Document Type : Original Article
Authors
1 Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
2 Department of Surgery, Ebonyi State University (EBSU), Abakaliki, Ebonyi State, Nigeria
3 Accident and Emergency Unit, Bishop Shanahan Specialist Hostal, Nsukka Enugu State, Nigeria
4 Department of Surgery, Mater Misericordie Hospital, Afikpo, Ebonyi State, Nigeria.
5 Accident and Emergency Unit, Bishop Shanahan Specialist Hostal, Nsukka Enugu State, Nigeria.
Abstract
Objective: Recently, emergency and essential surgical and anesthesia care at district hospitals is increasingly gaining recognition as a critical, though neglected element of health care system in Africa and other developing nations. Emergency laparotomy is a versatile procedure that can cure a great deal of acute abdominal conditions. The aim of this study was to document the indications and outcomes of laparotomy for emergency abdominal surgical conditions in our district hospitals.
Methods: This retrospective study was undertaken in district hospitals from January 2009 to December 2018. Associations between different variables were measured and compared using statistical tests of significance.
Results: Of the 879 patients evaluated, appendicitis (n=361, 41.1%) was the most frequent indication for emergency laparotomy followed by complicated external hernias (n=120, 13.7%). Other indications were adhesive intestinal obstruction (n=111, 12.6%), typhoid perforation (n=98, 11.1%), perforated peptic ulcer (n=89, 10.1%), trauma (n=58, 6.6%), colorectal cancer (CRC) (n=18, 2.0%) and others (n=24, 2.8%). The vast majority of patients (n=726, 82.6%) were presented after 24 hours of the onset of disease. Approximately, one-third of patients (n=278, 31.6%) had comorbidities, 867 (98.6%) had high ASA scores (III and IV) and 105 (11.9%) received intestinal resection with or without stoma. The main independent predictors of mortality were late presentation (P=0.003), generalized peritonitis (P=0.001), bowel resection (P=0.000) and high ASA (III and IV) scores (P=0.000). Overall, the mortality rate was 10.6%. The commonest complication was wound infection (39.7%), followed by intra-abdominal collection (10.0%).
Conclusion: The most common indication for emergency laparotomy was appendicitis followed by complicated hernias. The major independent predictors of mortality included bowel resection, high ASA score, late presentation and generalized peritonitis.
Keywords
Main Subjects
2. Christophe M, Alexandre N, Yihan L, Bethany LH, Jackline O, Theoneste N et al. Emergency general surgery in Rwanda district hospitals; a cross-sectional study of spectrum, management and patient outcomes. BMC Surgery 2017;17:121. DOI: 10.1186/s12893-017-0323-x
3. Stewart KP, Khanduri P, McCord C, Ohene-Yeboah M, Uranues S et al. Global disease burden of conditions
requiring emergency surgery. BJS 2014; 101: e9- e22. DOI:10.1002/bjs.9329
4. Luboga S, Macfarlane SB, Schreeb JV, Kruk ME, Cherian MN, Bergstrom S et al. Increasing Access to Surgical Services in sub- Saharan Africa: Priorities for National and International Agencies Recommendation by the “Bellagio Essential Surgery Group”. PLos Medicine 2009; 6(12):e1000200
5. Henry JA, Volk AS, Kariuki SK, Murungi K, Firmalo T, Laibon R et al. Ending Neglected Surgical Diseases (NSDs): Definitions, Strategies and goals for the next decade. Int. J Health Policy Management 2020; (4): 1-8 DOI: 10.34172/Ijhpm.2020.140
6. Fizan A, Shelly CBA, Afua AJH, Abatanga F, Elias S, Hayley OBA et al. Assessment of surgical and obstetrical care of 10 District Hospitals in Ghana using On-Site Interviews. J Surg Res 2010; 2: 12-18
7. Hendrikson BS, Keeney L, Morrell D, Candela X, John O, Hollenbeak CS et al. Epidemiology and Perioperative Mortality of Exploratory Laparotomy in Rural Ghana. Annals of Global Health 2020; 86(1): 1-7. DOI. https://doi.org/10.5334/aogh.2586
8. Jain D, Sharma R, Redd S. WHO safe surgery checklist: Barriers to universal acceptance. J Anaesthesiol
Clin Pharmacol 2018; 34:7-10 DOI: 10.4103/joacp. JOACP-307-16
9. Obonna GC, Arowolo OA, Agbakwuru EA, Etonyeaku AC. Emerging Pattern of Emergency Abdominal Surgeries in Ile-Ife, Nigeria. Nigeria J Surg Sci 2014; 24 (2): 31-5. DOI:10.4103/1116-5898.149600.
10. Chianakwana GU, Ihgogihu CC, Okafor PIS, Anyanwu SNC, Mbonu OO. Adult Surgical Emergency in a Developing Country: The Experience of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria. World J. surg 2005; 29: 804-808 DOI: 10.1007/s00268-005-7670-y
11. Ahmed A, Dauda M, Garba S, Ukwenya Y. Emergency Abdominal Surgery in Zaria, Nigeria. SAJS 2010; 48(2): 59-62.
12. Agboola JO, Olatoke SA, Rahman GA. Pattern and Presentation of Acute Abdomen in a Nigerian Teaching Hospital. Niger Med. J 2014; 55: 266-70
13. Ogbuanya AU, Emedike SOC. Abdominal Surgical Emergency in South Eastern Nigeria. Int J Recent Sci Res 2016; 7(4): 10217-10223.
