Fatal Peritonitis
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Date
2020
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Peritonīts ir aizvien aktuāla problēma akūtajā ķirurģijā visā pasaulē. Akūtu vēdera dobuma orgānu slimību agrīna diagnostika un ārstēšana ar antibiotiķiem ir samazinājusi mirstību no šīs patoloģijas. Bet aizvien eksistē sarežģīti peritonīta gadījumi pacientiem ar multiplām blakus saslimšanas. Saskaņā ar pētījumiem dažādās valstīs mediķi cenšas veidot stratēģiju, lai samazinātu augsto mirstību slimniekiem ar peritonītu.
Pētījuma mērķis bija analizēt fatālu peritonītu iemeslus un to attīstību ietekmējošus faktorus, kā arī to diferenciāldiagnozes pacienta dzīves laikā.
Materiāls and metodes. Tika veikts retrospektīvs 45 peritonītu gadījumu pētījums. Autopsiju protokoli un mikropreparāti tika atlasīti no 1350 2017.–2019.gadu Rīgas Austrumu klīniskās universitātes slimnīcas Patoloģijas centra autopsijām. Katrā gadījumā ņēmām vērā mirušā pacienta vecumu, dzimumu, analizējam hospitalizācijas ilgumu, laboratoros datus, klīniskās un patologa diagnozes, saslimšanu komplikācijas, kā arī blakusslimības, Izvērtējām arī klīnisko un patologa diagnožu neatbilstību gadījumus. Iegūtos rezultātus analizējām ar Excel un IBM SPSS® Statistics 26 programmas versiju ar Rīgas Stradiņa Universitātes Statistikas nodaļas atbalstu.
Rezultāti. Vidējais ar peritonītu mirušo pacientu hospitalizācijas laiks bija divas dienas, bet vairums slimnieku mira pirmajā diennaktī. Vidējais pacientu vecums miršanas brīdī bija 65 gadi. 61, 4% mirušo bija vīrieši, bet 38,6 %-sieviešu.
Biežākie fatāla peritonīta iemesli mūsu analizētajā pacientu grupā bija: neonkoloģiska digestīvās limības (25,6 %), ļaundabīgi audzēji (23,1 %), aizkuņģa dziedzera un žultspūšļa saslimšanas (15,4 %), HIV (10,3 %), zarnu vaskulāras ģenēzes saslimšanas un citas vēdera dobuma patoloģijas (17,9 %). Tikai vienā gadījumā tika sniegta ķirurģiska palīdzība. Sešos gadījumos pacienti tika atrasti miruši mājās bez medicīniskās palīdzības saņemšanas dzīves laikā. Slimnīcās un mājās mirušo gadījumus izvērtējām atsevišķi. 18 % fatālu peritonītu gadījumos klīnikās pastāvēja diferenciāldiagnostiskas grūtības. Biežāk netika diagnosticēti tādi peritonīta iemesli kā zarnu gangrēna, dažādas lokalizācijas maligni procesi un kuņģa čūlas perforācijas.
Secinājumi. Mūsu pētījuma rezultāti pierāda, ka fatāli peritonīti attīstījās slimniekiem mūža 7.dekādē un to biežākie iemesli bija tādas gremošanas sistēmas saslimšanas kā kuņģa čūla, zarnu un kuņģa vēzis. Analizētajos gadījumos fatālu peritonītu attīstībā liela nozīme bija ilgstošai ģimenes ārstu nepameklēšanai, kad varētu būt ārstētas daudzās blakus saslimšanas, starp kurām biežākās bija kardiovaskularās un aknu patoloģijas ar attecīgo orgānu hroniskiem bojājumiem. Gan mājās, gan slimnicās mirušo pacientu fatālo peritonītu attīstību noteica arī līdzestības trūkums no pacienta un viņa piederīgo puses, jo vairums slimnieku iestājās klīnikās vēdera dobuma orgānu onkoloģisku saslimšanu vēlīnās stadijās, kā arī neārstētu hronisku gremošanas sistēmas slimību paasinājumu perio
Objectives. Peritonitis is a common surgical emergency worldwide. Improved antibiotics and diagnostic procedures have reduced its mortality. But factors still exist that contribute to adverse outcomes. According the studies from different counties there are attempts to make strategies to reduce the high mortality in patients with peritonitis. Aim of study was to analyse and describe causes of fatal peritonitis, contributing factors of its mortal outcome and diagnostic discrepancies. Materials and methods. A retrospective study of 45 P. cases was made. They were selected from 1350 autopsy records (2017 – 2019) at RECUH Pathology centre. Each was analysed with parameters of age, gender, length of hospital stay, clinical and pathological diagnosis, complications, comorbidities, laboratory values and diagnostic discrepancies. Results where statistically analyzed by Excel and IBM SPSS® Statistics version 26 with the support from statistics unit at Riga Stradins University. Results. Mean age of patients at death was 65 years. 