Ranjith Cheriyan Philip1 , Swami Natarajan2
BACKGROUND Peritonitis is one of the major causes of morbidity and mortality worldwide. Scoring systems allow grouping of patients based on the severity of illness. Hence such grouping before treatment can allow analysis of morbidity and mortality rates. Mannheim Peritonitis Index (MPI) is a simple scoring system which allows the analysis of both morbidity and mortality rates among the patients presenting with peritonitis. This study was done to evaluate the efficiency of MPI in predicting outcome of patients with peritonitis in a tertiary care hospital, South India. METHODS A prospective observational study was conducted among patients with secondary peritonitis in the surgical department. MPI was calculated at admission or during the surgical management. All patients underwent laparotomy and managed according to the cause. Patients are grouped into three categories namely score < 21, between 22 and 29 and ≥ 30 based on MPI score. MPI score ≥ 30 were followed up until discharge or death. Complications such as wound infection, wound dehiscence, respiratory complications, urinary tract infection (UTI), enterocutaneous fistulas and intra-abdominal abscesses were noticed in each group. Mortality rates were also calculated in each group and were statistically analysed. RESULTS One hundred patients (68 males and 32 females) with both local and general peritonitis were included in the study. Most of the patients belong to age 15 to 30 with male predominance (male to female ratio was 2 : 1). Local peritonitis was found in 48 cases while general peritonitis was found in 52 cases. Bulk of the local peritonitis was due to appendicitis (47 %). Most common cause of general peritonitis was duodenal perforation (34 %). Among the complications, the most common were wound infection and respiratory complications followed by UTI and enterocutaneous fistulas. The MPI score and complications were found to be statistically significant (Fischer’s exact test = 111, p = 0.0001). When MPI score was < 21, the wound infection rate was very low, and no intra-abdominal abscess was observed. Higher MPI scoring was associated with increased wound infection rate. MPI scores below 21 had good prognosis and 0 % mortality. Scores between 22 and 29 showed highest morbidity and mortality of 45 %. While patients with scores ≥ 30 showed highest (90 %) mortality rate (p = 0.001).
