Clinical Outcome of Primary and Postoperative Visceral Perforations

Background: Peritonitis secondary to primary and postoperative gut perforation is still one of the commonest surgical emergencies in Italy and is associated with an high risk of morbidity and mortality. The present study examines the incidence and clinical outcome of patients with peritonitis operated on in our Surgical Unit. Methods: In this retrospective study, 105 patients with peritonitis from visceral perforation (females 51, males 54) operated on between 2001 and 2007 were studied. Several data including clinical presentation, operative findings and postoperative course were analyzed. Results: In our series we found 55 primary (52%) and 50 postoperative (48%) peritonitis. The main causes of primary peritonitis were: peptic ulcer perforation (13%), neoplasms (6%), diverticular disease (7%), traumatic disease (5%), ischemic disease (7%), foreing bodies (2%), iatrogenic causes (2%), others (10%). The sites of perforation were: stomach-duodenum in 32.5% of the cases, jejunum-ileum in 27.5%, proximal colon in 15% and distal colon in 25%. The overall mortality rate was 27%. An high mortality was observed in gastric and duodenal perforations (31.8%), and a lower mortality in proximal colon perforations (16.7%). Mortality rates in relation to the different causes of perforation were: neoplastic disease (37.5%), postoperative perforation (32.5%), trauma (20%), peptic disease (10%). Age of patients was the most important factor influencing mortality; the mortality rate reached 62.5% in patients over 75 years, but it was only 5.7% in patients younger than 60 years. Conclusion: Visceral perforations are a frequent occurrence in general surgery. In our experience, about an half of cases were secondary to abdominal surgery and were associated with an high risk of mortality. CT multilayer scan can be particularly useful in addressing the diagnosis and treatment especially in postoperative, traumatic or diverticular perforations. Age of patients is the main factor associated with postoperative mortality.