Abstract
RELATION OF CULTURE POSITIVITY AND DURATION OF PERFORATION IN CASES OF GASTRIC AND DUODENAL PERFORATION

*Dr. Nikita Kumar Theophilus, Dr. Karan Shetty and Dr. M. K. Ramesh

ABSTRACT

Aims: the aim of the study was to study the bacteriological profile of the peritoneal fluid in cases of gastric and duodenal perforation and correlate it with perforation-operative procedure interval and the associated morbidity and mortality associated with the perforation based on the operative interval. Methods: It is a cross sectional observation study ranging from January 2015 to July 2016, which was conducted in Victoria Hospital, Bangalore. The data was analyzed using rates, ratios proportions and percentages. The sample includes 64 cases of secondary peritonitis, resulting from gastric and duodenal perforation, where peritoneal fluid samples collected preoperatively, before the administration of an antibiotic dose was analyzed for bacteriological culture. Postoperatively complications were managed according to the associated pathology. Results: The sample size (n) was of 64 patients. 58 of the patients had a gastric perforation and 6 presented with a duodenal perforation. 18 patients yielded a positive growth of bacteria on peritoneal fluid culture. Majority of the patients who yielded a positive peritoneal culture presented 4 days after the onset of symptoms suggestive of gastric perforation. 22 of the patients who presented 3 days after onset of symptoms suggestive of perforation were in shock and required resuscitation, resulting in a delay in surgery. 7 of the patients who developed operative site wound infection, which resulted in prolonging the hospital stay from the usual 5 days to 1-2 weeks, presented 3 days after onset of symptoms. The patients who developed operative site wound infection yielded a peritoneal bacterial growth preoperatively. Conclusion: Majority of the cases of gastric perforation yielded sterile peritoneal fluid cultures. The incidence of secondary infection to the peritoneal fluid increases after the third day, which in turn results in a higher incidence of post operative complications. Patients who presented three days after onset of symptoms suggestive of gastric perforation increased the chances of intraoperative and postoperative morbidity and mortality. The associated mortality and morbidity of patients presenting with peptic ulcer perforation can be curtailed by earliest possible surgical intervention.

Keywords: peptic ulcer perforation, gastric perforation, duodenal perforation, secondary peritonitis, peritoneal culture.


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