Diagnostic effectively of Plain Radiography for Hallow Viscous Perforation in patients of Perforation Peritonitis admitted in surgery department of SMS Hospital Jaipur (Raj)
Abstract
In developing world where limited availability of resources and over burden of patient imposing a limitation in adapting advanced radiological technique as a first line of investigation, plain radiography may be considered as a valuable screening tool in detecting pneumoperitoneum if it’s effectively is acceptable. A validational type of observational study was conducted on 1723 patients of perforation peritonitis confirmed by laprotomy to find out the effectiveness of plain radiography in diagnosing hollow viscous perforation. All these patients were advised an upright chest and erect abdominal radiograph before going to surgery. Gas under Diaphragm (GUD) was seen and compared the findings of laprotomy to find out effectiveness of the plain radiography in diagnosing hallow viscous perforation. Positivity Rate of plain radiography either upright chest X-ray or erect abdomen in detecting pneumoperitoneum is 89.20%. So in developing world with limited resources plain radiography may be be adopted as screening tool in detecting pneumoperitoneum
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Introduction
Gastrointestinal perforations remain the most common cause of surgical pneumoperitoum since the time immortal. Perforation said to occur when pathology has breached through all the layers of the hollow viscus with resultant escape of intraluminal content into the peritoneal cavity and peritoneal contamination. This necessitates the patient to attend the casualty usually with the features of peritonitis either localized or generalized.
It has been stated that presence of pneumoperitoneum reflects visceral perforation in 85% to 90% of all occurrence1,2,3 and only 50% to 70% cases of hollow viscus perforation shows presence of pneumoperitoneum at first instance on plain radiography. 4,5,6,7 Sensitivity varied from 50% to 98%, depending upon the type of radiograph that has been captured (upright chest, erect abdomen, left lateral decubitus, supine abdomen film) and additional postural manoeuvre taken into account to increase the sensitivity of detecting pneumoperitoneum. 5,8,9,10,11
Conclusion
In developing world where limited availability of resources and over burden of patient imposing a limitation in adapting advanced radiological technique as a first line of investigation, plain radiography either upright chest X-ray or erect abdomen should be considered as a valuable screening tool in detecting pneumoperitoneum as a first line with positivity rate of 89.20% in detecting hallow viscous perforation which will be more cost effective, better interpretation and less operator dependent.