A PROSPECTIVE STUDY OF FACTORS AFFECTING MORBIDITY AND MORTALITY IN PATIENTS OF NON TRAUMATIC PERFORATION PERITONITIS
Introduction: In every surgeon’s career perforation peritonitis is one of the common major surgical emergencies. In most of developing countries like India because of illiteracy, poverty, unavailability of proper health care facilities in rural areas and lack of knowledge and proper referral medical services in most of the cases presentation to hospital is late, with established generalised peritonitis associated with features of septic shock, signs and symptoms of multi-organ failure, so treatment without major morbidity and mortality in such patient is always a challenge even after various advancement in techniques of surgery, availability of broad spectrum antibiotics, improved intensive care facilities.
Method: A cross sectional prospective study was done including total 100 cases of Perforation peritonitis over a period of 2 years at tertiary care center in central Rajasthan India and observation of clinical presentation, Time duration of symptoms, intra-op findings done and outcome measured in terms of postoperative morbidity and mortality, statistical analysis of all data done with chi-square test.
Results: In our study total (62%) of total patients were found to be in the age group of 31 to 60 years and among them (79%) were male, (78%) of the patients presented after 48 hrs of appearance of symptoms. In our study we found that most common causes of perforation peritonitis were duodenal perforation (36 cases) followed by gastric (30), ileal (22 cases), Jejunum (4 cases), Appendicular (2 cases), Colon (5 cases), Rectum (1 cases), Gallbladder (1 case), Meckel's diverticulum (1 case). In this study Overall mortality was 14% and morbidity was approximately 49%.
Conclusion: In this study we concluded that direct relationship of morbidity and mortality was present to the time interval between occurrence and presentation to hospital with timely surgical intervention and amount of contamination in peritoneal cavity. Other predictors were co-morbid medical illness like anemia, deranged renal and liver function tests, nutritional status, post operative complications, post operative care and increasing age of the patient.
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