COMPARISON OF PRE-OPERATIVE PERITONEAL WASH AND DRAINAGE VERSUS URGENT LAPAROTOMY STRATEGY IN PATIENTS WITH LATE STAGE PERFORATION PERITONITIS. A RANDOMIZED CONTROLLED TRIAL

Peritonitis is inflammation of peritoneum which is most commonly due to generalized or localized infection. Secondary peritonitis is the commonest form and a large percent of them is due to perforation or impending gastrointestinal perforation. The prognosis depends on multiple factors by which Ma...

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Main Author: Salah Kadhim Muslim
Format: Article
Language:English
Published: university of basrah 2018-12-01
Series:Basrah Journal of Surgery
Subjects:
Online Access:https://bjsrg.uobasrah.edu.iq/article_160099_ba07c8a9c40c05cc67bc778d9d34a569.pdf
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author Salah Kadhim Muslim
author_facet Salah Kadhim Muslim
author_sort Salah Kadhim Muslim
collection DOAJ
description Peritonitis is inflammation of peritoneum which is most commonly due to generalized or localized infection. Secondary peritonitis is the commonest form and a large percent of them is due to perforation or impending gastrointestinal perforation. The prognosis depends on multiple factors by which Mannheim Peritonitis Index (MPI) appears to be more practical. This study aimed to assess the value of pre-operative aspiration of peritoneal fluid followed by peritoneal wash and drainage before proceeding to definitive surgery in patients with MPI score>20. This prospective study was conducted in Al-Hussein Teaching Hospital in Al Nasserya city and Basrah Teaching Hospital in Basrah city from October 2003 to July 2014. Each patient admitted to the emergency department in these hospitals with the provisional diagnosis of perforation peritonitis was evaluated with MPI score. If the score was less than 20; the patient managed with resuscitation and broad spectrum antibiotics for 2-3 hours then by definitive surgery while those with MPI more than 20 were randomly divided into two groups; the first were managed with 2-3 hours resuscitation with intra-venous fluid resuscitation and antibiotics followed by urgent surgical exploration (USE). The second group were managed with percutaneous peritoneal drainage (PPD) with aspiration of the fluid and then irrigation of the peritoneal cavity with isotonic saline and followed by a drainage with aid of the gravity through another catheter located in the right ileac fossa. Sixty two patients included in this study who fulfilled the criteria of perforation peritonitis and MPI score more than 20. Around half of them the score was between 26-30. Perforated peptic ulcer is the commonest etiology. The most common cause of their high MPI score is the late presentation and the evidence of organ failure. Renal failure is the most prevalent organ failed in both groups. The overall mortality is decreased in (PPD) group. Those with urgent surgical exploration(USE) showed no improvements in the pre-operative vital signs, prolonged operation time and a higher mortality and more severe post-operative complication than PPD group. In conclusion, the pre-operative percutaneous peritoneal aspiration of the fluid followed by peritoneal irrigation and drainage in patients with advanced stage perforation peritonitis is associated with a significant improvement in the pre-operative pulse rate and blood pressure, decrease in the operation time, a decrease in the overall mortality and deep seated wound infection and dehiscence but it is associated with a higher mortality in the first post-operative day.
