Published Paper Details:

Background: Peritonitis is a common condition, faced by surgeons since centuries. It is a serious intra-abdominal infection (IAI), a frequently lethal condition, and continues to be one of the major problems that a surgeon has to face. Despite application of aggressive surgical techniques like irrigation with/without antibiotics, on demand reoperations, laparostomy, progress in antimicrobial agents and intensive care treatment, peritonitis continues to have a poor prognosis. Objectives: The aim of the present study was: To confirm the predictive value of MPI among the patients with intraoperative diagnosis of secondary peritonitis at the department of Surgery, S.M.H.S Hospital, Srinagar and to evaluate the severity of peritonitis on the basis of MPI. Methods: A prospective and observational study was carried out over a period of two years. A total of 172 patients were studied. Results: MPI score is strongly associated with outcome, and is an important index for predicting patient outcome in peritonitis. There was statistically significant increase in mortality with increase in MPI score, with survivors having a mean MPI of 18.0 and non-survivors having a mean score of 33.7. Peptic ulcer perforation was the most common etiology (30.81%), followed by appendicular perforation (27.33%). Small gut perforation was the next most common cause (9.88%) and gut gangrene cases amounted to 6.40%. Other etiological sources were genitourinary tract perforations (6.40%), postoperative peritonitis (5.23%), gall bladder perforation (2.33%), ruptured liver abscess (1.74%), Meckel�s diverticulum perforation (1.74%) and gastric perforation (1.16%). Mortality in our study was 13.37%, with 23 patients dying out of the 172 operated patients. Highest mortality was seen in patients with colorectal perforation and in patients with gastric perforation, followed by postoperative peritonitis. Conclusions: We conclude that the prognosis of peritonitis has improved due to application of modern surgical techniques; however a severity index is needed to be more objective. Mannheim Peritonitis Index is a useful method to predict outcome in these patients. All MPI adverse factors except for colonic origin behaved as expected. MPI is easy to calculate, does not need any laborious work, economically the cheapest for us and there is a marked difference between survivors and non-survivors.