Perforation Peritonitis:A Two Year Experience

Gastrointestinal perforations have been surgical problem since the time immortal. Scientists have found evidence of gastrointestinal perforations in Egyptian mummies. Perforation is said to occur once a pathology which extends through the full thickness of the hollow viscus leading to peritoneal contamination with intraluminal contents. Perforation can occur anywhere in the gastrointestinal tract starting from oesophagus to the rectum. Gastrointestinal perforation in our region generally occurs as a result of chronic inflammation due to Helicobacter pylori, NSAIDs like aspirin, stress, excessive smoking, alcohol, or coffee consumption. Other causes include appendicitis, diverticulitis, typhoid, malignancy. Instrumentation and blunt / penetrating abdominal trauma also account for a large number of cases of perforation peritonitis (1). Crohn's disease and less commonly ulcerative colitis are rare causes of perforation (2). If untreated, it leads to bacteremia, generalized sepsis, multiorgan failure, shock and abdominal abscess formation. The first successful surgical management for any gastrointestinal perforation was done for perforated gastric ulcer by Ludwig Heusner in Germany in 1892 in the form of partial gastrectomy (3). Gastrointestinal perforation is a serious surgical problem in developing nations with substantial morbidity and mortality and is one of the most common cause of emergency surgery performed in GMC Jammu. Materials and Methods This study was undertaken in Department of Surgery, Government Medical College, and Jammu from January 2006 to February 2008. Four hundred cases of gastrointestinal perforation reporting to emergency were included in the study. All patients admitted under the study were put to detailed history taking including history of acid peptic disease, prolonged NSAIDS use, smoking, history of abdominal trauma and any other associated disease or related to cause of gastrointestinal perforation. A complete clinical examination was done. All patients were stabilized hemodynamically and broad spectrum antibiotics usually a combination of injectable third generation cephalosporin and metronidazole was administered. Blood transfusion was given whenever Abstract Four hundred patients who presented in the emergency of GMC Jammu as a case of perforation peritonitis over a period of two years were studied. In most of the cases diagnosis was made by clinical examination supplemented by investigations in the form of standing X-ray chest PA view with domes of diaphragm, Ultrasound abdomen and abdominal paracentesis. Contrast enhanced CT scans of abdomen were conducted on patients where the diagnosis of perforation peritonitis was doubtful. After resuscitation, Laparotomy was done in all the patients and thorough peritoneal lavage was done. A note of the site, size, type, number of perforations was made and biopsy was taken from the edge of the perforation whenever indicated. The most common cause of gastrointestinal perforation in our study was duodenal ulcer perforation, followed by appendicitis, typhoid perforation, blunt/penetrating trauma, gastric perforation, obstruction, iatrogenic, malignancy, and recurrent perforation. Primary closure of the perforation was most commonly done procedure, followed by appendectomy, resection anastomosis of the gut and exteriorization of the gut. The overall mortality was 6 % and morbidity in the form of wound infection, fever, respiratory complications, residual abscess, dyselectrolytemia, burst abdomen, jaundice, sepsis, cardiac complications, anastomotic disruption was present