Clinical Outcomes of Emergency Exploratory Laparotomy in Patients with Perforation Peritonitis: A Single-Center Experience

Abstract

Background: Perforation peritonitis is one of the most frequently encountered surgical emergencies in developing countries and carries substantial morbidity and mortality. Emergency exploratory laparotomy remains the cornerstone of management. This study evaluated the aetiological spectrum, operative findings, and postoperative clinical outcomes in patients undergoing emergency laparotomy for perforation peritonitis at a tertiary care centre.

Methods: A prospective observational study was conducted on 120 consecutive patients presenting with clinical and radiological features of hollow viscus perforation who underwent emergency exploratory laparotomy over an 18-month period. Demographic data, duration of symptoms, site and cause of perforation, operative procedure, postoperative complications, length of hospital stay, and mortality were recorded. The Mannheim Peritonitis Index (MPI) was calculated for each patient, and its association with mortality was analysed. A p-value < 0.05 was considered statistically significant.

Results: The mean age was 42.3 ± 15.6 years with a male predominance (70.0%). Duodenal perforation was the commonest site (31.7%), followed by ileal (25.0%) and gastric (15.0%) perforations. Simple closure with an omental patch was the most frequently performed procedure. Surgical site infection (28.3%) was the leading postoperative complication. The overall mortality was 15.0%. A delayed presentation beyond 48 hours and an MPI score greater than 26 were significantly associated with mortality (p < 0.05).

Conclusion: Perforation peritonitis remains a life-threatening emergency with considerable mortality driven largely by delayed presentation, advanced peritoneal contamination, and a high MPI score. Early diagnosis, prompt resuscitation, and timely surgical intervention are critical determinants of a favourable outcome.