A 12-year-old girl in Bengaluru ended up in the hospital after trying a trendy liquid nitrogen paan in late April this year at a wedding reception. She began experiencing stomach pain shortly after.
Her family quickly rushed her to a hospital where doctors ran tests and concluded that she had a hole in her stomach — a condition known as perforation peritonitis.
Indianexpress.com reported earlier that doctors at Narayana Multispeciality Hospital in Bengaluru’s HSR Layout, where the girl underwent surgery, said liquid nitrogen causes a tremendous amount of force to be generated as it vaporises in an enclosed space.
Dr Vijay H S, operating surgeon (surgical gastroenterology), revealed in a statement issued on Monday, “The patient underwent exploratory laparotomy with intra-op-OGD scopy, and sleeve gastrectomy was swiftly conducted to address the critical condition. There was an unhealthy patch of about 4×5 cm on the lesser curvature of the stomach, which was taken care of with sleeve resection (a part of the stomach was removed). Post surgery she had two days of ICU stay and got discharged after six days.”
What is perforation peritonitis and how dangerous is it?
Dr Pranav Honnavara Srinivasan, senior consultant, Gastrointestinal surgery, Gastrointestinal oncology, Bariatric surgery and Advanced Laparoscopic Surgery at Sparsh Hospital, says, “Perforation peritonitis is a serious surgical condition that arises when a hole forms in one of the organs within the abdomen like stomach, small intestine, large intestine and appendix spilling bacteria-laden contents into the peritoneal cavity.”
Dr Prachi Bhosale, a paediatrician & neonatologist at Apollo Cradle, Brookfield, explains, “The peritoneum is incredibly sensitive, and any contamination can cause a rapid and dangerous inflammatory response.” Perforation peritonitis can disrupt normal gastrointestinal function. (Source: Freepik)
The peritoneum is a thin, smooth tissue lining the abdominal wall and covering the organs. When this is breached and exposed to bacteria, he informs that a life-threatening infection ensues and may result in death.
Typical surgical care procedures for a patient with perforation peritonitis
The cornerstone of treatment is surgery, says Dr Srinivasan. The gastrointestinal surgeon aims to:
Locate the perforation: This often involves laparoscopy, a minimally invasive procedure using a camera-guided instrument.
Patch the hole: The perforated organ is repaired or resected, depending on the severity.
Cleanse the contamination: The abdominal cavity is thoroughly irrigated to remove infectious material.
Drain potential pockets of pus: In some cases, drain tubes are placed to allow continued drainage of infection.
He adds, “The choice between open surgery (laparotomy) and laparoscopy depends on factors like the expertise of the surgeon, extent of contamination, the patient’s condition, and the facilities at the hospital.”
The road to recovery
According to Dr Srinivasan, the recovery timeline varies depending on the severity of the condition and the patient’s overall health.
After surgery, Dr Bhosale says that the patient’s diet and lifestyle need careful management to ensure proper healing. The initial stages of recovery involve a liquid diet to minimise stress on the digestive system. Gradually, soft and easily digestible foods are introduced.
“Typically, a hospital stay of 5-7 days is expected. During the first few days, the focus is on pain management, infection control, and initiating a clear liquid diet, which is then upgraded to a soft diet,” Dr Srinivasan adds.
In weeks 1-2, the removal of drains (if placed) occurs, he explains, continued monitoring is performed, and patients are discharged home with instructions for rest and wound care. Weeks 3-4 involve continuing physiotherapy and planning a return to work.
Potential long-term impacts of perforation peritonitis
There are some long-term effects of this condition that can affect a patient’s life. Dr Srinivasan lists them as follows
Digestive Dysfunction: Perforation peritonitis can disrupt normal gastrointestinal function, leading to symptoms such as abdominal discomfort, bloating, and irregular bowel movements
Scar Tissue Formation: Surgical repair of perforations can result in the formation of scar tissue called adhesions, which may cause organs to become stuck to one another, leading to chronic pain and bowel obstruction.
Nutritional Deficiencies: Prolonged illness and surgical interventions can impact nutrient absorption and metabolism, potentially leading to nutritional deficiencies. Patients may require dietary modifications or nutritional supplements to ensure adequate intake of essential nutrients.
Psychological Impact: Coping with a life-threatening illness such as perforation peritonitis can take a toll on a patient’s mental and emotional well-being which may benefit from counselling.
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