Spectrum of Acute Non Traumatic Diffuse Secondary Peritonitis in the Tropics

作     者：Mamadou Traore Kouakou Ibrahim Anzoua Kouamé Bernadin Kouakou Ismael Kalou Leh Bi Ahou Bernadette N’dri Aka Gerald Kakou Serge Amos Ekra Blaise Amos Kouakou Inza Bamba Roger Lebeau Bamourou Diane 

作者机构：General and Digestive Surgery Department Bouaké Teaching Hospital Bouaké Republic of Cô te d’Ivoire 

出 版 物：《Surgical Science》 (外科学（英文）)

年 卷 期：2020年第11卷第5期

页      面：89-98页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Peritonitis Appendicitis Typhoid Perforation Gastrointestinal Ulcer Perforation Prognostic 

摘      要：Background: Peritonitis is one of the most common surgical emergency in tropical countries. It is still a significant cause of mortality and morbidity. This study aimed to describe the aetiology of acute non traumatic diffuse secondary peritonitis (ANDSP) and to report the outcome after treatment. Material and Methods: A retrospective survey of patients with ANDSP was carried out from January 2007 to December 2016 in the Digestive and General Surgery Service of Bouaké Teaching Hospital in the central part of Côte d’Ivoire. The hospital is a tertiary referral centre and serves urban and rural population from Bouaké’s agglomeration but also from the whole central and northern parts of the country. During the study period, all patients found to have at laparotomy ANDSP were included. The analysed variables include epidemiologic charts, clinical presentation, cause of peritonitis, surgical treatment, postoperative outcome and prognostic factors. Results: Over the studied period 626 cases of ANDSP were operated on. The main aetiologies were gastroduodenal peptic ulcer perforation (n = 252, 41.1%), typhoid ileal perforation (n = 207, 33%) and appendicular peritonitis (n = 123, 19.6%). The mean duration of hospital stay was 13.8 ± 9.6 days (range 8 - 87 days). The length of hospital stay was significantly influenced by postoperative complications (23.5 ± 5.4 days versus 10.8 ± 2.7 days P = 0.000000). Two hundred and sixty one postoperative complications were recorded in 242 patients (38.6%) with wound infection being the commonest postoperative complication. A repeat laparotomy was indicated in 73 patients. Eigthy (n = 80) patients died (mortality 11.2%). Risk factors for death were hemodynamic shock, ASA II, Age ≥ 60 years, M PI 29 and digestive sutures performed in septic environment below the transverse mesocolon. Conclusion: The spectrum of aetiology of ANDSP in this tropical area is different from the one observed in the Western countries. Proper treatment o