Generalized peritonitis secondary to typhoid ileal perforation:Assessment of severity using modified APACHE II score

Abstract

Background: Generalized peritonitis from typhoid ileal perforation is a common cause of surgical emergency in the developing countries, associated with high morbidity and mortality. The severity assessment of a disease condition is often useful to prioritise treatment and reduce morbidity and mortality. High severity scores are usually associated with high morbidity and mortality; therefore, these patients may require more intensive treatment than those with low severity scores. Aim: The purpose of this study was to assess the severity of generalized peritonitis from typhoid ileal perforation using modified APACHE II score. Setting and Study Design: A teaching hospital unit serving the rural and semi-urban Nigerian community. It is a prospective study of patients with generalized peritonitis from typhoid ileal perforation. Materials and Methods: Over a period of 7 years, patients had severity of illness assessed using modified APACHE II score. Demographic, clinical, preoperative, operative and postoperative data on each patient were entered into a prepared proforma. Each patient had postoperative outcome and severity of illness were compared to determine the significance of the severity of illness on postoperative outcome. Results: The mean age was of 23.6 + 15.5 years, with 4:1 male: female ratio. Morbidity rate ranged from 8.8-71.3% and mortality in 17.5%. Modified APACHE II score ranged from 0-19, with a mean of 8.2 + 4, 7.6 + 4 for survivors and 9.4 + 2 in those who died. There was no death among the patients who scored 0-4, whereas mortality was 13% in those who scored 5-9, 41.2% in those who scored 10-14, and 50% in patients who scored 15-19 (P<0.05). The modified APACHE II Score significantly influenced mortality, but did not influence the incidence of other postoperative complications. Conclusion: A high APACHE II score was associated with high mortality, but did not predict morbidity rate in the patients studied. More study is needed involving a larger number of patients to further validate our findings.