14. Spence RT, Panieri E, Rayne SL. A multicenter evaluation of emergency abdominal surgery in South Africa: Results from the GlobalSurg-1 South Africa Study. SAMJ 2016; 106(2):163-168 DOI:10.7196/SAMJ.2016.v106i2.10183
15. Ohene-Yeboah M, Dally CK. Strangulated Inguinal Hernia in Adult Males in Kumasi. Ghana Med. J 2014; 48(2):101-105. DOI: http://dxrdoi.org/10.4314/gmj.v48i2.8.
16. Ogbuanya AU, Amah D. Delay in Presentation and Challenges of Treatment of Complicated Abdominal Wall Hernia in Rural Southeast Nigeria. Niger J Surg Sci 2018; 28(2):26-33. DOI: 10.4103/njss.njss-4-20
17. Alain C, Fon TA, Ngowe-Ngowe M. Which cause of diffuse peritonitis is the deadliest in the tropics? A retrospective analysis of 305 cases from the South-West Region of Cameroon. World J Emerg Surg 2016;11:14. DOI: 10.1186/s13017-016-0070-9
18. Ugochukwu AI, Amu OC, Nzegwu MA. Ileal perforation due to typhoid fever: Review of operative management and outcomes in an urban center in Nigeria. Int. J surg 2013;11:218-222. DOI: 10.1016/j.ijsu.2013.01.014
19. Chalya PL, Mabula JB, Koy M, Mchembe MD, Jaka HM, Kabangila R et al. Clinical profile and outcomes of surgical treatment of perforated peptic ulcers in Northwestern Tanzanian: A tertiary hospital experience. World J Emerg Surg 2011; 6:31. DOI: 10.1186/1749-7922-6-31
20. Sondashi KJ, Odimba BFK, Kelly P. A Cross–Sectional Study on Factors Associated with Perforated Peptic Ulcer Disease in Adults Presenting to UTH, Lusaka. Med J Zambia 2011;38(2): 15-22
21. Jhobta RS, Attri AK, Kaushik R, Sharma R, Jhobta A. Spectrum of Perforation Peritonitis in India: Review of 504 Consecutive Cases. World J Emerg Surg.2006; 1: 26. DOI:10.1186/1749-7922-1-26
22. Memon AA, Siddiqui FG, Abro AH, Agha AH, Lubna S, memo AS. An audit of secondary peritonitis at a tertiary care University Hospital of Sindh, Pakistan. World J. Emerg Surg 2012; 7:6. DOI:10.1186/1749-7922-7-6
23. Menekse E, Kocer B, Topcu R, Olmez A, Tez M, Kayaalp C. A Practical Scoring System to Predicts Mortality in Patients with Perforated Peptic Ulcer. World J Emerg.Surg.2015;10:7. DOI:10.1186/s13017-015-0008-7
24. Saunders DI, Murray D, Pichel AC, Varley S, Peden CJ. Variation in Mortality after Emergency Laparotomy: The First Report of the UK Emergency Laparotomy Network. BJA 2012; 109(3):368-375. DOI: 10.1093/bja/aes165
25. Solomkin JS, Mazuski JE, Brandley JS, Rodvold KA, Goldstein EJC, Baron EJ. Diagnosis and Management
of Complicated Intra–abdominal Infections in Adults and Children: Guidelines by the Surgical Infection Society and the Infections Diseases Society of America. Clinical Infections Disease (CID) 2010; 50:133-164. DOI:10:1086/649554.
26. Thorsen K, Soreide JA, Soreide K. What Is the Best Predictor of Mortality in Perforated Peptic Ulcer Disease? A population-Based, Multi-variable Regression Analysis Including Three Scoring Systems. J Gastrointest Surg 2014;18:1261-1268. DOI: 10.1007/s11605-014-2485-5.
27. Hanks L, Lin CP, Tefera G, Seyoum N. Abdominal Surgical Emergencies at Tikur Anbessa Specialized Hospital in Ethiopia; A shifting paradigm. East Cent Afr. J Surg 2013;19 (1): 90-94
28. Ohene-Yeboah M, Togbe B. An audit of appendicitis and appendectomy in Kumasi, Ghana. WAJM 2006; 25(2): 138-143.
29. Bingener J, Ibrahim-Zadar I. Natural Orifice Transluminal Endoscopic Surgery for Intra-abdominal Emergency Conditions. BJS 2014; 101: e80-e89. DOI: 10.1002/bjs.9352.
30. Ogbuanya AU, Emedike SOC. Elective Repair of Uncomplicated Inguinal Hernias in South eastern Nigeria.
Asian J Med Sc 2015; 7(2): 90-95. DOI: 10.3126/ajms.v7i2.13349.
)