Author(s): Janardhana Rao Konkena1, Manmadha Rao Vayalapalli2, Naveen Kumar Podili3, Pruthvi Raj Karumuri4, Ram Prakash Gurram5

Secondary peritonitis due to perforation of Gastrointestinal Tract (GIT) is one of the most common surgical emergencies worldwide. The spectrum of aetiology of secondary peritonitis in tropical countries differs from western countries. This study was conducted in King George Hospital, Visakhapatnam, in the state of Andhra Pradesh, India. The purpose of this study is to highlight the salient causes of secondary peritonitis and its outcome.
A retrospective analysis of 603 patients of secondary peritonitis was done from January 2013 to December 2015 at King George Hospital, Visakhapatnam, Andhra Pradesh, India. All cases which were found to have peritonitis as a result of perforation of any part of GIT at the time of surgery were included in the study. All cases with either primary peritonitis or that due to anastomotic dehiscence were excluded.
A total of 603 patients were studied. Among them, 493 (81.7%) were males and 110 (18.3%) were females. Most common cause of secondary peritonitis in our study was acid peptic disease(52.40%) followed by appendicular pathology(11.2%), gastrointestinal perforation due to injury of abdomen (9.62%), small bowel perforation due to typhoid aetiology (7.63%), gangrenous bowel (6.30%), ruptured liver abscess (2.98%), biliary peritonitis (1.99%) and some miscellaneous rare causes. Overall, mortality in this study was found to be 8.95%.
The spectrum of secondary peritonitis in North Coastal Andhra Pradesh differs from other areas in India and western countries. Highest incidence of secondary peritonitis is due to perforation noted in gastroduodenal region, which is in contrast to western hemisphere where the predominant cause is lower gastrointestinal tract. Considering the relatively higher rate of gastroduodenal perforation quoted in this study, it is vital that awareness about the role of Helicobacter pylori ought to be considered. Special focus must also be made to increase awareness regarding limited use of NSAIDS, which have been incriminated as a major cause of such pathologies and are also widely abused.