Prediction of mortality in secondary peritonitis: a prospective study comparing p-POSSUM, Mannheim Peritonitis Index, and Jabalpur Peritonitis Index.

BACKGROUND: Risk scoring systems are required to allow accurate prognostication, compare outcomes of surgery, and allow patients to make informed decisions about their health. This prospective study compares the p-POSSUM (Portsmouth Modification to Physiological and Operative Severity Score for Enumeration of Mortality), Mannheim Peritonitis Index, and Jabalpur Peritonitis Index for their utility in predicting mortality in patients with peritonitis. METHODS: Perioperative data was collected from 235 patients with secondary peritonitis and used to calculate p-POSSUM, MPI, and JPI scores. The accuracy of the 3 scores was compared using receiver operator characteristic curves. RESULTS: p-POSSUM and Mannheim Peritonitis Index were similar in their accuracy with area under the curve (AUC) values of 0.756 and 0.757. Jabalpur Peritonitis Index had an AUC of 0.665. CONCLUSION: p-POSSUM and Mannheim Peritonitis Index can be used to predict mortality in patients with secondary peritonitis. Jabalpur Peritonitis Index is not suited for this purpose. Further studies are required to improve the diagnostic performance of p-POSSUM and MPI in patients with secondary peritonitis.

A Rare Case of Complex Hernia Causing Urethral Obstruction.

Abdominal wall hernias rarely cause obstruction of the urinary tract. We present the case of a patient undergoing regular smooth dilatations for urethral stricture since 8 years who developed right inguinoscrotal swelling and narrowing of urinary stream since 2 years of age. There was a growing difficulty in dilatation due to path distortion of urethra by the hernia. He had a history of open suprapubic cystostomy (SPC) 8 years ago. The patient refused surgery till he landed with an inability to pass dilators and difficulty in passing urine. He was taken up for right inguinal exploration with internal optic urethrotomy (IOU). Intraoperatively, he was found to have right inguinal hernia with incisional hernia at the site of SPC which was repaired and a cystoscopy revealed urethral deviation with anterior urethral stricture for which IOU was done. Postoperatively, the patient's urethral tract straightened and his urinary complaints resolved. A complex hernia can cause urethral deviation and obstruction due to pressure effects of its contents and should be repaired at an early stage.