Epidemiological, clinical and prognosis aspects of acute generalized peritonitis in South-Kivu Province: descriptive observational study of 278 cases

Introduction

the aim was to determine epidemiological, clinical, therapeutic, and prognostic aspects of acute generalized peritonitis (AGP).

Methods

we conducted an observational, cross-sectional and multicentre study over 2 years of 278 cases of acute generalized peritonitis operated in semi-urban and urban hospitals in South-Kivu Province, Democratic Republic of Congo.

Results

the population of this study was young with a mean age was 28.9 ± 16.1 years with extremes of 1.3 years to 80 years with a sex ratio M: F of 0.8. Peritonitis aetiology was dominated by intestinal perforation 132 cases (47.4%), the admission time in 65, 5% was more than 72 hours. Acute abdominal pain was the most reason for consultation in 93.2% of cases, 11.9% of patients were in hypovolemic shock. In 40.6%, the treatment of patients consisted in intestinal resection with terminal anastomosis, or ileostomy in 32.7%. About the outcomes, 32.4% of the patients had a surgical reoperation and 15.8% of the digestive fistulas were reported. The average duration of the hospitalization was 23.4 ± 20.3 days. Morbidity rate was 14.7%.

Conclusion

the AGP remains one of the abdominal emergencies observed in different semi-urban and urban hospitals of the province of South-Kivu, causing some problems of medical and surgical management, starting from the delay of admission, the severity of the symptoms related to the etiology of the intestinal perforation. In all cases, AGP requires a well-executed resuscitation procedure and surgical technique to improve the prognosis and reduce mortality, which seems to be high in this study.

[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.