Case Series of Acute Abdominal Surgery in Rural Sierra Leone

Abstract

In many poor countries of the world the need for surgical treatment of acute abdominal emergencies is largely unmet. In some cases this service is provided by physicians with little postgraduate surgical training, and there is a paucity of published data on the outcomes of this service. This series of sequential cases of acute abdominal surgical emergencies from a hospital in rural Sierra Leone illustrates the causes, outcomes, and challenges in this setting. All patients with an acute abdomen from September 1992 until September 1994 who required surgery were identified by review of theater records, ward books, and patients' notes. Altogether, 173 cases were identified. Operative diagnoses included ectopic pregnancy (n = 43), strangulated hernia (n = 45) 15 of which required bowel resection, appendicitis (n = 15), normal appendix (n = 4), uterine rupture (n = 9), perforated ulcer (n = 8), tubal or pelvic abscess (n = 7), volvulus (n = 6), and others. Ninety percent survived to discharge after a median postoperative stay of 9.2 days (range 7-127 days). Of the 18 deaths, 83% occurred during the first 3 days. Factors associated with poor outcome were ileal perforation due to typhoid fever and resection of bowel after a strangulated hernia. These results show that acute abdominal surgery can be done at the district level in poor countries using limited facilities by staff without extensive surgical training. The outcomes are comparable to those from larger centers.

Strangulated Inguinal Hernia in Adult Males in Kumasi

“…Over all the proportion of inguinal hernias that were repaired for strangulation in this study was 26.4% (Table 1). Similar figures have been reported from studies in Nigeria (25%) 12 , Sierra Leone (33%) 13 and Uganda (76%) 14 . These findings all indicate that in Africa a large number of inguinal hernias present to hospital as emergencies.…”

“…Distance to health facility and cost of travel are important factors in decision making to seek surgical care for an inguinal hernia and can be a barrier to elective repair as was in the case Sierra Leon. 13 Grime and his colleagues recently published a review of barriers to surgical care in low -income and middle -income countries. 19 Some of the key barriers were cultural such as fear of undergoing surgery, fear of anaesthesia and fear of bad or unfavourable outcomes as a result of surgery.…”

Urgences chirurgicales digestives en Afrique subsaharienne : étude prospective d’une série de 622 patients à l’Hôpital national de Zinder, Niger

“…Dans nos régions, la fièvre typhoïde sévit à l'état endémoépidémique, comme dans d'autres pays de l'Afrique subsaharienne en voie de développement [11,17,19,20]. Jhobta et al [15] La hernie étranglée, première cause d'OIA, est l'apanage du sujet jeune de sexe masculin en milieu africain [3,6,13,18] . Au sud du Sahara, les patients porteurs de pathologies chirurgicales a priori bénignes ne consultent souvent qu'en cas de complications [5,12,13,29].…”

The range of abdominal surgical emergencies in children older than 1 year at the komfo anokye teaching hospital, Kumasi, Ghana

“…Their parents usually tend to use herbal preparations and/or buy over-the-counter drugs for their children, hoping that the pain will disappear; and when it does not, they visit various peripheral primary health care facilities, where they are either mismanaged [2] or detained for a number of days before being referred to our center, usually late and in a very bad state. Many from the rural areas die from untreated abdominal emergencies [3] as a result of lack of health education, poverty, poor hygiene and sanitation and poor living conditions and facilities. [4] Most children with abdominal pain are admitted to Komfo Anokye Teaching Hospital from all the communities in and around it.…”