Peritonitis is defined as inflammation of a portion or all of the parietal and visceral peritoneum. Peritonitis may be acute or chronic, septic or aseptic, primary or secondary, localized or generalized. Secondary peritonitis is the most common form that follows an intra-peritoneal source usually from perforation of hollow viscera [1,2].

Acute generalized peritonitis due to underlying hollow viscous perforation is a critical and life-threatening condition. It is a common surgical emergency in most of the general surgical units across the world. It is often associated with significant morbidity and mortality [1,2].

Early prognostic evaluation is desirable so as to be able to select high-risk patients for more aggressive treatment especially in severe peritonitis. Despite spectacular advances in understanding pathogenesis of disease, in diagnostic modalities discovery of broad spectrum antibiotics, invention of modern advance equipments like ventilators, advancement of knowledge in surgical and anesthesiology field, peritonitis still poses major problem for surgeons as far as morbidity and mortality is concerned [3,4].

The aim of this study is to assess the Socio-demographic characteristics and its association with outcome in Secondary Peritonitis cases in a tertiary care Hospital.

Aims and Objectives

To evaluate the Socio-demographic characteristics and its association with outcome in Secondary Peritonitis cases in a tertiary care Hospital. 

This study was conducted in the Department of Surgery IGMC, Shimla over a period of twelve months from January 2021-December 2021. 

Inclusion Criteria:

• All adult patients (>18 years of age) presenting with the clinical diagnosis of perforation peritonitis of either sex

• All Patients willing to participate in the study

Exclusion Criteria: 

• Patients operated elsewhere before presentation

• Patients unwilling to participate in the study

• Patients on drugs which alter the level of arterial lactate 

Study Methodology: 

• The proposed study was a longitudinal, prospective study in which all patients presenting to the Department of Surgery, IGMC, Shimla with a diagnosis of secondary peritonitis and fulfilling the inclusion and exclusion criteria were recruited

• The diagnosis of secondary peritonitis was established based on clinical examination, investigations and operative findings

• Informed and written consent was taken from the patient/relative

• Resuscitation, preoperative and postoperative treatment was performed according to the established protocol for perforation peritonitis

• Relevant information was collected

Statistical Analysis 

Data compiled in the excel sheet and further analysed by using IBM SPSS Statistics 28 and result displayed in number and percentage. To access the relationship between parameters under study outcome various hypothesis was designed and results were compiled in results and observation section using t-test and Chi-square test.

In this retrospective study total 250 patients with diagnosis of perforation peritonitis were evaluated. Among the total Males were 205 (82%) and Females were 45 (18%). Mean age of the patients was 47.28±17.34 years with range from 18 to 87 years. Among the total, 99(39.6%) patients were age <40 years while 151(60.4%) patients were aged >40 years (Table 1). 

Among the total, 32(12.80%) were expired while 218(87.20%) were discharged after treatment. 

Among the total 205 males, 19 (9.3%) were expired and 186(90.7%) were discharged while among total 45 females 13 (28.9%) were expired and 32(71.1%) were discharged. There was significant difference in mortality among males and females (Table 2). 

Mean age of 32 expired patients was 59.16±13.32 years while mean age of 218 discharged patients was 45.49±16.96 years. There was significant difference in mortality according to age (Table 3).

Among the total 205 Males mean BMI was 21.93±3.00 while among the total 45 females mean BMI was 20.68±2.46 (Table 4).

Among the total 32 expired patients mean BMI was 22.69±3.54 while among the total 218 discharged patients mean BMI was 21.76±2.80. There was no significant difference in mortality according to BMI (Table 5).

Table 1: Age and Gender Distribution of Study Participants 

Table 2: Association Between Gender and Outcome

Table 3: Association Between Mean Ages with Outcome

Table 4: Average BMI in Males and Females of the Study Participants

Table 5: Mean BMI Comparison Between Outcome

Out of 250 patients included in the study 203 patients (81 %) were male while only a small fraction i.e. 47 patients (18.8%). This predominance in incidence of secondary peritonitis in males has been reported in most of the studies. Ghosh et al. [5] observed 84.58% incidence in male in their study of 545 patients. Similar results were seen by Jhobta et al. [6] where incidence in male population was 84%. This high incidence in males is attributed to more prevalence of lifestyle risk factors like smoking, alcohol intake, prone to gastrointestinal infections like typhoid, helicobacter because of preoccupation in outdoor activities, more chances of roadside accidents and assault leading to traumatic perforations.

In our study mean age was 47.25 years ranging from 18-87 years, minimum age as per protocol was 18 years so patients below this age were excluded from the study. Jhobta et al. [6] studied 504 patients age ranging from 3-90 years where mean age was 36.8 years and most of the patients were in the age group 31-50 years and Singh et al. [7] reported mean age of 40.04 years (14-70 years) in 84 patients of perforation peritonitis.

Shin et al. [8] analyzed 117 patients of intestinal perforation and observed mean BMI of 21.7 Kg/m², 16 patients (13.67%) had BMI <18 kg/m² and 95 (81.19%) had >18 Kg/m².

In the present study, maximum patients of secondary peritonitis were males and less than 40 years old. There was significant association of mortality with gender and age group while there was no significant association of mortality with BMI.

1. Bhaskar, A. and L. Alishala. “Acute Peritonitis: A Clinical Study.” International Journal of Surgery Sciences, vol. 4, no. 1, 2020, pp. 85–90.

2. Ahuja, A. and R. Pal. “Prognostic Scoring Indicator in Evaluation of Clinical Outcome in Intestinal Perforations.” Journal of Clinical Diagnostic Research, vol. 7, no. 9, 2013, pp. 1953–1955.

3. Naveen, P. and P.K. Dhannur. “Modified APACHE II Scoring and Mannheim’s Peritonitis Index (MPI) in Predicting the Outcome of Patients with Peritonitis Secondary to Hollow Viscus Perforation.” International Journal of Surgery Sciences, vol. 3, no. 3, 2019, pp. 403–407.

4. Malik, A.A. et al. “Mannheim Peritonitis Index and APACHE II – Prediction of Outcome in Patients with Peritonitis.” Turkish Journal of TrSauma and Emergency Surgery, vol. 16, no. 1, 2010, pp. 27–32.

5. Ghosh, P.S. et al. “Epidemiology of Secondary Peritonitis: Analysis of 545 Cases.” International Journal of Scientific Study, vol. 3, 2016, pp. 83–88.

6. Jhobta, R.S. et al. “Spectrum of Perforation Peritonitis in India – Review of 504 Consecutive Cases.” World Journal of Emergency Surgery, vol. 1, 2006, p. 26.

7. Singh, R. et al. “Preoperative Predictors of Mortality in Adult Patients with Perforation Peritonitis.” Indian Journal of Critical Care Medicine, vol. 15, 2011, pp. 57–63.

8. Shin, R. et al. “Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation.” Annals of Coloproctology, vol. 32, 2016, pp. 221–227.