BAGIAN ILMU BEDAH

FAKULTAS KEDOKTERAN
UNIVERSITAS PATTIMURA

JOURNAL
DESEMBER 2016

POST-OPERATIVE PERITONITIS: DIAGNOSTIC

PROBLEMS, MORBIDITY AND MORTALITY IN
DEVELOPING COUNTRIES

disusun oleh
MARLON SOSELISA
(2010-83-034)
Pembimbing:
dr. Helfi. Nikijuluw. Sp. B-KBD
DIBAWAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK
PADA BAGIAN ILMU BEDAH FAKULTAS KEDOKTERAN
UNIVERSITAS PATTIMURA
AMBON
2016

A
B
S
T
R
A
C
T

Goal:

study the diagnostic difficulties

post-operative morbidity

mortality of peritonitis.

Patients and Methods:

Superior to 15 years whose diagnosis of postoperative peritonitis was made.

Retrospective study (between 1999 and 2013 )

Results:

Epidemiology 23573 lantern and 148 cases

Clinical Found Most were clinical signs

Intraoperative findings

Fever27,7%
Hypotention 37,2 %
Abdominal distention21,6%
The cry of umbilicus66,9%
Diffuse dullness 22,3%
Abdominal contracture47,3%
Presensce of pus 100%
22,9 % anastomotic leak
Phrenic ascess 17,6%
Iatrogenic perforation 13,5%
Digestive fistula 25%
Other causes Stomiale necrosis (12,2%) and evisceration (8,8%)

Conclusion:

diagnosis of post-operative peritonitis is difficult in a developing country.

Morbidity and mortality is high.

Improved diagnostic tools are needed.

2

Postoperat
K
ive
E
Morbidity
Peritonitis
Y
and
W
Mortality
O
R
Surgery
D
S
3

I
N
T
R
O
D
U
C
T
I
O
N

Diagnostic

and treatment
challenge to practitioners.
mortality ranging (30% to
71% ) linked to visceral
multi failures it causes.
to determine the diagnostic
difficulties and pre and
postoperative complications
they entail in developing
country.
4

P
a
t
i
e
n
t
s
and

M
e
t
h
o
d
s

Patients

Primary endpoint
Fistula
Necrosis
Perforation iatrogenic intra abdominal
abscess residual

Secondary endpoint
The presence of abdominal symptoms
Prognosis using Manheim Prognostic
Index (MPI)

Methods

Retrospective
2013)

study

(1999

and
5

R
E
S
U
L
T
S

2357
3
lante
rn
and
148
case
s

EPIDEMI
OLOGY

Fever27,7%
Fever27,7%
Hypotention
Hypotention
37,2
37,2 %
%
Abdominal
Abdominal
distention21,6
distention21,6
%
%
The
The cry
cry of
of
umbilicus66,9
umbilicus66,9
%
%
Diffuse
Diffuse
dullness
dullness
22,3%
22,3%
Abdominal
Abdominal
contracture47
contracture47
,3%
,3%

Clinic
Found
Most
Were
Clinical
Signs
Presensce
Presensce of
of
pus
pus 100%
100%
22,9
22,9 %
%
anastomotic
anastomotic
leak
leak
Phrenic
Phrenic
ascess
ascess 17,6%
17,6%
Iatrogenic
Iatrogenic
perforation
perforation
13,5%
13,5%
Digestive
Digestive
fistula
fistula 25%
25%
Other
Other causes
causes
Stomiale
Stomiale
necrosis
necrosis
(12,2%)
(12,2%) and
and
evisceration
evisceration
(8,8%)
(8,8%)

Intraop
erative
Finding
s

D
I
S
C
U
S
S
I
O
N

C
O
N
C
L
U
S
I
O
N

Postoperative

peritonitis is a
serious complication of
abdominal surgery, often
difficult to diagnose.
Support based on a
multidisciplinary approach in
which the surgeon,
anesthetist and intensives
radiologist plays a significant
role.
Only an early and effective

Thank you very much

10