A Prospective Study on Perforated Peptic Ulcers: Peritoneal Fluid and Its Clinical Relevance to Overall Outcome

Abstract

Objective: To determine whether the spectrum of microorganisms isolated from the peritoneal fluid in a case of perforated peptic ulcer influences the various post-operative complications and the overall outcome of the patient. Perforated Peptic Ulcers (PPUs) carry the risk of severe complications, and extensive peritoneal contamination is common in India, with a potentially different microbial spectrum compared to Western India. Peritoneal fluid culture may be valuable in predicting patient outcomes.
Material and Methods: The study was conducted in the Post Graduate Department of General Surgery, Institute of Medical Sciences & SUM Hospital, Bhubaneswar, Odisha, India, over 3 years and included 525 patients with generalized peritonitis due to PPUs. Peritoneal fluid collected during surgery was analyzed for microorganisms. Postoperative complications and overall outcomes were correlated with the severity of peritonitis and the isolated microorganisms.
Results: In this series, the incidence of PPUs in males outnumbered females 11.5:1, and delayed presentation (>48 hours) occurred in 42.0% of patients. Peritoneal fluid cultures were positive in 59.0% of samples, with Escherichia coli (49.0%) being the most common isolate, followed by Klebsiella pneumoniae (K. pneumoniae), Citrobacter freundii (C. fruendii), Enterococcus faecalis (E. faecalis), and Candida albicans (C. albicans). Culture positivity significantly increased the risk of postoperative complications (odds ratio 6.75 times, p-value<0.05) and the need for critical life support (odds ratio 10.2 times, p-value<0.05).
Conclusion: Peritoneal fluid culture in PPU patients is a crucial investigation, revealing the spectrum of microorganisms and highlighting their impact on disease progression and postoperative outcomes.