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To diagnose GP, your doctor will likely take X-rays of your chest or abdomen to check for air in the abdominal cavity. They may also perform a CT scanto get a better idea where the perforation might be. They'll also order lab work to:
look for signs of infection, such as a high white blood cell count evaluate your hemoglobin level, which can indicate if you have blood loss evaluate electrolytes evaluate acid level in the blood assess kidney function assess liver function The diagnosis is based mainly on clinical grounds. Plain X-ray, ultrasound and CT scan are the tools that can ascertain the diagnosis. However diagnostic laparoscopy can be helpful in some cases. The study has been carried out to evaluate various etiological factors, modes of clinical presentation, morbidity and mortality pattern of different types of perforation peritonitis presented in RIMS Hospital.
Material and Methods The study was conducted from September 2010 to August 2012. A total of 490 cases of perforation peritonitis were treated in the Department of Surgery, RIMS hospital Imphal, India were included in the study. The cases due to anastomotic dehiscence or those patients who were not willing to participate have been excluded. In all patients of suspected perforation peritonitis, resuscitation was given first and initial diagnosis was made on the basis of detailed history, physical finding and presence of pneumoperitoneum on erect abdominal X-ray. Emergency investigations were done that included Hb%, serum urea and electrolytes, random blood sugar and urine albumin and sugar. Ultrasound of abdomen was done in selected patients. In all cases nasogastric tube was put for gastric aspiration. Urinary catheterization was done for monitoring urine output. After proper hydration, all the patients who were fit for anaesthesia underwent emergency exploratory laparotomy. Control and repair source of contamination, generous irrigation of peritoneum and drain insertion was done during surgery. Abdomen was closed with continuous non-absorbable suture. The patients who were not fit for surgery were managed conservatively and ultrasound guided vacuum suction drain inserted when possible.
The higher incidence of wound infection may be because majority (38.51%) of patients presented late (>72hours) to the hospital with well-established peritonitis and majority were older group. Moreover 91(19.40%) patients had pre-operative co-morbidities and morbidity was higher among them. Overall morbidity of 50.24% was comparable with the study by Jhobta RS et al.,.
Overall mortality in this study was 10% and similar mortality were reported by various studies varying from 6% to 38%.
Conclusion The majority of perforation peritonitis cases in the study comprised of peptic ulcer perforations followed by typhoid ileal, appendicular and traumatic perforations. Tuberculous and idiopathic perforations were rare. Overall morbidity and mortality were acceptable. However, with conservative treatment, moribund patients and in cases of extremely delayed presentation, worse outcomes were noted. The basic principles of early diagnosis, prompt resuscitation and urgent surgical intervention still form the cornerstones of management in these cases. It is once again confirmed that the spectrum of peritonitis in our part of the world is markedly different from that of the western world.
Aims & Objectives: Intestinal Perforations are most common surgical emergencies seen worldwide. Despite improvement in diagnosis, antibiotics, surgical treatments and intensive care support, it is still an important cause of mortality in surgical patients. This study was done to know the spectrum of etiology, clinical presentation, management and treatment outcomes of patients admitted with perforation peritonitis in our hospital. Methods: A prospective study was done over a period of 3 years from January 2011 to December 2013 in SMS medical college and hospital, Jaipur, Rajasthan which included 1400 patients diagnosed with perforation peritonitis. All patients admitted with perforation of gastrointestinal tract were included in this study. All cases of primary peritonitis and anastamotic leaks were excluded from this study. Results: Total of 1400 cases were included with 74.28% being males. The time taken for resuscitation, diagnosis and preparation of patient for surgery was less than 12 hours in 83.4% of cases.