Peritoneal lavage plays an important role intraoperatively in treatment of peritonitis. Various fluids have been used for peritoneal lavage previously but now with the use of antibiotics in lavage the post operative recovery time can be minimized and there is better clinical output of patient. Among various antibiotics metronidazole has proved to be most beneficial in treating the peritonitis.
In this study, patients who were operated for peritonitis were randomly allotted into saline and metronidazole lavage group. Postoperative complications like wound infection, sepsis, faecal fistula ,intra–abdominal abscess and death were noted.
The saline lavage group had 41% incidence of wound infection, 10% intra–abdominal abscess, 30% sepsis, 5% faecal fistula and 7% mortality. Metronidazole lavage group had 25% wound infection, 8% intra–abdominal abscess, 20% sepsis, 1% faecal fistula and 5% mortality.
There is no statistically significant difference in the outcome between the saline group and the metronidazole group.

INTRODUCTION: Acute peritonitis a fairly common surgical emergency. It may be caused secondary to hollow viscus perforation, transmigration of intestinal flora in case of bowel ischemia and rarely primary peritonitis.⁽¹⁾ So  General supportive measures such as maintenance of hydration, correction of electrolytes imbalance, and surgical closure of the perforation and intraoperative peritoneal lavage has been the cornerstone in the management of patients with peritonitis. Different types of fluids have been used for peritoneal lavage in peritonitis patients like sterile water, warm saline, povidone–iodine, saline with antibiotics, etc.^(2–4)

Peritoneal lavage reduces the bacterial load in the peritoneal cavity, reducing the sepsis and helps rapid recovery of the patient.^(5,6) In this study, the effect of plain warm salin lavage  is compared to that of lavage with Metronidazole.

Materials and methods: This study was conducted in the Department of General Surgery, NIMS Medical college and Hospital during the period of Feburary 2016 to January 2018. A total of 200 patients were included in this study, out of which 172 were males and 28 were females. All patients who underwent laparotomy for peritonitis in the age group of 15– 60 years were included.

Patients presenting with clinical features of peritonitis were diagnosed with a combination of clinical examination, blood investigations, erect x–ray abdomen and ultrasound abdomen. Cases were randomly divided into two groups, each receiving plain saline peritoneal lavage and metronidazole lavage. Plain saline lavage group received intraoperative peritoneal lavage with 3 L of saline. Metronidazole lavage group received intraoperative peritoneal lavage using 3 L of saline mixed with 200 ml of metronidazole.

Cases were followed up till the discharge or death of the patient. Postoperative complications like wound infection, intra–abdominal abscess, sepsis, faecal fistula and death were noted. Postoperative hospital stay was noted. Results of both groups were compared statistically.

Results: 200 cases were included in this study out of which 172 were males and 28 were females. Highest number of patients were in the age group of 20– 29 years (32%). The most common cause of peritonitis in this study was duodenal ulcer perforation (60%), followed by ileal (20%) and appendicular perforation (10%). Other causes were gastric perforation, ischaemic bowel, traumatic jejunal perforation, perforated Meckel’s diverticulum.