Management of Peritonitis as Emergency in a Tertiary Care Center
Management of Peritonitis
Background: Peritonitis is defined as inflammation of the peritoneal cavity. This study was done to know the various trends of management in peritonitis cases in Amritsar district of Punjab state of India. Subjects and Methods:In this study 50 cases of peritonitis were screened on the basis of lab investigations, X-rays(chest and abdomen), ultrasonography and abdominal aspiration whenever required. Majority of perforation peritonitis patients presented to emergency with electrolyte disturbances followed by septicemia. Investigations, X-ray chest showed air under diaphragm. Ultrasound showed free fluid,four quadrant aspiration showed nature of peritoneal fluid of perforation. Patients were initially resuscitated and managed with surgery to correct the underlying pathology.Results: Anaemia was present in 12% of cases. 22% of cases presented with septicaemia (TLC>12000/mm3). Four quadrant aspiration analyses which showed that fecal matter was in the aspirate in 36% cases. Clear fluid was present in 22% cases. Bilious fluid was present in 12% cases. Haemorrhagic fluid was present in 4% cases, pus was present in 4% cases. No aspiration fluid was seen in 22% of cases.Conclusion: The most common site for the perforation is Terminal ileum (48.5%), followed by Stomach (31.4%), Duodenum (14.2%), colon (2.8%), jejunum (2.8%).Fever (90%) is the most common post-operative complication followed by Paralytic ileus (70%) and superficial wound infections (50%). post-operative complications are Anemia/ hypoproteinemia (10%), Burst abdomen (2%), Chest infections (10%), and Anastomotic leaks (0%).