Non-trauma surgical emergencies in adults: Spectrum, challenges and outcome of care

Ibrahim, Nazir; Oludara, Mobolaji; Ajani, Abdulwahab; Mustafa, Ibrahim; Balogun, Rufai A; Idowu, Olufemi Emmanuel; Osuoji, RI; Omodele, F. O.; Aderounmu, A O A; Solagberu, Babatunde A

doi:10.1016/j.amsu.2015.09.004

Cited by 20 publications

(27 citation statements)

References 20 publications

(31 reference statements)

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“…Future studies should prospectively follow such patients to shed light on reasons for their lack of surgical treatment and outcome post discharge. The mortality rate (3.2%) and postoperative complications rate (33.8%) are comparable to studies done in other low- and middle-income settings [4, 8]. While there was no difference in post-operative complications, clinical outcomes, and length of hospital stay for patients treated by a general surgeon compared to general practitioners, these outcomes are difficult to compare given the difference in the types of conditions treated.…”

Section: Discussionsupporting

confidence: 60%

“…However, performing these procedures at district hospitals is often a challenge. Surgical delivery is often complicated by inadequate diagnostic tools, inadequately trained personnel, and insufficient infrastructure for resuscitation and surgery [4]. Combined with patient delays in presentation, these factors contribute to poor patient outcomes [5].…”

Section: Introductionmentioning

confidence: 99%

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Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes

et al. 2017

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BackgroundManagement of emergency general surgical conditions remains a challenge in rural sub-Saharan Africa due to issues such as insufficient human capacity and infrastructure. This study describes the burden of emergency general surgical conditions and the ability to provide care for these conditions at three rural district hospitals in Rwanda.MethodsThis retrospective cross-sectional study included all patients presenting to Butaro, Kirehe and Rwinkwavu District Hospitals between January 1st 2015 and December 31st 2015 with emergency general surgical conditions, defined as non-traumatic, non-obstetric acute care surgical conditions. We describe patient demographics, clinical characteristics, management and outcomes.ResultsIn 2015, 356 patients presented with emergency general surgical conditions. The majority were male (57.2%) and adults aged 15–60 years (54.5%). The most common diagnostic group was soft tissue infections (71.6%), followed by acute abdominal conditions (14.3%). The median length of symptoms prior to diagnosis differed significantly by diagnosis type (p < 0.001), with the shortest being urological emergencies at 1.5 days (interquartile range (IQR):1, 6) and the longest being complicated hernia at 17.5 days (IQR: 1, 208). Of all patients, 54% were operated on at the district hospital, either by a general surgeon or general practitioner. Patients were more likely to receive surgery if they presented to a hospital with a general surgeon compared to a hospital with only general practitioners (75% vs 43%, p < 0.001). In addition, the general surgeon was more likely to treat patients with complex diagnoses such as acute abdominal conditions (33.3% vs 4.1%, p < 0.001) compared to general practitioners. For patients who received surgery, 73.3% had no postoperative complications and 3.2% died.ConclusionWhile acute abdominal conditions are often considered the most common emergency general surgical condition in sub-Saharan Africa, soft tissue infections were the most common in our setting. This could represent a true difference in epidemiology in rural settings compared to referral facilities in urban settings. Patients were more likely to receive an operation in a hospital with a general surgeon as opposed to a general practitioner. This provides evidence to support increasing the surgical workforce in district hospitals in order to increase surgical availability for patients.

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Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes

et al. 2017

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“…Appendicitis is one of the most frequent surgical emergencies in adult and pediatric populations [1, 2]. Common complications include appendicular phlegmon (appendicular mass), appendicular abscess, and peritonitis.…”

Section: Introductionmentioning

confidence: 99%

Thoracic Empyema as Rare Complication of an Appendicular Mass: A Case Study and Review of the Literature

Vasquez-Rios

Calixto-Aguilar

Pajuelo

et al. 2018

Case Reports in Pediatrics

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Introduction Thoracic empyema is an infrequent complication of appendicitis that has rarely been reported in the literature. Case Presentation and Review of the Literature The case of a 11-year-old boy who was admitted for medical management of an appendicular mass is presented. His clinical course was complicated by the development of an appendicular abscess and an extensive right-sided empyema. A comprehensive review of the literature was conducted including the most representative cases. The data were collected and analyzed by two independent investigators. Ten cases were found. Most patients were young individuals (mean age: 25.1 years; male : female ratio: 0.5). Risk factors for thoracic empyema included pregnancy (10%) and age (60%). The most frequent organisms isolated were Escherichia coli, Bacteroides spp., and Klebsiella spp. The survival rate was 100%. Conclusion Thoracic empyema should be considered a potential cause of respiratory distress in patients with appendicitis. Furthermore, the abdomen should be carefully evaluated as a source of infection in patients with thoracic empyema without an underlying lung disease.

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“…Appendicitis is a prevalent cause of abdominal pain, and the lifetime risk of appendicitis is 7%; worldwide, it more frequently requires a non-trauma emergency procedure. [1] , [2] , [3] It is a typical disease of young men, with a high incidence in those aged 10–19 years and a low frequency (5–10%) in elderly individuals aged more than 50–60 years. [3] , [4]…”

Section: Introductionmentioning

confidence: 99%

Complicated acute appendicitis presenting as an abscess in the abdominal wall in an elderly patient: A case report

Souza

Nunes²,

Massuqueto

et al. 2017

International Journal of Surgery Case Reports

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Non-trauma surgical emergencies in adults: Spectrum, challenges and outcome of care

Cited by 20 publications

References 20 publications

Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes

Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes

Thoracic Empyema as Rare Complication of an Appendicular Mass: A Case Study and Review of the Literature

Complicated acute appendicitis presenting as an abscess in the abdominal wall in an elderly patient: A case report

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