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.

1. Turnage RH, Badgwell B. Abdominal Wall, Umbilicus, Peritoneum, Mesenteries, Omentum, and Retroperitoneum. In: Sabiston Textbook of Surgery. Elsevier; 2012. p. 1088–113.
2. Bali RS, Verma S, Agarwal PN, Singh R, Talwar N. Perforation Peritonitis and the Developing World. ISRN Surg. 2014 Apr;2014:1–4.
3. Yadav D, Garg PK. Spectrum of Perforation Peritonitis in Delhi: 77 Cases Experience. Indian J Surg. 2013 Apr;75(2):133–7.
4. Malhotra MK, Singal R, Chowdhary K, Sharma RG, Sharma S, Dhankhar A. Spectrum of Perforation Peritonitis in a Rural Medical College. Bangladesh J Med Sci. 2016 Apr;15(1):70–3.
5. Nabi I, Munjewar C, Ranjan G, Gupta S, Ahirwar N, Chaudhary P, et al. Spectrum of perforation peritonitis at a tertiary healthcare centre: A prospective cohort study of 1908 cases. Hell J Surg. 2016 May;88(3):181–5.
6. Rajkumar DR, Singh DM, Neogi DP, Kumar DS, Gupta DV. Profile of intestinal stomas at a tertiary referral centre of central India. Int J Med Res Rev. 2016 Jun;4(6):881–8.
7. Chaudhary P, Nabi I, Ranjan G, Tiwari AK, Kumar S, Kapur A, et al. Prospective analysis of indications and early complications of emergency temporary loop ileostomies for perforation peritonitis. Ann Gastroenterol. 2015;28(1):135–40.
8. Sarkut P, Dundar HZ, Tirnova I, Ozturk E, Yilmazlar T. Is stoma care effective in terms of morbidity in complicated ileostomies? Int J Gen Med. 2015 Aug;243.
9. Jhobta, Attri AK, Kaushik R., Sharma R, Jhobta A: spectrum of perforative peritonitis in India 504 consecutive cases. World J of Emerge Surge, 5; 1:26. Sep.2006
10. Gupta S., Kaushik R: peritonitis – the Eastern experience. World J Emergency surge .26; 1:13 Apr 2006
11. AtmanalapSS, Aydinil B, Ozturk H, Oren D, Basoglu M, Yildigan MI: Typhoid intestinal perforations: twenty six years experience: W J Surge 31(9):1883-1888, sept 2007
12. Burch JM, Martin RR, et al: Evolution of the treatment of injured colon in 1980s, Arch Surge 126:979-984, 1991.
13. Onen A, Dokucu AI,Cidgem MK,Oztruk H,Otcu S, Yucesan S:Factors affecting morbidity in typhoid intestinal perforations in children, Ped Surg int18(8):696-700, Dec2002
14. Stothart JC Jr, Brubacher L, Simono Witz DA: complications of emergency stoma formation Arch Surge 126:979-984, 1991
15. Arumugam PJ, Ben L, et al:A prospective audit of stoma –analysis of risk factors and complications and their management . Colorectal Dis 5:49-52,2003.
16. Del Pino A, Pearl RK, Clintron JR, Orsay CP, Tan A, Abacrian H: Enterostomal complications: are emergently created enterostomas at greater risk? Am Surge 63(7):653-656, Jul 1997.

Dr Vinod B. Khade

Department of General Surgery, K.B. Bhabha Municipal Hospital, Bandra west, Mumbai 400050, India