61,4 % were males. Median hospitalization time was 2 days. The majority had died within 1 day. The most common pathological diagnoses were the cause of the peritonitis were non-oncological gastrointestinal (26 %), oncological (23 %), pancreas and gallbladder (16 %), HIV (10 %) and vascular (7 %) and other causes (18 %). Only one case involved surgery. In 6 cases the patient has been found dead at home. Hospital and home cases were analyzed separtately. In 18 % cases misdiagnoses were found. Common situations when misdiagnoses had occurred, where when the patient had intestinal ischemia, malignancies of various origins and perforation of PUD. Conclusions. This study demonstrates that the fatal peritonitis developed at 7th decade of age and the main reasons for it were such alimentary disorders as PUD and carcinomas of colon and stomach. Other contributing factors to mortal outcome of peritonitis is lack of attendance of GPs. When multiple comorbidities could be treated, the the most common concomitant diseases is cardiovascular and liver disorders. Both in hospital and home cases the development of fatal peritonitis was determined by a lack of sharing the responsibility from patient himself and his relatives as the majority of patients presented to clinics in the late stages of malignancies of the organs of the abdominal cavity, as well as during the period of exacerbation of untreated chronic diseases of the digestive system. Diagnostic discrepancies happen mainly due to emergency situations with short hospitalization time when it was impossible to order deeper examination of patient with appropriate lab tests.
Objectives. Peritonitis is a common surgical emergency worldwide. Improved antibiotics and diagnostic procedures have reduced its mortality. But factors still exist that contribute to adverse outcomes. According the studies from different counties there are attempts to make strategies to reduce the high mortality in patients with peritonitis. Aim of study was to analyse and describe causes of fatal peritonitis, contributing factors of its mortal outcome and diagnostic discrepancies. Materials and methods. A retrospective study of 45 P. cases was made. They were selected from 1350 autopsy records (2017 – 2019) at RECUH Pathology centre. Each was analysed with parameters of age, gender, length of hospital stay, clinical and pathological diagnosis, complications, comorbidities, laboratory values and diagnostic discrepancies. Results where statistically analyzed by Excel and IBM SPSS® Statistics version 26 with the support from statistics unit at Riga Stradins University. Results. Mean age of patients at death was 65 years. 61,4 % were males. Median hospitalization time was 2 days. The majority had died within 1 day. The most common pathological diagnoses were the cause of the peritonitis were non-oncological gastrointestinal (26 %), oncological (23 %), pancreas and gallbladder (16 %), HIV (10 %) and vascular (7 %) and other causes (18 %). Only one case involved surgery. In 6 cases the patient has been found dead at home. Hospital and home cases were analyzed separtately. In 18 % cases misdiagnoses were found. Common situations when misdiagnoses had occurred, where when the patient had intestinal ischemia, malignancies of various origins and perforation of PUD. Conclusions. This study demonstrates that the fatal peritonitis developed at 7th decade of age and the main reasons for it were such alimentary disorders as PUD and carcinomas of colon and stomach. Other contributing factors to mortal outcome of peritonitis is lack of attendance of GPs. When multiple comorbidities could be treated, the the most common concomitant diseases is cardiovascular and liver disorders. Both in hospital and home cases the development of fatal peritonitis was determined by a lack of sharing the responsibility from patient himself and his relatives as the majority of patients presented to clinics in the late stages of malignancies of the organs of the abdominal cavity, as well as during the period of exacerbation of untreated chronic diseases of the digestive system. Diagnostic discrepancies happen mainly due to emergency situations with short hospitalization time when it was impossible to order deeper examination of patient with appropriate lab tests.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Peritonīts, autopsiju protokoli, mirstība, diferenciāldiganozes, seniori, Peritonitis, mortality, elderly, differential diagnoses, contributing factors, autopsies, emergency.