Publication:

Spectrum of perforation peritonitis in Kashmir: a prospective study at our tertiary care centre

Background Objective of this study was to study the spectrum of perforation peritonitis in Kashmir. Like all over world, perforation peritonitis is the most prevalent surgical emergency tackled & treated by a surgical team in Kashmir. The etiology leading to peritonitis in tropical countries shows a different spectrum from its western world. This study was conducted at Govt. Medical College & Associated hospitals, Srinagar, Jammu & Kashmir in department of general surgery with aim to highlight the spectrum of perforation peritonitis treated and to improve its outcome thereafter.

Methods A prospective designed study including 356 patients admitted and diagnosed as perforation peritonitis were studied in terms of clinical presentations, etiology, site of perforation, surgical treatment, post-operative complications and mortality, at GMC Srinagar over a period of two years from Feb 2011 to Jan 2013. All patients were resuscitated, underwent emergency exploratory laparotomy and on laparotomy cause of perforation peritonitis was found and controlled.

Results The most common cause of perforation in our series was perforated duodenal ulcer (189 cases) followed by perforated appendix (53 cases), ileal perforation (53 cases), gastric perforation (25 cases) and the rest being perforations of large gut, Meckel’s diverticulum, jejunal perforation, GB perforation. Traumatic gut perforations generally following blunt trauma seem to be on rise. The mortality rate in our series was 10.2% with a morbidity rate of nearly 28%, wound infection being the commonest.

Conclusions The etiology of perforation peritonitis in Kashmir continuously differs in spectrum from western country. Largest part of perforations were noticed in the upper part of the gastrointestinal tract contrary to the western countries where the perforations are mostly encountered in the distal part. The commonest cause of perforation peritonitis in our setup is perforated duodenal ulcer, followed by perforated appendix, ileal perforations. Majority of the large bowel perforations are secondary to obstruction with transmural necrosis. Perforations secondary to malignancy are not common in our part.