BACKGROUND AND OBJECTIVESPeritonitis due to hollow viscous perforation is one of the most common surgical emergencies in surgical practice. This may be due to persistence of the various risk factors among population like H. pylori infection, NSAID's, enteric fever and several others. This condition needs an emergency surgical intervention, a scoring system should be able to assess the need, type and quality of the care required for a particular patient. Realizing the need for a simple accurate scoring system in these conditions, the present study was undertaken to evaluate the performance of MPI scoring system in predicting the risks of morbidity and mortality in patients with peritonitis due to hollow viscous perforation.

Background: Small bowel perforation is one of the most common abdominal surgical emergencies encountered in present study region. Late presentation makes them a diagnostic and treatment dilemma. The aim of present study was to determine the age, sex, incidence, etiological factors, clinical features and various surgical procedures for small bowel perforations and its complications in the setup.Methods: Present study is a prospective observational study of 100 cases, conducted in a single teaching institute from October 2015 to December 2016. Various data such as presentation by the patient, age and sex incidence, etiologies, pathological features, morbidity and mortality associated with the causation and management were evaluated, tabulated and assessed. By analyzing the data, common etiologies of small bowel perforation, the most appropriate modality of investigation, treatment, and complications associated with different methods of management and possible ways to prevent them were studied.Results: Among all small bowel perforation, duodenal perforation (70%) was the commonest cause of small bowel perforation followed by ileal (23%) and jejunal (7%) perforations. The most common causes of ileal perforation was typhoid (47.8%) followed by tuberculosis (13%) and traumatic (13%). Overall mortality in small bowel perforation was 15%, with ileal perforation (39%) showing higher mortality rate than duodenal perforation (8.5%). Wound infection, toxaemia, uraemia, hypotension, and respiratory complications were common complications, more commonly noted in cases of ileal perforation.Conclusions: The study showed that effective pre-operative management with adequate fluid resuscitation, immediate operative intervention and good post-operative care led to better outcomes in these cases. Hence timely diagnosis and prompt management is the gold standard for favourable outcome in patients with small bowel perforation.

BACKGROUND AND OBJECTIVES Typhoid ileal perforation is a common problem seen in tropical countries. Over the years, advances in the treatment of typhoid fever has decreased the incidence of typhoid ileal perforation. This study is conducted to throw a light on prognostic factors in the surgical outcome of typhoid ileal perforations. METHODOLOGY Fifty consecutive patients clinically diagnosed as having typhoid ileal perforation was taken for the study over a period of 18 months from November 2011 to May 2013. Pre-operative patients were investigated for the air under the diaphragm using upright chest X-ray and erect abdomen X-rays. Blood culture and Widal tests were done to diagnose the patients that they were suffering from typhoid fever. Patients with general peritonitis due to other causes excluded from the study. RESULTS Out of 50 patients, there were 40 (80%) males and 10 (20%) females, thus the male:female ratio was 4:1. Their ages ranged from 16-58 years. There were 32 patients presented early and 18 patients presented lately. The patients presented to the hospital with spectrum of symptoms. All the patients had pain abdomen to present with, out of which 29 patients had fever, 33 had dehydration and 16 had shock on presentation. In these 50 patients, 33 patients had single perforations and 17 had multiple perforations. The single perforation was treated with simple closure and resection anastomosis was done in cases of multiple perforations. The patients were observed for complications of surgery. The mean hospital stay was 13.28 days. We lost 6 cases. There were 19 cases of wound infection, 12 cases of wound dehiscence, 7 cases of enterocutaneous fistula, 4 cases of respiratory tract infections. The blood culture was positive in 4 cases and the culture yielded Salmonella typhi. The Widal test was positive in 44 cases. There were 13 cases of abdominal fluid culture positive. All yielded the growth of E. coli. CONCLUSION Typhoid ileal perforation is one of the most common surgical emergency encountered by the general surgeon. Widal test is still useful in the diagnosis of typhoid fever in our country. The number of perforations and the peritoneal contamination and the delay in getting medical facility-surgery, shock at the time of presentation at hospital are directly proportional to the morbidity and mortality. Availing early medical facility, which is a modifiable risk factor. If timely early medical attention is sought, majority of morbidity and mortality can be tackled.