Spectrum of perforation peritonitis and evaluating the efficacy of Mannheim peritonitis index in predicting the prognosis

INTRODUCTION: Perforation peritonitis has been found to be a common surgical emergency in India. Despite advancements in antimicrobials and supportive care, mortality associated with diffuse suppurative peritonitis is high. The Mannheim Peritonitis Index is a specific score, which has a good accuracy and has ease of handling of clinical parameters. It allows for easy prediction of the prognosis in patients with peritonitis. AIM OF THE STUDY: 1. To assess the effectiveness of the Mannheim peritonitis index in predicting the outcome of patients with peritonitis. 2. To assess the significance of each risk factor of the Mannheim index in predicting the prognosis. 3. To assess the morbidity and mortality rates in patients with peritonitis. 4. Evaluate various conditions leading on to peritonitis. METHODOLOGY: The study is done in 50 patients with peritonitis due to hollow viscous perforation who presented to PSG Hospitals, Coimbatore. MPI score was calculated for each patient and the post operative course followed up. RESULT: In our study, appendicular perforation was found to be the most common cause of perforation peritonitis accounting for 26 percent of the cases. This is followed by perforation of peptic ulcer (20 %) and traumatic perforations (16%). 64 % of patients with peritonitis had MPI score of less than 21. These patients had a morbidity rate of 34.37. Thirty percent had MPI score within 21 to 29. These patients had a morbidity rate of eighty percent. There were three patients who had MPI score of above 29. Two of these patients died and the remaining one had post op morbidity. There was no mortality in the other two groups. The association of increasing MPI score with mortality and morbidity is found to be significant. The p value is 50 years, presence of organ failure, site of perforation, extent of peritonitis and the nature of peritoneal exudate were found to be positively associated with the prognosis. CONCLUSION: The most common causes of perforation peritonitis were found to appendicitis and peptic ulcer disease. It has been found that the Mannheim peritonitis index has been a good predictor of mortality as well morbidity in patients with peritonitis