[Digestive surgical emergencies in Sub-Saharan Africa: a prospective study of a series of 622 patients at the National Hospital of Zinder, Niger]

Typhoid intestinal perforation in Francophone Africa, a scoping review

Typhoid intestinal perforation (TIP) is a leading cause of peritonitis and indication for emergency surgery in Africa, with reported mortality rates up to 30% in pediatric patients. Currently, data on TIP in Western databases are primarily from countries that speak English, likely due to non-English publication and citation biases. Despite the high burden of infectious diseases in Francophone Africa, data from these countries regarding TIP remain limited. This study aims to highlight the incidence and morbidity of TIP in Francophone African countries using an extended search algorithm. We conducted a scoping review using the PubMed, EMBASE, and SCOPUS databases with the keywords "peritonitis", "non-traumatic ileal perforation", and "typhoid" in Francophone African countries. Additionally, we contacted surgeons in Africa and concurrently used citation chasing to obtain data not found in western databases. In total, 32 studies from 12 countries were identified and included in this review. A total of 22 publications were in French. Patient median age was 20 years and TIP caused a median of 35% of acute peritonitis cases. Mortality rates ranged from 6-37% (median: 16%). Rate of complications ranged from 15-92% (median: 46%). Ileostomy creation as a treatment for TIP varied between hospitals (0-79%), with the highest rates reported in Niger. In Francophone Africa, TIP is associated with high morbidity and mortality, most commonly in children and young adults. Interventions, including improved sanitation and the introduction of typhoid conjugate vaccines into routine vaccination programs, have the potential to significantly decrease typhoid fever and its complications.

Prevalence and mortality rate of abdominal surgical emergencies in Sub-Saharan Africa: a systematic review and meta-analysis

INTRODUCTION

Abdominal surgical emergencies remain prevalent in various healthcare settings, particularly in regions with limited access to basic surgical care, such as Africa. The aim of this literature review is to systematically assess publications on abdominal surgical emergencies in adults in sub-Saharan Africa to estimate their prevalence and mortality rate.

METHODOLOGY

A systematic review was conducted. The latest search was performed on October 31, 2022. We estimated the pooled prevalence with a 95% confidence interval (CI) for each abdominal surgical emergency, as well as overall postoperative mortality and morbidity rates.

RESULTS

A total of 78 studies were included, and 55.1% were single-center retrospective and monocentric studies. The mean age of the patients was 32.5 years, with a sex ratio of 1.94. The prevalence of each abdominal surgical emergency among all of them was as follows: appendicitis: 30.0% (95% CI: 26.1-33.9); bowel obstruction: 28.6% (95% CI: 25.3-31.8); peritonitis: 26.6% (95% CI: 22.2-30.9); strangulated hernias: 13,4% (95% CI: 10,3-16,5) and abdominal trauma: 9.4% (95% CI: 7.5-11.3). The prevalence of complications was as follows: mortality rate: 7.4% (95% CI: 6.0-8.8); overall postoperative morbidity: 24.2% (95% CI: 19.4-29.0); and surgical site infection 14.4% (95% CI: 10.86-18.06).

CONCLUSION

Our study revealed a high prevalence of postoperative complications associated with abdominal surgical emergencies in sub-Saharan Africa. More research and efforts should be made to improve access and quality of patient care.

Facteurs influençant le délai de prise en charge aux urgences chirurgicales du CHU Sourô Sanou

INTRODUCTION

Assessing patient turnaround times is essential for improving the quality of care in emergency service departments.

PURPOSE OF THE RESEARCH

This study looked at waiting and treatment times, and their associated factors, in the surgical emergency service department at the Souro Sanou National Teaching Hospital (SSNTH) in Bobo-Dioulasso, Burkina Faso.

RESULTS

This study was carried out on 380 patients with a median age of thirty-eight. The sex ratio was 0.54. In 63.7 percent of cases, the participants lived in urban areas. Most of the patients surveyed were farmers (34.7 percent). The median waiting time for patients was eleven minutes. The nature of the trauma sustained was associated with the waiting time. The median time taken to administer first aid was sixty-three minutes, with the unavailability of medication at the hospital pharmacy cited as a factor contributing to this delay. The median time taken to obtain paraclinical results was 134 minutes and 102 minutes for laboratory tests and scans, respectively. The factor associated with delays in obtaining scan results was the need for surgical intervention. The median waiting time for surgery was 24.3 hours.

CONCLUSIONS

The turnaround times in the SSNTH surgical emergency department are long. For the improvement of patient turnaround times to be possible, an overhaul of the department is in order. In particular, a rapid consultation team needs to be established, and essential drugs for emergency care need to be made readily available.

Epidemiology of Digestive Surgical Emergencies in a Sub-Saharan African Country: A Multicentre Pilot Study Protocol

Introduction

Digestive surgical emergencies remains one of the main general surgery activities. Despite the associated mortality rate in low income countries, epidemiologic data about this subject is rare and multicenter studies are even more. We aimed to study an epidemiology of digestive surgical emergencies in Senegal by multicenter protocol.

