O.O. Ayandipo1,2, O.O. Afuwape1,2, D.O. Irabor1,2, A.I. Abdurrazzaaq2 and N.A. Nwafulume2
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan.
- Department of Surgery, University College Hospital, Ibadan.
Background: Peritonitis is a life-threatening condition and requires urgent surgical management. Despite improvements in the care of patients with peritonitis, its management is still challenging and associated with significant morbidity and mortality. The aim of this study was to determine factors influencing the outcome in patients managed for peritonitis in a tertiary health institution in Nigeria.
Methods: A retrospective study involving 302 patients managed for peritonitis over a 3- year period. The biodata, clinical findings, diagnosis, pre-operative care, mode of anaesthesia, cadre of the surgeon, intraoperative findings, postoperative care, and the outcomes were retrieved from their records.
Results: Three hundred and two patients were operated on for peritonitis during the period. The mean age of the patients was 48 ± 12 years. Twenty (6.6%) patients had other co-morbidities, with hypertension being the most frequent. Ruptured appendicitis was the most common cause of peritonitis, 83(27.5). Twenty-eight (9.2%) patients had complications, 19 patients (6.5%) required intensive care unit admission, 25 patients (8.4%) required a second exploratory laparotomy. The mortality rate was 2.4%. There was a statistically significant association between an adverse outcome and presentation with shock, anaemia, jaundice and oliguria
Conclusion: The factors influencing outcome are similar to those of other Africa countries. However, the mortality rate in our study is lower. Peri-operative specific organ support and prompt surgical intervention should be instituted to improve outcome. We suggest a prospective study to elucidate the effect of these factors, 3and to determine the predictive power of the various scoring systems.
Dr. O.O. Ayandipo
Department of Surgery,
University College Hospital,
Peritonitis is a life threatening condition, which requires urgent optimal surgical attention. It is a common surgical emergency in developing countries as well as the world at large1 with varying aetiologies. Peritonitis may be primary or secondary based on its causative mechanism. Primary peritonitis rarely requires any surgical intervention unlike, the more common, secondary peritonitis. Secondary peritonitis occurs following gastro-intestinal perforations from inflammatory, post traumatic or post-operative aetiologies2.
Despite modern surgical techniques, recent developments in antimicrobial therapy and supportive care, the treatment and outcome of patients managed for generalized peritonitis remains challenging4. The management of the surgical condition is still associated with significant morbidity and mortality5,6 because of marked derangement of the body’s homeostasis, and subsequent progression to Multiple Organ Dysfunction Syndrome(MODS). Mortality rates of 13-43% have been reported7. These adverse outcomes are closely influenced by interplay of patient related, disease related and intervention related factors. There are very few studies in developing countries, such as Nigeria, that have evaluated the role of patient-related, disease related and intervention-related factors in the outcome of generalized peritonitis.
This study, therefore, aimed to evaluate the outcome of generalized secondary peritonitis in a cohort of patients treated in a single tertiary hospital in Nigeria by considering patient-related factors, disease-related factors and intervention-related factors.
This retrospective study was conducted at a tertiary level, University College Hospital Ibadan in Nigeria, which is 1000-bedded, serving a population of about six million people. It has the full complement of medical and surgical specialties with an Emergency Department and a functional Intensive Care Unit. The case notes of patients who were treated for generalized peritonitis in the hospital between January 2010 and December 2012 were reviewed. The records reviewed included the admission records in the Emergency Department and surgical wards registers, theatre operation records and unit registers of the general surgery divisions. All patients aged 16 years or older and admitted with a diagnosis of peritonitis were included in the study. Patients who were diagnosed appropriately but died prior to surgery were excluded from the study. The hospital protocol for patients with peritonitis included adequate fluid resuscitation, nasogastric decompression, administration of broad spectrum antibiotics and oxygen supplementation prior to surgery. Hydration continued during and after the surgery.
The bio-data, clinical findings, diagnosis, pre-operative care, mode of anaesthesia, cadre of surgeon, intraoperative findings, post-operative care and outcome were retrieved. The pre-operative (at presentation) and post-operative clinical and biochemical parameters like co-morbidity, jaundice, shock, vital signs and urinary output were also recorded. The outcome variables were morbidity or mortality within one month of surgery, and morbidity related to the surgery even after one month of surgery. The patients that were followed up for at least one-month post operation but were lost to follow up were considered as alive. The data were presented in frequency tables and percentages as well as graphical representation. Statistical analysis was done with descriptive statistics using SPSS version 21 and level of association between the outcomes and clinical/ laboratory parameters like co-morbidity, jaundice, shock, pre-operative vital signs and urinary output were conducted using Chi square. The level of significance was set at p-value of 0.05.