Perforative Peritonitis: A Clinical Overview

This chapter was aimed to identify factors in patients with peritonitis which have a significant bearing on morbidity and mortality.In India, perforative peritonitis is the most frequent surgical emergency requiring immediate surgical care. Even with improvements in surgical methods, antibiotic treatments, and critical care assistance, managing peritonitis remains extremely challenging, complex, and demanding. The study was a single center, prospective observational study conducted in Lokmanya Tilak Municipal Hospital, Sion, Mumbai, India. Consecutive patients with perforative peritonitis admitted to the emergency and those who were fitting into the eligibility criteria included in the study. A detailed history and clinical examination and blood investigation performed followed by use of appropriate diagnostic procedures such as X-ray, CT-scan with additional help of USG and diagnostic paracentesis if required and according to the need of the hour. A total of 50 patients studied with age range 18-60 years with mean age of presentation 36.80 years and mortality rate was 16%. The result reveals that 33.33% of the mortality rate in age group 41-50 years which is highest followed by the deaths in age group 51-60 years is 28.6%. There is increasing trend in mortality with age except there is slight drop in age group 51-60 and 60% of >10 day hospital stay was found in that age group.. We found most of the patients having no growth in peritoneal contamination followed by E. coli (34%) highly sensitive to amikacin. Most common complication was wound infection. study indicated that most common surgical procedure used is primary closure as most common pathology was gastroduodenal perforation. Patients' condition deteriorates as a result of delayed hospital admission, which is a major contributing factor to unfavorable outcomes. The characteristics that significantly predict death are anemia, renal failure, septicemia, quantity of pollution, size, and number of perforations. These risks are all significant at 5%. Therefore, mortality can be decreased if patients exhibiting the aforementioned symptoms are identified early and receive the appropriate treatment.