Résumé
Background: Despite the surgical treatment, sophisticated intensive care units, latest generation antibiotics and a better understanding of pathophysiology, the morbidity and mortality rate of perforation peritonitis are still high. Patients are usually managed by subjective decision of surgeon based on which mortality is very high.Methods: This was a double-blind observational study conducted over a period of 18 months on 50 patients with small bowel perforations. Based on the acute physiology and chronic health evaluation (APACHE) II score at presentation, patients were triaged into 3 groups: group 1 (score ≤10), group 2 (score 11 to 20) and group 3 (score >20). Study population was managed by the subjective decision of the operating surgeon who was blinded off the APACHE II score of patients. Hence removing the possibility of bias and observing a correlation between surgical outcome and APACHE II score of the patient.Results: Patients with higher APACHE II score (>10) were more likely to undergo exteriorization of bowel. Length of hospital stay was also found to be increased with an increase in score. APACHE II score of 10 was found to predict mortality with significant difference between 2 groups. Below this score the mortality was 0% and above this score the mortality rate rose to 31.25%.Conclusions: APACHE II can be used as a reliable and uniform scoring system as its assessment at presentation in patients of small bowel perforations provides an insight to their surgical management as well as predicting overall outcome.
Résumé
Background: Peritonitis, while no longer the over whelming problem it once was, is still the most common cause of death, ballooned surgical treatment of abdominal disease. In 5 to 7 present of all autopsies, peritonitis is either the primary or a contributory cause of death. Therefore the present study has been undertaken to find out the actual cause of death peritonitis. Methods: This study was conducted after the institutional ethical clearance and informed written consent from all the subjects. Fifty surgically proved perforative peritonitis cases admitted to the surgical wards were included in the study. Radiological examination was done in all the cases to detect pneumoperitoneum. Ulcer edge biopsy was taken from peptic and non-specific ileal perforations. The data are expressed as mean and the percentile was calculated in each parameters. Results: 90% of the subjects were males and the patients belong to the age group of 31-40 years. Of the 32 cases of perforated peptic ulcer, 19 gave the previous history of pain abdomen lasting from 6 months to 15 years, one gave the history of fever and in 14 cases there was no history. The pneumoperitoneum is demonstrable on X-ray in 60-80% cases of peptic as well as non-traumatic small bowel perforations. Conclusion: The study showed that the maximum mortality occurred in those patients who were admitted to the hospital after more than 24 hours from the time of appearance of the first symptom. Therefore, it is advised not to delay in attending the hospital rather than delayed surgery.