Methods and analysis

it will a prospective multicenter pilot study from May to July 2022. The patients were from General surgery departments of these teaching hospital in Senegal: Dakar Principal Hospital, Aristide le Dantec Hospital, Dalal Jamm hospital and Saint-Louis Regional Hospital. The Schwartz formula was used. We used a proportion of abdominal surgical emergency of 20%. We had a sample size of 246 patients.

Ethics and dissemination

this research protocol will be submitted to Ethics committee of four hospital that included. The results of this study can help to get better the management of our digestives emergencies and at the same time improve mortality rate.

Highlights

Digestive surgical emergencies is a public health issueBecause of high mortality rate in poorest countries, epidemiological data in Senegal must be knownThese information can help to lower associated mortality.

[Complications of surgical management of non-traumatic acute abdomens of digestive origin at the Yaoundé central hospital, Cameroon (November 2019 - July 2020)]

Objective

Acute non-traumatic digestive surgical emergencies are a frequent cause of emergency in Africa. We undertook this study to investigate the morbidity and mortality of these patients in Cameroon, a developing country in Central Africa.

Patients and methodology

This was an analytical cross-sectional study with prospective data collection, over a period of eight months (November 2019 to July 2020), at the Yaoundé central hospital (Cameroon). The latter is a second category (intermediate) public health facility in the Cameroon health pyramid, mainly welcoming patients without health insurance. All patients operated on for an acute non-traumatic digestive abdomen were included. The patients were followed up until the 12^th postoperative week. We used Cox univariate regression to determine factors associated with the occurrence of postoperative complications. The significance threshold retained was 0.05.

Results

We collected 120 patients, representing 14.6% of all surgical emergencies. The mean age of the patients was 37.6 ± 13.5 years. Eighty (66.7%) were male with a sex ratio of 2. The two main preoperative diagnoses were acute generalized peritonitis (n = 58 or 48.3%) and intestinal obstruction (n = 38 or 31.7%). The two main etiologies were peptic ulcer perforation (n = 35) and acute appendicitis (n = 24). The delay between the onset of symptoms and consultation was 1.9 day and an average of 36.8 hours elapsed between diagnosis and surgery. During postoperative time the morbidity and mortality rates were 33.3 and 10%, respectively. Postoperative complications were mostly minor according to the Clavien-Dindo classification, with 21 cases of grade I (33.8%) and 12 cases of grade II (19.3%). The main cause of death was sepsis (8 out of 12 cases). We identified seven factors significantly associated with an increased risk of postoperative complications among whom three were modifiable: The consultation delay greater than 72h (p = 0.02), the time between diagnosis and the surgical intervention greater than 48h (p = 0.01) and the operating time greater than 2h (p = 0.05).

Conclusion

In our context, the results of the surgical management of acute non-traumatic abdomens of digestive origin are marked by high morbidity and mortality. The possible solutions are: the organization of public awareness campaigns to prompt rapid consultation in the event of acute abdominal pain, the establishment of universal health coverage as well as the improvement of technical platforms.

Perioperative management of gastrointestinal surgery in a resource-limited hospital in Niger: Cross-sectional study

Background

Perioperative management in digestive surgery is a challenge in sub-Saharan Africa. Objective: To describe the process and outcomes of perioperative management in gastrointestinal surgery.

Materials and methods

This was a single center cross-sectional study over a 4-month period from June 1 to September 30, 2017, in a Nigerien hospital (West Africa). This study included caregivers and patients operated on gastrointestinal surgery.

Results

We collected data for 56 caregivers and 253 patients underwent gastrointestinal surgery. The average age of caregivers was 38.6 ± 8.7. The median length of professional practice was 9 years. Almost 52% of caregivers (n = 29) did not know the standards of perioperative care. The median age of patients was 24 years, and male gender constituted 70% of cases (n = 177) with a sex ratio of 2.32. Patients came from rural areas in 78.2% (n = 198). Emergency surgery accounted for 60% (n = 152). The most surgical procedure was digestive ostomies performed in 28.9% (n = 73), followed by hernia repair and appendectomy in 24.5% (n = 62) and 13.9% (n = 35) respectively. The postoperative course was complicated in 28.1% (n = 71) among which 13 deaths. In the group of caregivers, the poor practice of perioperative management was associated with poor professional qualification, insufficient equipment, insufficient motivation (p < 0.05). The ASA3&ASA4 score, undernutrition, emergency surgery, poor postoperative monitoring, and poor psychological preparation were associated with complicated postoperative outcomes (p < 0.05).

Conclusion

The inadequacy of the technical platform and the lack of continuous training for healthcare staff represented the main dysfunctions of our hospital. The risk factors for complications found in this study need appropriate perioperative management to improve prognosis in gastrointestinal surgery.

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Perioperative care in gastrointestinal surgery in a challenge in Sub-Saharan countries.

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This setting is characterised by the difficulty of geographical access to hospital, lack of equipment.

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Risk factors for complications are multifactorial.

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This study can be a draft for improvement the quality of care in low resource settings.

