title: Acute Physiological and Chronic Health Evaluation II Score and its Correlation with Three Surgical Strategies for Management of Ileal Perforations.
abstract: BACKGROUND
  Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. It is reported to constitute the fifth common cause of abdominal emergencies due to high incidence of enteric fever and tuberculosis in these management based on Acute Physiological and Chronic Health Evaluation II (APACHE II) score.
  
  
  METHODS
  The following study was conducted in the Department of General Surgery, Government Medical College, Patiala. A total of 57 patients were studied and divided in to Group I, II, and III. APACHE II score accessed and score between 10 and 19 were blindly randomized into three procedures primary closure, resection-anastomosis, and ileostomy. The outcome was compared.
  
  
  RESULTS
  Ileal perforations were most commonly observed in the third and fourth decade of life with male dominance. APACHE II score was accessed and out of total 57 patients, 6 patients had APACHE II score of 0-9, 48 patients had APACHE II score of 10-19, and 3 patients had APACHE II score of ≥20. In APACHE II score 10-19, 15 patients underwent primary closure, 16 patients underwent resection-anastomosis, and 17 patients underwent ileostomy.
  
  
  CONCLUSIONS
  Primary closure of perforation is advocated in patients with single, small perforation (<1 cm) with APACHE II score 10-19 irrespective of duration of perforation. Ileostomy is advocated in APACHE II score 10-19, where the terminal ileum is grossly inflamed with multiple perforations, large perforations (>1 cm), fecal peritonitis, matted bowel loops, intraoperative evidence of caseating lymph nodes, strictures, and an unhealthy gut due to edema.
authors: Department of Surgery, Government Medical College, Patiala, Punjab, India.
authors: Anand
authors: A
authors: Munghate
authors: Department of Surgery, Government Medical College, Patiala, Punjab, India.
authors: Ashwani
authors: A
authors: Kumar
authors: Department of Surgery, Government Medical College, Patiala, Punjab, India.
authors: Sushil
authors: S
authors: Mittal
authors: Department of Surgery, Government Medical College, Patiala, Punjab, India.
authors: Harnam
authors: H
authors: Singh
authors: Department of Pathology, Pandit Bhagwan Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
authors: Jyoti
authors: J
authors: Sharma
authors: Department of Surgery, Government Medical College, Patiala, Punjab, India.
authors: Manish
authors: M
authors: Yadav
keywords: Acute Physiological and Chronic Health Evaluation II; Acute abdomen; ileostomy; intestinal perforation; peritonitis