A study of acute peritonitis: evaluation of its mortality and morbidity

Abstract

Background: Acute peritonitis remains an important cause of morbidity and mortality in emergency surgery. The contributory causes are delay in seeking the surgical advice, infection, toxemia, old age, associated illnesses and postoperative complications. The objective of this study was to evaluate the mortality and morbidity in cases of acute peritonitis and to evaluate the factors affecting the outcome of peritonitis. Methods: This is a prospective, non-randomized study of 120 cases which were treated as surgical emergencies for acute peritonitis during July 2009 to July 2011 at S. V. S. Hospital, Mahabubnagar. Thorough clinical examination was done. Clinical symptoms and signs namely pain abdomen, distension, vomiting, tenderness, guarding, rigidity, absent bowel sounds; obliteration of liver dullness formed the criteria for suspicion of peritonitis. Plain x- ray abdomen and ultra sound abdomen were done to confirm the diagnosis. Results: A total of 120 patients were studied out of which 28 died giving a mortality rate of 23.33%. Patient’s age ranged from 10-82 years with a mean age of 39.57 years. Maximum deaths were seen in the age group of 50-64 years. Among the studied cases majority were males i.e. 100 males compared to only 20 females. But the death rates were found to be almost similar among both the sexes. i.e. 24% in males compared to almost similar i.e. 20% in females. From the above table, it is seen that survival was 100% if the exudates was clear. As the exudates consistency deteriorated, the survival rate decreased and the mortality rate increased. Most common cause of peritonitis in the study was DU perforation 40%. Mortality rate was found to be very high in case of peritonitis caused by gangrenous bowel (46.15%) followed by trauma in 37.5% of cases. Conclusions: A total of 120 cases were studied. Mortality was 23.33% and morbidity was 51%. Out of the variables studied Age >50 years was significant. Pre-op duration of >24 hours was significant. Nature of peritoneal fluid was also significant. Female sex was not found to be significant. Early diagnosis and intervention is the best way to prevent mortality and morbidity in peritonitis. Keywords: Acute peritonitis, Evaluation, Mortality, Morbidity