Evaluating the Correlation between Elevated Intra-abdominal Pressure and Outcomes of Perforation Peritonitis: An Observational Study from North India.

BACKGROUND

Perforation peritonitis is among the primary causes of elevated intra-abdominal pressure (IAP). Numerous studies have reported the association of high IAP with impaired perfusion to various organs, ultimately leading to multi-organ failure and mortality. Still, it is underdiagnosed. The present study aims to correlate the postoperative morbidities of perforation peritonitis with the increase in IAP.

METHODS

This observational study included 55 patients with perforation peritonitis who underwent either emergency laparotomy or drain placement interventions. Foley's catheter was utilized to measure urinary bladder pressure, and this bladder pressure indirectly assisted in determining IAP. Data concerning the occurrence of postoperative morbidities, like surgical site infection (SSI), wound dehiscence, burst abdomen, prolonged ileus, acute respiratory distress syndrome (ARDS), and acute renal failure (ARF), were collected. The incidences of these morbidities were correlated with the IAP using the Spearman's correlation coefficient.

RESULTS

The mean preoperative IAP was 27.4 ± 3.6 cm H2O. We observed a higher incidence of SSI (41%) than other postoperative morbidities, including wound dehiscence (27%), ARDS (21%), burst abdomen (17%), prolonged ileus (11%), and ARF (7%). A direct correlation was observed between IAP and morbidities such as SSI, wound dehiscence, and prolonged ileus. In contrast, an inverse correlation was noticed between IAP and morbidities like burst abdomen, ARDS, and ARF, but these were statistically nonsignificant. With these postoperative morbidities, the average duration of hospital stay was 7.1 ± 3.2 days.

CONCLUSION

The findings of the study revealed an uncertain correlation between the postoperative outcomes of perforation peritonitis and elevated IAP. Although nonsignificant, these inferior correlations with postoperative morbidities warrant further research with a larger sample size.