A STUDY OF CLINICAL PRSENTATION AND MANAGEMENT OF 52 CASES PERFORATIVE PERITONITIS AND THEIR EVALUATION WITH RESPECT TO SOCIODEMOGRAPHIC FACTORS

In the series, 52 cases of perforation peritonitis were studied during the period from November 2012 to November 2014 at PEOPLE’S COLLEGE OF MEDICAL SCIENCES &RESEARCH CENTRE BHOPAL, INDIA. Duodenal ulcer perforation was the most common cause of perforation in perforative peritonitis, next commonest was appendicular perforation followed by enteric perforation. Colonic perforations are rare. Duodenal ulcer perforation was more common in the 50 years and above age group. The highest number of patients was seen in the age group 40 years and above, irrespective of the pathological conditions. Perforation was more cmmon in male than female. 82.7% male & 17.3% female. Majorities of patient were belonging to rural area with poor socioeconomic status and were unskilled workers. Smoking and use of non steroidal anti–inflammatory drugs are important risk factors for peptic ulcer perforation. Most of the patients presented within 24-48 hrs of the clinical symptoms. But delay hospitalization shows high morbidity & mortality. Presence of gas under the diaphragm confirms the diagnosis, but their absence does not exclude the diagnosis. Sudden onset of abdomen pain, was constant symptom. Vomiting and nausea were also seen. Tenderness, rigidity & guarding are important signs. Absence of bowel sounds is one of the early sign of perforation peritonitis. Resuscitation & preoperative management of the patient is as important as the surgical procedure. Risk factors for operation of perforation was old age, duration of perforation, size of perforation & presence of preoperative shock. Laparotomy with closure of the perforation and omental patch closure to be the commonest method of surgical management in perforative peritonitis. Typhoid and appendicular perforation were more common in 20 - 40 years age group. History of fever is one of the most useful clinical criteria to differentiate typhoid from other perforations. Simple repair of perforation in two layers is the treatment of choice for typhoid perforations. Post operative morbidity occurred in 19.2 %( major complication only) of cases and mortality of 3.8%.