Journal of Surgical Technique and Case Report
Journal of Surgical Technique and Case Report
ORIGINAL ARTICLE
Year : 2015  |  Volume : 7  |  Issue : 2  |  Page : 32-36

Acute physiological and chronic health evaluation ii score and its correlation with three surgical strategies for management of ileal perforations


1 Department of Surgery, Government Medical College, Patiala, Punjab, India
2 Department of Pathology, Pandit Bhagwan Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India

Correspondence Address:
Anand Munghate
Department of Surgery, Government Medical College, Patiala - 147 001, Punjab
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2006-8808.185653

Rights and Permissions

Introduction: Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. It is reported to constitute the fifth common cause of abdominal emergencies due to high incidence of enteric fever and tuberculosis in these management based on Acute Physiological and Chronic Health Evaluation II (APACHE II) score. Methods: The following study was conducted in the Department of General Surgery, Government Medical College, Patiala. A total of 57 patients were studied and divided in to Group I, II, and III. APACHE II score accessed and score between 10 and 19 were blindly randomized into three procedures primary closure, resection-anastomosis, and ileostomy. The outcome was compared. Results: Ileal perforations were most commonly observed in the third and fourth decade of life with male dominance. APACHE II score was accessed and out of total 57 patients, 6 patients had APACHE II score of 0-9, 48 patients had APACHE II score of 10-19, and 3 patients had APACHE II score of ≥20. In APACHE II score 10-19, 15 patients underwent primary closure, 16 patients underwent resection-anastomosis, and 17 patients underwent ileostomy. Discussion and Conclusion: Primary closure of perforation is advocated in patients with single, small perforation (<1 cm) with APACHE II score 10-19 irrespective of duration of perforation. Ileostomy is advocated in APACHE II score 10-19, where the terminal ileum is grossly inflamed with multiple perforations, large perforations (>1 cm), fecal peritonitis, matted bowel loops, intraoperative evidence of caseating lymph nodes, strictures, and an unhealthy gut due to edema.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed625    
    Printed19    
    Emailed0    
    PDF Downloaded86    
    Comments [Add]    

Recommend this journal