Improving results of surgery for fecal peritonitis due to perforated colorectal disease: A single center experience

• This study investigates results of surgery for fecal peritonitis due to colorectal perforation during the last decade.
• It shows lower rates of complications and mortality and highlights the MPI as the strongest predictor of outcomes.
• MPI score may help to select patients who better benefit from colorectal resection for fecal peritonitis.

Purposefecal peritonitis due to colorectal perforation is a dramatic event characterized by high mortality. Our study aims at determining how results of sigmoid resection (eventually extended to upper rectum) for colorectal perforation with fecal peritonitis changed in recent years and which factors affected eventual changes.MethodSeventy-four patients were operated on at our institution (2005–2014) for colorectal perforation with fecal peritonitis and were divided into two numerically equal groups (operated on before (ERA1-group) and after (ERA2-group) May 2010). Mannheim Peritonitis Index (MPI) was calculated for each patient. Characteristics of two groups were compared. Predictors of postoperative outcomes were identified.ResultsPostoperative overall complications, major complications, and mortality occurred in 59%, 28%, and 18% of cases, respectively, and were less frequent in ERA2-group (51%, 16%, and 8%, respectively), compared to ERA1-group (68%, 41%, and 27%, respectively; p = .155, .02, and .032, respectively). Such results paralleled lower MPI values in ERA2-group, compared to ERA1-group (23(16–39) vs. 28(21–43), p = .006). Using receiver operating characteristic analysis, the best cut-off value for MPI for predicting postoperative complications and mortality was 28.5. MPI > 28 was the only independent predictor of postoperative overall (p = .009, OR = 4.491) and major complications (p < .001, OR = 23.182) and was independently associated with a higher risk of mortality (p = .016, OR = 13.444), as well as duration of preoperative peritonitis longer than 24 h (p = .045, OR = 17.099).Conclusionsresults of surgery for colorectal perforation with fecal peritonitis have improved over time, matching a concurrent decrease of MPI values and a better preoperative patient management. MPI value may help in selecting patients benefitting from surgical treatment.