Emerging Spectrum of Perforation Peritonitis in Developing World

Area of Science:

• Gastroenterology
• Surgical Emergencies
• Epidemiology

Background:

• Gastrointestinal perforations are a leading cause of acute abdominal pain in surgical emergency rooms.
• Trends in incidence, perforation site, and patient demographics differ in developing nations compared to Western countries.
• The etiological spectrum of gastrointestinal perforations varies significantly between developing and developed regions.

Purpose of the Study:

• To investigate the current trends in perforation peritonitis in India.
• To analyze the demographic, clinical, and etiological characteristics of patients with perforation peritonitis.
• To compare perforation peritonitis patterns in India with those reported in Western countries.

Main Methods:

• A consecutive series of 350 patients with perforation peritonitis were studied.
• Data collected included age, sex, seasonal variations, clinical presentation, biochemical parameters, radiological and intraoperative findings, surgical intervention, and postoperative outcomes.
• The study was conducted in a single surgical unit at Darbhanga Medical College and Hospital, India.

Main Results:

• Duodenal ulcer was the most frequent cause (~50%), followed by typhoid (20%), traumatic (14.5%), appendicular (7.4%), and tubercular (3.1%) perforations.
• Males were more commonly affected (3:1 ratio), with peak incidence in the second and third decades of life.
• Peptic ulcer perforations peaked in autumn/winter, while typhoid perforations were more common in summer/rainy seasons.

Conclusions:

• The spectrum of perforation peritonitis in India differs from Western countries, characterized by younger age at presentation, distinct perforation sites, and varied etiological factors.
• Infective pathologies account for approximately 25% of cases in the developing world.
• Developing regions exhibit a higher prevalence of upper gastrointestinal tract perforations, contrasting with the predominance of lower gastrointestinal tract perforations in the West.