Ankan Ghosh1, Anindya Halder1, Nirmalya Sen2, Aiindrila Dhara5, Sourav Ghosh4, Khulem Stellone Singh3

1Department of General Surgery, All India Institute of Medical Sciences, Kalyani, India
2Division of Molecular Medicine, Bose Institute, Kolkata, India
3Department of General Surgery, Regional Institute of Medical Sciences (RIMS), Imphal, India
4Department of Biochemistry and Biophysics, University of Kalyani, Kalyani, India
5Department of Biological Science, Tata Institute of Fundamental Research, Mumbai, India


Objective: Secondary peritonitis is caused by infection of the peritoneal cavity due to perforation of the alimentary tract. Mannheim’s peritonitis ındex (MPI) is a prognostic scoring system that predicts outcomes in peritonitis. Increasing MPI scores correlate with poor outcomes and mortality. The objective of this study is to evaluate the effectiveness of MPI-based prognosis and its impact on Indian patients with secondary peritonitis.

Material and Methods: For understanding the effectiveness of the MPI scoring system, a cross-sectional data analysis of published studies on secondary peritonitis from 10 geographical locations in India was performed. The 10-site study results were compared with unpublished in-house study data for individual MPI parameters to analyze any variations of MPI score-based predictions across a diverse Indian population. Patients were divided into risk groups on the basis of MPI scores: <21 mild, MPI= 21-29 moderate, MPI> 29 severe risk.

Results: We observed a significant correlation between mortality with age and gender as reported worldwide. Site of perforations were prevalent in the upper alimentary tract with the majority being gastro-duodenal for the Indian population as opposed to distal parts in the western population. Higher lethality in India is often associated with evolution time, organ failure, and sepsis due to delayed presentation and poor management.

Conclusion: MPI scoring is effective in predicting risk across geographically diverse Indian populations. The sensitivity and specificity of MPI scores are more reliable and a score >29 specifically recommends aggressive resuscitation & monitoring of patients, initiation of broad-spectrum antibiotics, and intensive care support to reduce mortality and morbidity.

Keywords: Secondary peritonitis, Mannheim’s peritonitis index, infection, mortality

Cite this article as: Ghosh A, Halder A, Sen N, Dhara A, Ghosh S, Singh KS. A comparative analytical study on outcome of secondary peritonitis using Mannheim’s peritonitis index in geographically diverse Indian patients. Turk J Surg 2023; 39 (4): 300-309.


Ethics Committee Approval

Ethics approval [No: A/206/REB-Comm (SP)/RIMS/2015/472/90/2018] was obtained from Research Ethics Board Regional Institute of Medical Sciences Imphal before the commencement of the study. Signed informed consents were taken from all participants. Privacy of the participants was maintained. No organ/sample were procured from any prisoners. Apart from the in-house study data, data for all studies were curated from a published work so requirement of ethics approval for published studies was revoked.

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - AH, NS; Design - AG, AD, SG, KSS, NS, AH; Supervision - NS, AH; Fundings; AG, KSS, Materials - AG; Data Collection and/ or Processing - AG, KSS, AH, NS; Analysis and/or Interpretation - AG, AD, SG, KSS, NS, AH; Literature Search - NS, AH, AD, SG; Writing Manuscript - AG, NS, AH; Critical Reviews - NS, AH, AD.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.