ETIOLOGICAL SPECTRUM OF PERFORATION PERITONITIS

Abstract

Objective: To determine the etiological spectrum of perforation peritonitis in patients undergoing laparotomy at Military Hospital Rawalpindi.
Study Design: Descriptive Study.
Place and Duration of Study: Surgical department, Military Hospital, Rawalpindi from Jun 2011 to Jan 2014, over a period of about 2.5 year.
Material and Methods: A total of 150 patients with perforation peritonitis who underwent laparotomy were included in our study while those in which peritonitis was result of complication of previous treatment such as anastomotic dehiscence were excluded from the study. All the patients were selected by consecutive sampling technique. Patients’ demographic data, pre-op data, operative findings and post-op data were recorded and finally analyzed by using SPSS version 21.
Results: Out of 150 patients 128 were females while remaining 22 were males, with male to female ratio of 1:5.81. Age range of patients was 20-70 with mean age of 30 ± 10. Major presenting complaints were acute abdomen, vomiting, abdominal distension, fever and altered bowel habits. Seven percent patients gave positive history of use of NSAIDs. Operative findings include typhoid in 33 (22%), tuberculosis in 25 (16.6%), duodenal ulcer perforation in 22 (14.6%), appendicitis in 20 (13.3%), traumatic perforation in 18(12%), malignancy in 16 (10.6%), strangulation of bowel in 6(4%), gastric ulcer in 5 (3.3%), volvulus in 3(2%), Meckels diverticulum in 1(0.6%) and CMV(Cytomegalovirus) ileal perforation in 1(0.6%) patients. Small bowel was the most common site of perforation. Post-op complications include wound infection, fever, wound dehiscence, burst abdomen, anastomosis leak, sepsis and cardiac and respiratory complications.
Conclusion: Enteric fever is the commonest cause of perforation peritonitis in our setup followed by intestinal tuberculosis as the second most common cause. Small bowel is the most common site of perforation.