Thalabathik Kumara Vikram, S (2018) Prospective study on impact of ultrasound guided flank drain insertion on the perioperative outcome of cases of perforative peritonitis with hemodynamic instability. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: Hollow viscus perforation with secondary peritonitis is an abdominal emergency. Patients who are not fit for immediate surgery undergo resuscitation prior to laparotomy. Flank drain insertion under ultrasound guidance can effectively resuscitate these patients. AIMS AND OBJECTIVES: This study is concerned with the comparison of the perioperative outcomes of patients undergoing (test group)/not-undergoing (control group) flank drain insertion during resuscitation prior to laparotomy and the scope to implement the same. METHODOLOGY: From August 2016 to July 2017, 50 patients diagnosed with perforative peritonitis with hemodynamic instability in GRH Madurai will be recruited in this study. Patients are segregated into control and test groups. In control group resuscitation is done with IV fluids, inotropes. In test group, in addition to IV fluids and inotropes, flank drain insertion is done. After stabilization laparotomy and omental patch closure is done in both groups. Outcomes are analysed. RESULTS: Period of resuscitation is significantly lower in test group. Inotropic support was required post operatively in 7 out of 25 patients in test group and 15 out of 25 patients in control group. Post-op mechanical ventilation was required in in 1 out of 25 patients in test group and 8 out of 25 patients in control group. Return of bowel sounds were earlier among test group than controls. 1 out of 25 patients in test group and 5 out of 25 patients in control group expired. CONCLUSION: Management of sepsis is a challenge in treating patients with perforation peritonitis Percutaneous placement of abdominal drains under ultrasound guidance may act as a temporizing measure by reducing intra- abdominal pressure of patients with perforation peritonitis. It can lead to improvements in their physiological status and significantly contributes to their resuscitation and postoperative outcome.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Perforative peritonitis ; Resuscitation ; Flank drain ; Perioperative outcome ; Sepsis ; Abdominal pressure. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 05 Aug 2018 16:18 |
| Last Modified: | 05 Aug 2018 16:28 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/9085 |
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