Title: Study of Cause and Outcome of Stoma in Septic Peritonitis
Authors: Dr Vinod B. Khade, Dr Amit Ajit Desai
DOI: https://dx.doi.org/10.18535/jmscr/v9i10.28
Abstract
Introduction: Peritonitis is the inflammation of peritoneum and peritoneal cavity, usually caused by a localized or generalized infection[1]. Mounting studies have shown different etiological spectrums for perforation peritonitis in India compared to rest of the world.[2-5] An intestinal stoma is one of the lifesaving surgical procedure employed during the management of perforation peritonitis.
A variety of complications associated with stoma formation and its closure have been reported Complications following the creation of an intestinal stoma are experienced by 20–70% of the patients.[6,7,8]
With this backdrop, the present study was carried out to evaluate the indications and adverse risk factors which lead to stoma formation in perforative peritonitis. Further, patients outcome in terms of mortality and morbidity where stoma were also evaluated.
Method: Retrospective data was collected for patients who had undergone intestinal stoma for perforative peritonitis at Department of General Surgery at a tertiary care hospital in Mumbai, over a period of 2years (From August 2011 to November 2013.
Data collected included personal details like age and sex of the patient, primary disease causing peritonitis, adverse risk factors, type of stoma, complications following stoma and length of hospital stay.
Results: Over the time period of 2 years, 50 patients underwent stoma. Average age of the patients was 35 years (Range 17 – 78 years). 64% were males and 36% were females.
Major cause of peritonitis was enteric fever (n= 12), followed by tuberculosis of intestine (n= 11). Major adverse risk factors were sepsis (n= 35), anemia (n=33) and hypoproteinemia (n=29).
Commonest site for stoma was the ileum (n=39). The other sites for stoma were transverse colon (n=7), sigmoid colon (n=2) and jejunum (n=2). The commonest type of stoma was loop stoma (n=22) followed by double barrel stoma (n=10) and end stoma (n=7).
Wound infection was the commonest complication (n=28) followed by respiratory complications (n=17). Average duration of hospital stay was 17.1 days (Range 6 -90 days). There was 14% mortality.
Conclusions: Common indications for intestinal stomas were perforative peritonitis following enteric fever and tuberculosis. This is the pattern commonly seen in tropical countries of the Indian subcontinent. Main complications were wound infections followed by respiratory complications.
Keywords: Perforative peritonitis, Intestinal stoma.
