Neupane Subita, Koirala Dinesh Prasad, Kharel Sanjeev, Silwal Shirish, Yadav Krishna Kumar
Department of General Practice and Emergency Medicine, Nepal Academy of Medical Sciences, Kathmandu, Nepal.
Department of GI and General Surgery, Pediatric Surgery Unit, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.
Ann Med Surg (Lond). 2022 Sep 11;82:104528. doi: 10.1016/j.amsu.2022.104528. eCollection 2022 Oct.
The most common surgical emergency in general surgery is perforation peritonitis. It is a serious condition with a mortality rate of up to 20%, and it is the third most common cause of surgical abdomen after appendicitis and intestinal obstruction. The aim of this study to discuss clinical profile and management of perforation peritonitis in a hospital in central Nepal.
This prospective study was done for one year at Bharatpur Hospital, Chitwan Nepal. In our study, only patient above 15 years were included and those who were not fit for anesthesia and surgery were excluded. Most of the patient were diagnosed clinically supported by lab investigations and imaging like X-ray and ultrasonography of abdomen. The variables analyzed were the risk factors of the patient like smoking, alcohol, liver disease and previous abdominal surgeries.
The majority of the patients were in the age group 50-59 years in male and 40-49 years in female. Among sixty cases, 31 were female and 29 were male with Female: Male ratio of 1.06:1. The most common cause of perforation found was peptic ulcer compromising 88.3% (53 cases) followed by appendicular perforation accounting 8.3% (5 cases). Similarly, Tubercular perforation was found in 3.3%. Smoking was most common risk factor accounting 88.3%, followed by alcohol consumption (48.33%) while, 15% of patients had positive history of NSAIDs consumption. On imaging, 38.33% patient had air fluid level on X-ray and 78.33% had gas under diaphragm. On blood investigation, leukocytosis was found in 53.33% of patients, hyponatremia in 10% of patients and hypokalemia in 18.33% of patients. While on urine examination, albumin was found in 5% of patients. The repair of perforation along with omentopexy was done in 73.3% of patients while only repair was done in 15% of patients. Only 8.3% opted for appendectomy while a very few patients (3.3%) went for resection with anastomosis. The Postoperative complications found were wound infection (43.3%), paralytic ileus (18.33%), sepsis (15%), followed by electrolyte imbalance (11.6%), postoperative bowel obstruction (6.6%) and burst abdomen (1.6%). While, there were only 3 cases of mortality.
Perforation peritonitis is a frequently encountered surgical emergency. Various factors like age, sex, duration, site of perforation, extent of peritonitis and delay in surgical intervention are associated with morbidity and mortality. A successful management depends upon early surgical intervention, source control and exclusive intraoperative peritoneal lavage.
普通外科中最常见的外科急症是穿孔性腹膜炎。这是一种严重疾病，死亡率高达20%，是继阑尾炎和肠梗阻之后外科急腹症的第三大常见病因。本研究旨在探讨尼泊尔中部一家医院穿孔性腹膜炎的临床特征及治疗方法。
本前瞻性研究在尼泊尔奇旺的巴拉特普尔医院进行了一年。在我们的研究中，仅纳入15岁以上的患者，排除那些不适合麻醉和手术的患者。大多数患者通过实验室检查以及腹部X线和超声等影像学检查进行临床诊断。分析的变量包括患者的危险因素，如吸烟、饮酒、肝脏疾病和既往腹部手术史。
大多数患者男性年龄在50 - 59岁，女性年龄在40 - 49岁。60例患者中，女性31例，男性29例，男女比例为1.06:1。发现的最常见穿孔原因是消化性溃疡，占88.3%（53例），其次是阑尾穿孔，占8.3%（5例）。同样，结核性穿孔占3.3%。吸烟是最常见的危险因素，占88.3%，其次是饮酒（48.33%），而15%的患者有非甾体抗炎药使用史。影像学检查中，38.33%的患者X线显示气液平面，78.33%的患者膈下有气体。血液检查发现，53.33%的患者白细胞增多，10%的患者低钠血症，18.33%的患者低钾血症。尿液检查中，5%的患者有蛋白尿。73.3%的患者进行了穿孔修补加网膜固定术，15%的患者仅进行了修补。仅8.3%的患者选择了阑尾切除术，极少数患者（3.3%）进行了切除吻合术。术后并发症包括伤口感染（43.3%）、麻痹性肠梗阻（18.33%）、脓毒症（15%），其次是电解质失衡（11.6%）、术后肠梗阻（6.6%）和腹部裂开（1.6%）。同时，仅有3例死亡病例。
穿孔性腹膜炎是一种常见的外科急症。年龄、性别、病程、穿孔部位、腹膜炎程度以及手术干预延迟等多种因素与发病率和死亡率相关。成功的治疗取决于早期手术干预、源头控制和术中彻底的腹膜灌洗。
