World Journal of Pharmaceutical
and Medical Research

( An ISO 9001:2015 Certified International Journal )

An International Peer Reviewed Journal for Pharmaceutical and Medical Research and Technology
An Official Publication of Society for Advance Healthcare Research (Reg. No. : 01/01/01/31674/16)
ISSN 2455-3301
IMPACT FACTOR: 6.842

ICV : 78.6

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Abstract

PERITONITIS: OUTCOME AND TREATMENT BY LAPROTOMY IN CCM MEDICAL COLLEGE AND HOSPITAL

Dr. Yeshwant Ganpatrao Kale*

ABSTRACT

Perforation peritonitis is the commonest surgical emergency in Indian subcontinent and still carries considerable morbidity and mortality. Despite advances in surgical techniques, antimicrobial therapy and intensive care support, management of peritonitis continues to be highly demanding, difficult and complex. The spectrum of aetiology of perforation continues to be different from that of western countries. Severe peritonitis, or abdominal sepsis, is characterized by high mortality and morbidity due to multiple organ failure (MOF) from septic shock. Mortality rates have decreased slightly over the last few decades, and range from 20 to 60 %. Morbidity rates are as high as 50 % with subsequent long hospital and intensive care unit (ICU) stays. Despite modern surgical techniques, recent developments in antimicrobial therapy and supportive care, the treatment and outcome of patients managed for generalized peritonitis remains challenging. Inspite of modern surgical techniques, developments in antimicrobial therapy and supportive care, the treatment and outcome of patients managed for generalized peritonitis still remains a challenge. Material and Methods: Admission records in the Emergency Department and surgical wards registers, theatre operation records and unit registers of the general surgery divisions were reviewed and noted. Sociodemographic data was collected from patients who were included in the study. All patients aged 18 years or older admitted with a diagnosis of peritonitis were included in the study. Patients who died before operation were excluded from the study. Informed written consent was obtained from each patient who was ready to participate in the study. Adequate fluid, nil by mouth, nasogastric decompression, administration of broad-spectrum antibiotics and oxygen supplementation prior to surgery was followed. Hydration was continued during and after the surgery. Statistical analysis was done. Results: A total of 89 patients were included in the study who were diagnosed of peritonitis and were operated for the same. Out of 89 patients 55 (61.80) were male and 34 (38.20) patients were female. Mean age of the patients was 58±18.4. Most common aetiology for peritonitis was ruptured appendix (56, 62.92%) followed by perforated peptic ulcers (10, 11.24%). In perforated gastric mucosa 6 (6.74%) cases were observed. In gangrenous small bowel and penetrating abdominal injury 5 (5.62%) cases each were operated. 2 (2.25%) patients were observed in partial intestinal obstruction. While 1 (1.12%) case each was observed in Pelvic inflammatory disease, obstructed supra umbilical hernia, ruptured hepatic abscess, perforated typhoid ileitis, cancer of the ascending colon and pancreatitis.8 patients has to shift to surgical intensive care unit for supportive care, mechanical ventilation or inotropic support, 3 of whom were hypotensive postoperatively necessitating inotropic support. One patient with elevated creatinine had haemodialysis. There were 2 mortalities (2.25%) and 8 (8.99%) patients were diagnosed with bacterial infection in microbiology report. Conclusion: The spectrum of perforation peritonitis in India continues to be different from its western countries. Multiple relaparotomies increase the systemic inflammatory mediator response resulting in an increased incidence of MOF and mortality.Adequate resuscitation and appropriate surgical intervention, as well as appropriate peri-operative specific organ support should be instituted to improve outcome.

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