Primary peritoneal drainage in critically ill patients of perforation peritonitis (an experience of 60 cases)

Abstract

Background: Objective of the present study was to evaluate applicability of Primary Peritoneal Drainage (PPD) under LA in critically ill patients as pre-laparotomy support when laparotomy under GA could not be done. Also to assess outcome in terms of survival, patients needing definitive surgery and complications associated with the procedure on immediate and follow up basis.Methods: A prospective designed study including 60 critically ill patients admitted and diagnosed as perforation peritonitis were subjected to PPD under LA as per inclusion and exclusion criteria, at GMC Jammu, Jammu and Kashmir, India from November 2013 to October 2015.Results: The average age of patients was 53.43 years (20-80 years) with M:F ration of 7:3. All patients presented in shock with very high ASA, combined and MPI scores. 40 patients died after PPD/laparotomy and 20 patients survived. From amongst survivors, 08 (40%) patients required no further treatment and 12 (60%) survivors required definitive laparotomy and treatment of the cause. Overall mortality was 66.67%, attributed to extraordinary delay in presentation, old age, High ASA and other score.Conclusions: From the present study it was concluded that in adults the procedure did not proved comparable to standard surgical intervention as definite procedure but it did proved to be an effective modality of resuscitation and patient stabilization unlike in NEC of infants; PPD under LA. Overall the procedure is a low cost intervention and provide cheaper alternative to sustain and improvise the status of patient with a possibility of widespread applicability in low resource situations provided interdepartmental support from ICU, Dialysis and CCU is available.

Pre-operative Intraperitoneal Drainage Under Local Anesthesia: A Promising Resuscitation Tool in Peritonitis Secondary to Hollow Viscus Perforation During CORONA Pandemic.

“…A study by Bhasin et al reported a series of 60 critically ill patients of peritonitis in whom intra-peritoneal drains were inserted. They reported a mortality rate of 66.67%, which is very high as compared to ours [23]. A study by Baloch et al reported a mortality rate of 16% that is comparable to the present results.…”

Outcomes of Primary Peritoneal Drainage and Taylor’s Conservative Method in High-Risk Cases of Perforated Peritonitis

“…This is in contrast with majority of the studies, which have observed a lower death rate in patients undergoing percutaneous peritoneal drainage 16,17,18,19 . Only a few studies have comparable results with our research 14,20 . This difference might probably be attributed to the availability of better ICU facilities in other setups.…”

“…According to our study, the mean age was 49+-9 years, and majority of patients were male 14,16,17 . This is mostly in accordance with previous studies, however Asghar et al and Saber et al have documented a higher prevalence of high-risk perforation peritonitis in older age groups.…”

“…Moreover, the results of these studies show variable results. (French meta-analysis) Thirumanikandan et al demonstrated a mortality rate of 22%, whereas Bhasin et al showed a death rate of 66% after application of this management strategy 13,14 . This controversy in literature and scarce data on this topic prompted us to carry out this study in our setup.…”

Enteric Fever Complicated by Intestinal Perforation in Children: A Persistent Health Problem Requiring Surgical Management

“…11 There were 52.50% patients with below optimal haemoglobin who required blood transfusion, and 26 cases required platelets transfusion before surgery. Tube laparotomy - a bridging procedure before surgery, in patients who need prolong optimization to reduce the septic load and elevated intra-abdominal pressure, 12 , 13 was done in 28% of patients.…”