Etiology, treatment outcome and prognostic factors among patients with secondary peritonitis at Bugando Medical Centre, Mwanza, Tanzania

Abstract

IntroductionSecondary peritonitis due to perforation of the gastrointestinal tract is one of the most common surgical emergencies all over the world and is associated with significantly morbidity and mortality. Previous studies conducted at Bugando Medical Centre (BMC) were retrospective and each was focused on single etiology; therefore there was an obvious need to evaluate the etiologies, treatment outcome and their prognostic factors altogether.MethodsThis was a descriptive cross-sectional study involving patients with secondary peritonitis admitted at BMC from May 2014 to April 2015. Sociodemographic and clinical characteristics among consented patients were collected using questionnaires. Peritoneal aspirate, biopsy and blood were collected perioperatively and processed using standard operating procedures. Analysis was done using STATA version 11 software.ResultsThe study enrolled 97 patients with the female to male ratio of 1:1.8 and approximately 41.2 % (40/97) were in their third and fourth decades of life. Only 3 (3.09 %) patients arrived to the hospital within 24 hours of onset of illness, 26 (26.80 %) patients presented with shock and HIV seropositivity among all patients was 13.40 % (13/97). The common etiologies of secondary peritonitis were perforated appendicitis 23 (23.71 %), peptic ulcer disease 18 (18.56 %), ischemia 18 (18.56 %) and typhoidal perforation 15 (15.46 %). Of the 97 patients, 35 (36.08 %) had complications and 15 (15.46 %) died. Presence of premorbid illness and post-operative complication were found to be associated with death (p values = 0.004 and <0.001 respectively).ConclusionsThe most common etiologies of secondary peritonitis at BMC are perforated appendicitis, peptic ulcer disease, ischemia and typhoidal perforation. Premorbid illness and postoperative complications in this setting are associated with death and as the matter of fact proper screening on admission should be done to identify patients with premorbid illness and confer prompt management.

Patterns and Early Treatment Outcomes of Peritonitis among Patients Admitted at Dodoma Regional Referral Hospital, Dodoma Region, Tanzania

“…This difference is due to the fact that the study of Mineccia was done in developed countries where there are improved settings. But they are comparable with the results of the study done at Bugando hospital Tanzania of which postoperative complications were 36% and death were 15.5% [15,16]. Few patients (13.6%) were treated conservatively because they had no surgically demanding condition.…”

Peritonitis in Children: Experience in a Tertiary Hospital in Enugu, Nigeria

“…Despite antimicrobial therapy, surgical intervention is the cornerstone of treatment for secondary peritonitis [7] . In the present study, the male dominance of cases is consistent with the reports of other studies on secondary peritonitis [8,9,10] . However, Fowler reported a female dominance with regards to primary peritonitis [11] .…”

Comparison of antimicrobial resistance patterns of ESBL and non ESBL bacterial isolates among patients with secondary peritonitis at Bugando Medical Centre, Mwanza – Tanzania

“…Of the three types of peritonitis, secondary peritonitis has a major clinical impacts due to loss of integrity in hollow viscus resulting into perforation and is the most common form of peritonitis encountered in surgical practice causing significant morbidity and mortality when not timely and promptly intervened [ 1 – 4 ]. The most common causes of secondary peritonitis are perforated peptic ulcer disease, perforated small and large intestine, intestinal obstruction and many others [ 3 – 6 ]. The complications of secondary peritonitis are significant and include perforated viscus, hypovolemic shock, electrolyte imbalance, sepsis, multiorgan failure and deaths [ 1 , 6 ].…”

“…The most common causes of secondary peritonitis are perforated peptic ulcer disease, perforated small and large intestine, intestinal obstruction and many others [ 3 – 6 ]. The complications of secondary peritonitis are significant and include perforated viscus, hypovolemic shock, electrolyte imbalance, sepsis, multiorgan failure and deaths [ 1 , 6 ].…”

“…At Bugando Medical Centre (BMC), secondary peritonitis is the commonest indication for admission in the surgical wards; it is associated with significant workload, severe complications and deaths [ 6 , 12 , 13 ]. In our recent work at BMC, we delineated the etiology, treatment outcome and prognostic factors associated with secondary peritonitis [ 6 ]. To ensure rational antimicrobial therapy to patients with secondary peritonitis, this study was conducted to determine the proportion of bacteriologically confirmed patients with secondary peritonitis due to ESBL and their drug susceptibility profiles.…”