Predictive power of Mannheim Peritonitis Index.

OBJECTIVE: To evaluate Mannheim Peritonitis Index (MPI) in predicting outcome in patients with secondary peritonitis and to assess each risk factor independently regarding its contribution towards final outcome. DESIGN: Prospective analytical study. PLACE AND DURATION OF STUDY: Surgical Unit-II of Rawalpindi General Hospital, from December 1999 to January 2001. PATIENTS AND METHODS: One hundred and twenty-six patients who presented to the department with secondary peritonitis were included in the study. MPI score was calculated for each patient on a pre-designed proforma and the patients were followed-up till death or discharged from the hospital. Death was the main outcome measure against which the MPI scores were analyzed under two categories; (i) score > or = 26 and < 26 (ii) scores < 21, 2-29, and > 29. Data was analyzed on software SPSS (version 11.0). Chi-square test was used to assess any significant association between scores and outcome. Odds ratios were calculated for individual risk factors. RESULTS: Mortality rate for MPI score > or = 26 was 28.1% while for scores less than 26 it was 4.3%. For MPI scores pound 20 mortality rate was 1.9%, for scores 21-29 it was 21.9% and for score 30 or more it was 28.1%. Chi-square showed significant association between mortality and increasing MPI score (p < 0.01). Odd ratios calculated were significant for age > 50 years, malignancy, organ failure, pre-operative duration of peritonitis > 24 hours and cloudy, purulent exudate. CONCLUSION: Increasing MPI score is strongly associated with outcome in secondary peritonitis.

Comparison between strictureplasty and resection anastomosis in tuberculous intestinal strictures.

OBJECTIVE: To compare the effectiveness, safety and morbidity of strictureplasty with resection anastomosis in patients with tuberculous small gut strictures. DESIGN: Prospective comparison study. PLACE AND DURATION OF STUDY: Surgical Unit-I of Rawalpindi General Hospital from March 2000 to February 2002. PATIENTS AND METHODS: Thirty patients who presented with intestinal obstruction due to tuberculous strictures, and underwent either resection anastomosis or strictureplasty were included in the study. Data was collected on a proforma and analyzed using software SPSS (version 8.0). Chi-square and t-test were used to test the hypothesis. Main outcome measures included the presence or absence of postoperative leakage anastomosis, wound infection, recurrence of intestinal obstruction and postoperative stay. RESULTS: Chi-square test applied to see the effectiveness showed no significant difference (p>0.5) between the two procedures. t-Test on the score of morbidity also showed no significant difference (p>0.5) between the two procedures. CONCLUSION: Both procedures performed were equally effective and had equal morbidity in cases of intestinal tuberculous strictures. Strictureplasty is superior to resection anastomosis in cases of multiple strictures as it conserves gut length and can even be performed safely in cases with coexistent gut perforation.