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Background: Peritonitis is defined as inflammation of the peritoneal cavity, caused by a number of etiologic agents including bacteria, fungi, viruses, chemical irritants, and foreign bodies. The Mannheim peritonitis index (MPI) is one of the simple scoring systems in use that allows the surgeon to easily determine outcome risk. Aims and objective: To estimate outcome of patients with perforation peritonitis. To evaluate effect of MPI score in identification of high risk cases.Methods: A prospective study was conducted in 100 patients with peritonitis due to hollow viscous perforation at surgical unit of tertiary care unit. The duration of study was 2 years. All the data was recorded. Written informed consent was obtained and data was analyzed using appropriate analysis strategy.Results: In this study, total 100 patients enrolled, out of which 54 % patients were in the age group <50 years and 46% patients were in the age group >50 years. Mortality was higher among patients with age group more than 50 years (21%) and in female patients (37.93%). 18 patients had organ failure. 87 patients had preoperative duration was >24 hours. 93% patients had non-colonic origin of sepsis. In 52 (52%) patients total MPI score was <21 while 25 (25%) patients total score was 21-29 and it was >29 in 23 (23%) patients. Mortality was higher among patients with MPI Score more than 29 (95.65%).Conclusions: MPI is accurate to be used with patients with peritonitis and should be considered reliable and simple reference for estimating their risk of death. This study differs in one adverse outcome variables, non-colonic origin of sepsis, we advocate need for further studies on Mannheim peritonitis index to include colonic origin of sepsis.
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Background: Acute generalized peritonitis from gastrointestinal hollow viscus perforation is a potentially life-threatening condition. Mannheim peritonitis index (MPI) is a specific scoring system that facilitates early identification of patients with severe peritonitis for aggressive surgical approach and improved outcomes.Methods: A prospective observational study in 60 patients attending surgical emergency unit with perforation peritonitis was conducted to analyse the predictive capacity of MPI. MPI score was categorized into 3 groups: <21, 21 to 29 and >29. Data was compared for predicting mortality and morbidity. P value, chi square test and 95% CI were used as statistical tools.Results: Two thirds of 60 patients studied were younger than 50 years of age. Prognosis was poorer in patients above 50 years with age. 80% presented after 24 hours. Ileal perforation was the commonest etiology. Morbidity and mortality were worst in patients with MPI score >29.Conclusions: Mannheim peritonitis index is disease specific, easy to apply and effective scoring system predicting the outcome in perforation peritonitis, with increasing MPI score being directly proportional to higher mortality and morbidity of the patient.
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Background: Peritonitis is one of the most common surgicalemergencies with significant morbidity and mortality. Multiplescoring systems have been proposed and assessed inpredicting the outcome in patients with peritonitis. A scoringsystem should be able to assess the need, type, and quality ofthe care required for a particular patient. Realizing the need fora simple and accurate scoring system in these conditions, thepresent study was undertaken to evaluate the Prognosticevaluation of intraperitoneal sepsis in perforation peritonitis byevaluating the efficacy of Elebute and Stoner grading andMannheim peritonitis index (MPI) in predicting the overall riskof morbidity and mortality in patients with peritonitis. This studywas conducted to identify the predicting ability of both thesescores and to compare MPI with Elebute and Stoner grading(ESG) system.Aim: To predict outcome of patients with peritonitis using theElebute and Stonjej grading of sepsis and Mannheim peritonitisindex in these patients and to predict the possible clinicaloutcome and to compare the results of both the scoringsystems.Patients & Methods: The present work is based on theobservations made in 48 patients of perforation peritonitisadmitted in surgical ward of Rama Medical College Hapur,Uttar Pradesh, India from March 2017 to March 2018. Thediagnosis of perforation peritonitis was made on the basis ofdetailed history, physical examination, investigations andoperative findings. A detailed record was maintained carefullyfor every patient and evaluation of Elebute and Stoner gradingof sepsis and Mannheim peritonitis index were made and thenresults of both the scoring systems are compared.Results: Comparison of both the scoring systems showed thatsensitivity was almost equal in both the scoring systems (80%).But specificity and accuracy were slightly improved withElebute and Stoner grading of sepsis (89.42% and 87.36% Vs84.16% and 83.22%) respectively. This may be because ofmore organ systems incorporated in Elebute and Stonergrading of sepsis like hepatobiliary system, temperature,bleeding diathesis, central nervous system which had not beenincorporated in Mannheim Peritonitis index.Conclusion: In the univariate analysis both scoring systemsstudied, were relatively accurate for identifying patients athigher risk for dying from peritonitis. It was found thatprediction among the dead was better than survived in both thescoring systems.
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Background: Perforation peritonitis is one of the most commonly encountered surgical emergencies in our country. The prognosis of secondary peritonitis remains poor despite development in diagnosis and management. Early identification of patients with severe peritonitis may help in selecting patients for aggressive surgical approach.Methods: The study was conducted in 128 cases of perforation peritonitis admitted and treated in the department of surgery in a tertiary care centre. Initial diagnosis was made on the basis of detailed history, clinical examination and presence of pneumoperitoneum on erect abdominal X-ray. Patients were first assessed using a predesigned Performa, then MPI score was calculated for each patient and the patients were followed-up till death or discharge from the hospital.Results: The ROC curve analysis shows area under the curve was 0.986 with a standard error of 0.008, 95% CI (0.971 to 1.001), p<0.0001. In our study authors found that for the MPI score of 26, sensitivity was 91.3% and specificity was 92.4%, with a positive likelihood ratio of 12.01 and a negative likelihood ratio of 0.09. Age of the patient, presence of organ failure, associated malignancy, generalised type of peritonitis and the original MPI Score has got a significant association with the final outcome (i.e. p value <0.05).Conclusions: MPI is an excellent prognostic index for peritonitis with high accuracy in individual prognosis that is cheap, cost effective, easily measurable and reproducible. The study accentuates that early diagnosis, appropriate resuscitation and prompt surgical intervention still remain the keystones in the management of perforation peritonitis.