A CLINICAL STUDY & MANAGEMENT OF PERFORATION PERITONITIS

Kuna Madhuri Devi, Gottapu. Venkata Naidu, D. Prasad Rao

Abstract


Peritonitis due to perforation of viscus, either traumatic or non-traumatic is an important cause of morbidity and mortality in an emergency. Remarkably, however, only within the last century has significant progress been made in the successful treatment of the disease. The reduction in mortality from 90% at the turn of the century to the estimated 10-15% also includes support of improved and effective antibiotics along with our understanding of inflammatory response. Since presentation of a case of perforation peritonitis varies from mild dull aching pain to frank guarding and rigidity with associated symptoms, there is also a need to know the spectrum of presentation as well as the most frequent among them. Peritonitis as such has such diverse etiology and thus there is a need to enlist the different etiologies leading to the disease. Aims and Objectives: The purpose of this study was to evaluate the relative incidence of various causes of perforation and also to find the incidence of G.I. perforation in relation to age, group and sex of the patient. Importance has also been given to the clinical presentation, relevant investigations and various modalities of treatment.Materials and methods: This study has been based on the analysis of 50 cases of gastro-intestinal perforation admitted to AIMS, B G Nagara from October 2008 to April 2010.These were the cases which were admitted consecutively and were treated in the Department of General Surgery. Cases were admitted on emergency basis. Results : Out of 50 patients presented to emergency department with features of perforation peritonitis, 24 patients (48%) of them were found to have peptic ulcer perforation. This was followed by appendicular perforation (20%). Tubercular perforation is relatively rare. Mortality rate was found to be 4%, the cause of which was diagnosed as septicaemia. Conclusion: Surgery is the line of management of perforation peritonitis. Early diagnosis with appropriate investigations and treatment with antibiotics, fluid and electrolyte balance and exploratory laparotomy is always advocated for better patient compliance and relatively low mortality.

 


Keywords


Perforation peritonitis, Peptic ulcer disease, Gastric perforation, Blunt trauma abdomen, Typhoid perforation, Exploratory laparotomy

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