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spelling doaj.art-5a3ec9a6c94541dbb58392692436e0a22022-12-22T03:13:07Zenguniversity of basrahBasrah Journal of Surgery1683-35892409-501X2018-12-01242677610.33762/bsurg.2018.160099160099COMPARISON OF PRE-OPERATIVE PERITONEAL WASH AND DRAINAGE VERSUS URGENT LAPAROTOMY STRATEGY IN PATIENTS WITH LATE STAGE PERFORATION PERITONITIS. A RANDOMIZED CONTROLLED TRIALSalah Kadhim MuslimPeritonitis is inflammation of peritoneum which is most commonly due to generalized or localized infection. Secondary peritonitis is the commonest form and a large percent of them is due to perforation or impending gastrointestinal perforation. The prognosis depends on multiple factors by which Mannheim Peritonitis Index (MPI) appears to be more practical. This study aimed to assess the value of pre-operative aspiration of peritoneal fluid followed by peritoneal wash and drainage before proceeding to definitive surgery in patients with MPI score>20. This prospective study was conducted in Al-Hussein Teaching Hospital in Al Nasserya city and Basrah Teaching Hospital in Basrah city from October 2003 to July 2014. Each patient admitted to the emergency department in these hospitals with the provisional diagnosis of perforation peritonitis was evaluated with MPI score. If the score was less than 20; the patient managed with resuscitation and broad spectrum antibiotics for 2-3 hours then by definitive surgery while those with MPI more than 20 were randomly divided into two groups; the first were managed with 2-3 hours resuscitation with intra-venous fluid resuscitation and antibiotics followed by urgent surgical exploration (USE). The second group were managed with percutaneous peritoneal drainage (PPD) with aspiration of the fluid and then irrigation of the peritoneal cavity with isotonic saline and followed by a drainage with aid of the gravity through another catheter located in the right ileac fossa. Sixty two patients included in this study who fulfilled the criteria of perforation peritonitis and MPI score more than 20. Around half of them the score was between 26-30. Perforated peptic ulcer is the commonest etiology. The most common cause of their high MPI score is the late presentation and the evidence of organ failure. Renal failure is the most prevalent organ failed in both groups. The overall mortality is decreased in (PPD) group. Those with urgent surgical exploration(USE) showed no improvements in the pre-operative vital signs, prolonged operation time and a higher mortality and more severe post-operative complication than PPD group. In conclusion, the pre-operative percutaneous peritoneal aspiration of the fluid followed by peritoneal irrigation and drainage in patients with advanced stage perforation peritonitis is associated with a significant improvement in the pre-operative pulse rate and blood pressure, decrease in the operation time, a decrease in the overall mortality and deep seated wound infection and dehiscence but it is associated with a higher mortality in the first post-operative day.https://bjsrg.uobasrah.edu.iq/article_160099_ba07c8a9c40c05cc67bc778d9d34a569.pdfcomparison of preoperative peritoneal wash and drainageurgent laparotomy strategyperforation peritonitis
spellingShingle Salah Kadhim Muslim
COMPARISON OF PRE-OPERATIVE PERITONEAL WASH AND DRAINAGE VERSUS URGENT LAPAROTOMY STRATEGY IN PATIENTS WITH LATE STAGE PERFORATION PERITONITIS. A RANDOMIZED CONTROLLED TRIAL
Basrah Journal of Surgery
comparison of pre
operative peritoneal wash and drainage
urgent laparotomy strategy
perforation peritonitis
title COMPARISON OF PRE-OPERATIVE PERITONEAL WASH AND DRAINAGE VERSUS URGENT LAPAROTOMY STRATEGY IN PATIENTS WITH LATE STAGE PERFORATION PERITONITIS. A RANDOMIZED CONTROLLED TRIAL
title_full COMPARISON OF PRE-OPERATIVE PERITONEAL WASH AND DRAINAGE VERSUS URGENT LAPAROTOMY STRATEGY IN PATIENTS WITH LATE STAGE PERFORATION PERITONITIS. A RANDOMIZED CONTROLLED TRIAL
title_fullStr COMPARISON OF PRE-OPERATIVE PERITONEAL WASH AND DRAINAGE VERSUS URGENT LAPAROTOMY STRATEGY IN PATIENTS WITH LATE STAGE PERFORATION PERITONITIS. A RANDOMIZED CONTROLLED TRIAL
title_full_unstemmed COMPARISON OF PRE-OPERATIVE PERITONEAL WASH AND DRAINAGE VERSUS URGENT LAPAROTOMY STRATEGY IN PATIENTS WITH LATE STAGE PERFORATION PERITONITIS. A RANDOMIZED CONTROLLED TRIAL
title_short COMPARISON OF PRE-OPERATIVE PERITONEAL WASH AND DRAINAGE VERSUS URGENT LAPAROTOMY STRATEGY IN PATIENTS WITH LATE STAGE PERFORATION PERITONITIS. A RANDOMIZED CONTROLLED TRIAL
title_sort comparison of pre operative peritoneal wash and drainage versus urgent laparotomy strategy in patients with late stage perforation peritonitis a randomized controlled trial
topic comparison of pre
operative peritoneal wash and drainage
urgent laparotomy strategy
perforation peritonitis
url https://bjsrg.uobasrah.edu.iq/article_160099_ba07c8a9c40c05cc67bc778d9d34a569.pdf
work_keys_str_mv AT salahkadhimmuslim comparisonofpreoperativeperitonealwashanddrainageversusurgentlaparotomystrategyinpatientswithlatestageperforationperitonitisarandomizedcontrolledtrial