Intraperitoneal Drainage Under Local Anaesthesia In Patients Of Perforation Peritonitis Before Definitive Management: Is It Justified?
Introduction: Perforation peritonitis is one of the most frequently encounter surgical emergency around the world. In spite of advances in diagnosis, antimicrobial therapy, surgery, it remains a fatal affliction with high mortality rate. This high mortality rate makes way for innovation in techniques in addition to the persisting knowledge for a better outcome.
Aims: A pilot study was conducted, to evaluate the efficacy of intraperitoneal drainage in patients of perforation peritonitis during the resuscitation period before definitive surgical treatment.
Methods: This was a prospective control study, conducted on the patients of perforation peritonitis with gastro-intestinal perforation for a period of 2 years w.e.f. January, 2011 to November 2012. 100 patients were included in this study and were divided into two groups (50 each). Group I- patient with preoperative intraperitoneal drainage under local anaesthesia, group II- patient without preoperative intraperitoneal drainage, before definitive surgery.
Results: The overall morbidity and mortality of the patients in group-I were comparable with those in group-II
Conclusion: Intraperitoneal drainage under local anaesthesia, in patients of gastrointestinal perforation peritonitis seems to be effective in decreasing morbidity and mortality.
2. Gupta S and Kaushik R. world journal of emergency surgery. 2006; 1:13.
3. Oheneh-yeboah M. Postoperative complications after surgery for typhoid illeal perforation in Adults in Kumasi. West Afr J Med. 2007; 26(1):32-6.
4. Uccheddu A, Floris G, Altana ML, Pisanu A, Cois A, Farci SL. Surgery for perforated peptic ulcer in the elderly. Evaluation of factors influencing prognosis. Hepatogastroenterology. 2003; 50:1956–8.
5. Malangoni MA. Evaluation and management of tertiary peritonitis. Am Surg. 2000; 66:157–61.
6. Daniel AA and Avery BN. Risk factors for severe sepsis in secondary peritonitis. Surg Infect. 2003; 4(4):355-362.
7. Simmen HP, Heinzelmann M, Largiader F. Peritonitis: Classification and causes. Dig Surg.1996; 13:381-3.
8. Ein SH, Shandling B, Wesson D, Filler RM. A 13-year experience with peritoneal drainage under local anesthesia for necrotizing enterocolitis perforation. Journal of pediatric surgery. 1990; 25(10): 1034-1037.
9. Arveen S, Jagdish S, Kadambari D. Perforated peptic ulcer in South India: an institutional perspective. World J Surg. 2009; 33:1600–4.
10. Saber A, Gad M A, Ellabban GM . Perforated Duodenal Ulcer in High Risk Patients: Is Percutaneous Drainage Justified? N Am J Med Sci. 2012; 4(1): 35–39.
11. Afridi SP, Malik F, Ur-Rahman S, Shamim S, Samo KA. Spectrum of perforation peritonitis in Pakistan: 300 cases Eastern experience. World Journal of Emergency Surgery. 2008; 3:31.
12. Subramanyam SG, Sunder N, Saleem KM, Kilpadi AB: Peritonitis in patients over the age of 50 years: 98 cases managed surgically. Trop Doct 2005, 35(4):247-250.
13. Abbas SM, Kahokher A, Mahmoud M, Hill AG. The Simple Prognostic Index (SPI)-A pathophysiologic prognostic scoring tool for emergency laparotomy. J Surg Res. 2010; 163:59–65.
14. Kulah B, Gulgez B, Ozmen MM, Ozer MV, Coşkun F. Emergency bowel surgery in the elderly. Turk J Gastroenterol. 2003; 14:189–93.
15. Moller MH, Adamsen S, Wojdemann M, Moller AM. Perforated peptic ulcer: how to improve outcome? Scand J Gastroenterol. 2009; 44:15–22.
16. Jhobta RS, Attri AK, Kaushik R, Sharma R, Jhobta A. Spectrum of perforation peritonitis in India-review of 504 consecutive cases. World J Emerg Surg. 2006; 1: 26.
17. Kocer B, Surmeli S, Solak C, Unal B, Bozkurt B, Yildirim O, Dolapci M, Cengiz O. Factors affecting mortality and morbidity in patients with peptic ulcer perforation. J Gastroenterol Hepatol.2007; 22(4):565–570.
18. Barut I, Tarhan OR, Cerci C, Karaguzel N, Akdeniz Y, Bulbul N. Prognostic factors of peptic ulcer perforation. Saudi Med J. 2005; 26:1255–1259.
19. Rahman MM, Mamun AA, Hossain MD, Das MK. Peptic ulcer perforation: management of high-risk cases by percutaneous abdominal drainage. Trop Doct. 2005; 35:30–1.
20. Chou NH, Mok KT, Chang HT, Liu SI, Tsai CC, Wang BW, Chen IS. Risk factors of mortality in perforated peptic ulcer. Eur J Surg. 2000; 166(2):149–153.
21. LIoyd H, Ahmed I, Taylor S, Blake JRS. Index for predicting mortality in elderly surgical patients. Br J Surg. 2005; 92(4):487–492.
22. Rahman MM, Islam MS, Flora S, Akhter SF, Hossain S, Karim F. Mortality in perforated peptic ulcer patients after selective management of stratified poor risk cases. World J Surg. 2007; 31:2341–2344.
23. Minutolo V, Gagliano G, Rinzivillo C,Minutolo O, Carnazza M, Racalbuto A. Laparoscopic surgical treatment of perforated duodenal ulcer. Chir Ital. 2009; 61: 309-13.
24. Bertlef MJ, Halm JA, Bemelman WA, Van de Ham AC, Van de Harst E, Oei HI, Smulders JF, Steyerberg EW, Lange JF. Randomized clinical trial of laparoscopic verses open repair of perforated peptic ulcer: The LAMA trial. World J Surg. 2009; 33(7):1368-73.
Copyright (c) 2015 International Archives of BioMedical and Clinical Research
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.