Etiologic Spectrum of Intestinal Obstruction in Ningxia District: A Retrospective Analysis of 4908 Cases in a 10-Year Period

BACKGROUND

Economic disparity contributes to the variation of intestinal obstruction (IO) etiologic spectrum. Clarifying the etiology distribution in local regions can help to unravel IO and promote early diagnosis, henceforth making sure standardized therapeutic interventions.

METHODS

Medical data of 4908 inpatients diagnosed with IO admitted to the General Hospital of Ningxia Medical University between January 2004 and December 2013 were recruited and analyzed retrospectively. The associated profiles included demographic features, clinical manifestations, and previous therapeutic operations.

RESULTS

4908 cases of intestinal obstruction were identified during the period of study. It denoted that the hospitalization rate of IO has maintained upward momentum; the top four causes of IO were adhesion, tumor, intussusception, and hernias. These covered up nearly 80% of the total constitution. Among them, adhesive intestinal obstruction accounted for 45.17%, malignant bowel obstruction for 21.09%, intussusception for 8.72%, and hernia for 4.73%; abdominal surgery constituted for the majority (78.62%) of adhesive obstruction. The followed up analysis also found that appendectomy accounted for the biggest percentage, 28% of operation cases. Malignant bowel obstruction can have a rate of 96.43% in 1035 cases led by tumor lesions. Of which, the primary intestinal malignant tumor accounted for 68.64% and metastatic tumors for 31.36%. Nearly 50% occurred in the large intestine. The overall mortality of all 4908 cases was 4.7%.

CONCLUSION

The hospitalizations of IO delineated an increasing trend. Adhesion was the main etiology in IO. The odds of malignant bowel obstruction was increasing in the proportion of IO. There were some differences towards the etiologic spectrum compared with western countries.

Pattern of Lower Intestinal Ostomies in a Low-Income Country: Case of Southeast of Niger Republic

BACKGROUND

Intestinal ostomies are common surgical procedures performed in visceral surgery as part of management for several gastrointestinal diseases. This study aims to report the socio-demographic characteristics, indications and prognosis of intestinal ostomies in low-income country.

METHODS

This was a 4-year retrospective study (January 2013 to December 2016) at Zinder National Hospital (Niger). All patients with a digestive ostomy on an ileum or colic segment were included in the study.

RESULTS

During the study period, 2437 patients underwent digestive surgery, including 328 gastrointestinal stomas (13.5%). Patients classified ASA3 were 60.7% (n = 199). The median age was 12 years (IQ: 7-25). Children represent 64% (n = 210) of patients with ostomy. The sex ratio was 2.60. The stoma was performed in emergency in 96.3% (n = 316) of cases. Acute peritonitis was the main indication of the stoma in 70.73% (n = 232). The ileostomies accounted for 75.61% (n = 248). Ostomy was intended as temporary in 97.3% of cases (n = 319). Complications were observed in 188 patients (57.3%). Mortality was 14.02% (n = 46). The indigent status (OR: 4.15 [2.20-7.83], P = 000), ASA score 4 (OR: 2.53 [1.54-4.15], P = 0.0003), Altemeier class IV (OR: 4.03 [2.10-7.73], P = 0.0000) and ileostomy (OR: 2.7853 [1.47-5.29], P = 0.0018) were statistically associated with the occurrence of major complications. The mean time for stoma closure was 59.3 ± 14.5 days.

CONCLUSION

Acute peritonitis was the main indication of digestive ostomy. The occurrence of major complications was associated with bad socioeconomic status, ASA4 score, Altemeier class IV and ileostomy.

Acute mechanical intestinal obstruction in children at zinder national hospital, Niger: Aetiologies and prognosis

BACKGROUND

To describe the aetiological and prognostic aspects of acute mechanical intestinal obstruction (AMIO) in children at Zinder National Hospital (Niger).

MATERIALS AND METHODS

This was a cross-sectional study on a period to January 2013-June 2015. The database included all children under 15 years of age with a surgical diagnosis of mechanical intestinal obstruction. P < 0.05 was considered statistically significant for analysis.

RESULTS

AMIOs represent 21.78% (n = 78) of child digestive surgical emergencies (n = 358). Median age was 12 months (range: 1 day-15 years). Fifteen (19.23%) were neonates and sixty children (76.92%) had ≤60 months. The sex ratio (male/female) was 2.8. The mean time from onset to presentation was 39.96 ± 36.22 h. Intussusception and strangulated hernias were the main causes of AMIO with, respectively, 43.59% (n = 34) and 29.48% (n = 23). Anorectal malformations represent 17.95% (n = 14) of cases of AMIO. Intestinal resection was made in 22.08% and colostomy in 19.23% of patients. The average length of hospital stay was 6.44 ± 4.30 days. The post-operative complications were recorded in 26 patients (33.33%), mostly surgical site infections. Overall mortality of AMIO was 15.38% (n = 12). It was higher in the neonates (33.33%) (P = 0.032). Deaths were associated with delay of admission (P = 0.0005) and waiting time for surgery (P = 0.019).

CONCLUSION

Intussusception and strangulated hernia are the most common cause of AMIO in children. Diagnostic and therapeutic delays, lack of paediatric intensive care and post-operative complications are prognostic factors.