Spectrum of Perforation Peritonitis in Delhi: 77 Cases Experience

Abstract

Perforation peritonitis is the most common surgical emergency encountered by surgeons all over the world as well in India. The spectrum of etiology of perforation peritonitis in tropical countries continues to differ from its western counterpart. This study was conducted at Hindu Rao Hospital, Municipal Corporation of Delhi, New Delhi, India, designed to highlight the spectrum of perforation peritonitis in the eastern countries and to improve its outcome. This prospective study included 77 consecutive patients of perforation peritonitis studied in terms of clinical presentations, causes, site of perforation, surgical treatment, postoperative complications, and mortality at Hindu Rao Hospital, Delhi, from March 1, 2011 to December 1, 2011, over a period of 8 months. All patients were resuscitated and underwent emergency exploratory laparotomy. On laparotomy cause of perforation peritonitis was found and controlled. The most common cause of perforation peritonitis noticed in our series was perforated duodenal ulcer (26.4 %) and ileal typhoid perforation (26.4 %), each followed by small bowel tuberculosis (10.3 %) and stomach perforation (9.2 %), perforation due to acute appendicitis (5 %). The highest number of perforations was seen in ileum (39.1 %), duodenum (26.4 %), stomach (11.5 %), appendix (3.5 %), jejunum (4.6 %), and colon (3.5 %). Overall mortality was 13 %. The spectrum of perforation peritonitis in India continuously differs from western countries. The highest number of perforations was noticed in the upper part of the gastrointestinal tract as compared to the western countries where the perforations seen mostly in the distal part. The most common cause of perforation peritonitis was perforated duodenal ulcer and small bowel typhoid perforation followed by typhoid perforation. Large bowel perforations and malignant perforations were least common in our setup.

Spectrum of nontraumatic perforation peritonitis: a prospective study of 277 cases with special reference to morbidity and mortality

“…who reported majority of them being in age group of 35-45 years. Mean age in our study was 30 which was comparable to that Yadav et al 6 , who reported the mean age to be 33.9 yrs. Males were seen to predominate in incidence in all the studies [6][7][8] .…”

“…Mean age in our study was 30 which was comparable to that Yadav et al 6 , who reported the mean age to be 33.9 yrs. Males were seen to predominate in incidence in all the studies [6][7][8] . The highest male preponderance was noticed by Jhobtaet al 7 , where the ratio of male to female was 5.2:1, followed by Yadav et al6 where the ratio was 4.9:1, which was almost similar to our study in which the ratio was 5.6:1.…”

“…Our study showed 58.48% patient had perforations due to peptic disease which was the most common cause of perforation. This was more than studies done by Jhobtaet al 7 , Afridi et al 8 and Yadav et al 6 .…”

A Comparative Study of Polydioxanone and Nylon for Abdominal Wall Closure With Interrupted Figure of Eight in Peritonitis Cases

“…Suture sinus occurred more frequently with nylon suture because of its long memory and stiff nature. Sinus formation occurred less frequently with the use of PDS because it had been found to be smooth, pliable and minimal memory (Table 5) [4,8,9].…”

“…This was probably due to interrupted technique of fascia closure, in which if any of suture was cut through, rest of sutures retained the fascia in opposition. Delayed absorbable and non-absorbable sutures were comparable in terms of incisional hernia incidence because PDS sutures loosed half of their mechanical strength in about 3 weeks and complete degradation took place in around 6 months, thus providing wound support for longer periods and reducing the chances of hernia formation (Table 6) [4,6,[9][10][11]. In nylon group, stitch granuloma rate was found to be 3.3% as compared to 0% in PDS group.…”