secondary to hollow viscous perforation

Abstract

Peritonitis involves the rapid removal of contaminants from the peritoneal cavity into the systemic circulation. It occurs because contaminated peritoneal fluid moves cephalad in response to pressure gradients generated by the diaphragm. The fluid passes through stomata in the diaphragmatic peritoneum and is absorbed into lymphatic lacunae. The lymph flows into the main lymphatic ducts via the substernal nodes. The resultant septicemia predominantly involves gram-negative facultative anaerobes and is associated with high morbidity. A prospective clinical study was conducted on 80 consecutive patients who presented to the surgical department of Hospital and Research Centre with peritonitis secondary to hollow viscus perforation. Study population consisted of 80 consecutive patients with peritonitis secondary to hollow viscus perforation which were confirmed on emergency laparotomy. In the study group of 80 patients, majority of the patients had duodenal perforation (40%). Highest survival rate was seen among duodenal perforation 32 of 32(100%) and the highest mortality was seen among patients with gastric, unknown and colonic perforations. The time of presentation of patients ranged from < 24 hours to 10 days. Most of the patients presented within 1-2 days. Mortality increased correspondingly with delay in presentation to the hospital. It was 25% for 1-2days, 62.5% for 3-5 days and 12.5% for 6 to 10 days. Delayed presentation was usually seen in cases of peritonitis secondary to appendicular perforation which had better prognosis compared to other hollow viscus perforation presenting late.