Collins Ephreme Noble, A (2020) A Clinical study on Perforation Peritonitis. Masters thesis, Tirunelveli Medical College, Tirunelveli.
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Abstract
INTRODUCTION: Peritonitis that occurs due to hollow visceral perforation, is a term frequently encountered in surgical practice. It is defined as the inflammation of the serosal membrane which lines the abdominal cavity and the organs contained within it. Introduction of an infection through a bowel perforation into the otherwise sterile peritoneal ambiance & introduction of a chemical irritant like gastric acid from a perforated ulcer are the common causes of peritonitis. AIMS AND OBJECTIVES: 1. To estimate the frequency of peritonitis secondary to hollow viscus perforation in relation to age, etiology, Site of perforation, Symptoms and signs. 2. To estimate the correlation between clinical sign and radiological investigation. 3. To find out the outcome of disease. MATERIALS AND METHODS: This study has been conducted in Department of General Surgery Tirunelveli Government Medical College. Based on the analysis of 100 cases of hollow viscous perforation admitted to Tirunelveli Medical College Hospital, Tirunelveli, fulfilling the criteria were selected for the study. Inclusion Criteria: ◈ Clinical /Radiologically proven cases of perforation peritonitis ◈ Age > 13 yrs, irrespective of sex. Exclusion criteria: ◈ Perforation peritonitis due to penetrating trauma ◈ Primary peritonitis, ◈ Post op peritonitis. All patients were subjected to Biochemical investigations, Chest X Ray, Abdominal X Ray erect view, USG abdomen and pelvis. After confirming the diagnosis Emergency Laparotomy and drainage was done. Depending on the site of perforation, appropriate treatment protocol was adopted. RESULTS: The highest number of patients encountered in this series were in the age group 50 years and above followed by the age group of 40-49 years. The commonest site involved in this study was duodenal ulcer perforation(54%) followed by appendicular perforation (24%) and ileal perforation (8%) pain abdomen was present in all cases. It was diffuse in 66% and localized to epigastrium in 20% followed by RIF in 10% and right hypochondrium in 4%. Gaurding and rigidity was present in 70 patients. 65% of patients who presented within 24 hours of the onset of pain had good prognosis and early recovery. 58 cases of duodenal and gastric ulcer perforation under went closure as described by Graham (Omentalpatchclosure). In this study most of the patients with hollow viscous perforation were above the age of 50 years and most of them were male. The commonest site involved in hollow viscus perforation was duodenal ulcer perforation, The most common time of presentation was within 24 hours of the onset of pain. Most common procedure done was omental patch closure for peptic ulcer perforation. CONCLUSION: ● The most common age group affected is 50 years and above. ● Duodenal ulcer perforations were more common in the age group of 50 years and above. ● Most of these patients present with clinical signs of peritonitis 24 hours within the onset of pain. ● Early admission and prompt treatment after diagnosis had good recovery. ● Diagnosis is made clinically and confirmed by presence of pneumo peritoneum on radiological investigation. ● Laparotomy with peritoneal lavage and perforation closure with omental patch closure of the perforation with omental patch (58%) is the commonest operative management for perforated peptic ulcer and the outcome is good.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 221711354 |
| Uncontrolled Keywords: | Perforation Peritonitis, Clinical study. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 11 Feb 2021 01:26 |
| Last Modified: | 11 Feb 2021 01:26 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14032 |
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