Perforation Peritonitis (Laparoscopic) | Pristyn Care

Risk Factors

Risk factors include:

• NSAID use causing peptic ulcer perforation
• Helicobacter pylori infection
• Steroid therapy impairing mucosal healing
• Delayed presentation of appendicitis
• Diverticular disease in the elderly
• Advanced malignancy with bowel wall invasion
• Immunocompromised state (HIV, steroids, chemotherapy)

Who Is at Risk

Elderly patients on NSAIDs or steroids, those with untreated peptic ulcer disease or diverticulitis, immunocompromised individuals, and patients with advanced colorectal malignancy are at highest risk of perforation peritonitis.

Diagnosis

Diagnostic evaluation includes:

• Erect chest X-ray showing free air under the diaphragm (pneumoperitoneum)
• CT abdomen with contrast: confirms site and extent of perforation
• Blood tests: full blood count, CRP, lactate, blood cultures
• Urine dipstick and pregnancy test where indicated
• Haemodynamic assessment for septic shock and organ dysfunction

Treatment: Laparoscopic Peritonitis Management

Pristyn Care performs emergency laparoscopic peritoneal washout, closure of perforation (Graham patch or primary repair), and, where indicated, bowel resection with or without stoma formation, following haemodynamic stabilisation.

Laparoscopic Repair Procedure

Procedure involves:

• Emergency laparoscopic approach with 3-4 ports after resuscitation
• Thorough peritoneal irrigation with warm saline (5-10 litres)
• Identification and closure of perforation site:
• Duodenal/gastric: Graham patch (omental patch repair) or primary suture
• Colonic: primary repair if feasible, or Hartmann’s procedure with colostomy
• Drain placement in all four quadrants
• Conversion to open surgery if haemodynamically unstable or dense adhesions

After the Surgery

Post-operative care includes:

• HDU or ICU monitoring for sepsis and organ function
• Nasogastric tube decompression until bowel function returns
• IV antibiotics (broad-spectrum, tailored to culture results)
• Proton pump inhibitor therapy for peptic ulcer perforation
• H. pylori eradication therapy post-recovery
• Gradual reintroduction of oral diet from day 3-5
• Stoma care education if stoma formed

Possible Complications of Peritonitis Surgery

Potential complications include:

• Residual intra-abdominal abscess requiring CT-guided drainage
• Anastomotic leak or patch failure
• Wound infection and dehiscence
• Prolonged ileus
• Septic shock and multi-organ dysfunction
• Incisional hernia at port sites
• Mortality risk in delayed or severe presentations