A CLINICAL STUDY AND MANAGEMENT OF SECONDARY PERITONITIS IN UPPER ASSAM DUE TO HOLLOW VISCUS PERFORATIONS

DR BIJOYANANDA DAS; DR PRAVEEN KUMAR GUPTA; DR SATYAKAAM CHOUDHURY

Volume : IX, Issue : X, October - 2019

A CLINICAL STUDY AND MANAGEMENT OF SECONDARY PERITONITIS IN UPPER ASSAM DUE TO HOLLOW VISCUS PERFORATIONS

Dr Bijoyananda Das, Dr Praveen Kumar Gupta, Dr Satyakaam Choudhury

Abstract :

INTRODUCTION Peritonitis secondary to perforation of the gastro intestinal tract requires emergency surgical intervention and is associated with significant morbidity and mortality rates. It is a common occurence in this country.Almost all cases of perforation of gastrointestinal tract require surgery. Laperotomy is needed with closure of the perforation with omental patch. peritoneal toilet and putting drain were the common method of surgical management in peritonitis due to non traumatic/ non obstructed hollow viscus perforation. MATERIALS AND METHODS The present hospital based prospective interventional study was conducted in the Department of Surgery. All the cases were admitted into the general surgery units of the department of surgery in Assam Medical College and Hospital, Diugarh during the period of one year from June 2016 to May 2017, above the age of 12 years.Hollow viscus perforation due to trauma (penetrating and blunt) and perforations due to obstruction were excluded. Diagnosis was made on the basis of clinical findings, history, laboratory investigations and radiological evidence. Special investigation was done only in selected cases. Culture and sensitivity tests of peritoneal exudate were done to check for the bacterial contamination and to guide antibiotic therapy. Immediate Surgery was performed in all the patients with perforations of the gut after preliminary resuscitation. conservative treatment was given when it considered as a "sealed" perforation showing the signs of improvement , poor general conditions and the associated serious illness needed operative management. RESULTS In our study perforation was found more common in males (79) and as comparative to females (17) within our sample of study of 96 patients. In this study most of patients with hollow viscus perforation were above the age of 50 years (36.5%) followed by the age group of 21–30 years (26%). The frequency of anatomical site of perforation, duodenal ulcer perforation (55.21%) was the commonest site involved, followed by ileal perforation (20.83%) and appendicular perforation (14.58%). In this study all the cases presented with pain, vomiting, fever and rigidity. The most common procedure done ,omental patch closure (63.54%), appendicectomy was done (14.58%) of all cases and simple closure was done in 11.45 of cases. Resection and anastomis was done in 6.25% of cases and loop ileostomy was done in 4.17% of cases. All these cases was closed with peritoneal toilet and drain. CONCLUSION Almost all cases of perforation of gastrointestinal tract require surgery. Laperotomy with closure of the perforation with omental patch closure, peritoneal toilet and drain were the commonest method of surgical management in peritonitis due to hollow viscus perporation.History of early and contineus fever is one of the most useful clinical criteria to differentiate typhoid from other perforations. Simple repair of perforation in two layers is the treatment of choice for typhoid perforations. Lower respiratory tract infections is the most common complication observed.