Réinterventions de chirurgie abdominale en milieu défavorisé : indications et suites opératoires (238 cas)

Mefire, Alain Chichom; Tchounzou, R.; Misse, P. Masso; Pisoh, Christopher Tagnyin; Pagbe, J. J.; Essomba, Arthur; Takongmo, S.; Malonga, E.

doi:10.1016/j.jchir.2009.08.018

Cited by 11 publications

(13 citation statements)

References 14 publications

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“…The mortality rate in our study was 53.4%, or more than half of patients ( Table 4). This result is higher than Dellinger 29% [3] and Chichom 29.8% [22] but lower than Nel 71% [4]. The causes of death in our series were acute renal failure, hepatic and septic shock.…”

Section: Discussioncontrasting

confidence: 56%

Post-Operative Peritonitis: Diagnostic Problems, Morbidity and Mortality in Developing Countries

Traoré¹,

Dembélé²,

Aoyama³

et al. 2014

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Goal: To study the diagnostic difficulties and post-operative morbidity and mortality of peritonitis. Patients and Methods: Retrospective study about the records of adult patients operated on between 1999 and 2013 whose diagnosis of post-operative peritonitis was made. Results: We achieved 23,573 lanterns and recorded 148 cases of postoperative peritonitis or 0.62%. The medium age was 37.1 ± 17.7 years and the sex ratio was 1.2. The delay between the initial intervention and reoperation was less than 5 days. Factors occurrence of postoperative peritonitis were those related to the initial surgery: septic context 70.8%, emergency surgery 81.1% under the seat mesocolic 25% and 20.3% initial surgical technique. The diagnosis was made preoperatively in 62.2% (n = 92). Ultrasound has found an effusion in 29.7% (n = 44). Cytobactériologic review identified germs in 85.1% (n = 126) and sterile in 12.9% of patients (n = 22). The most frequent etiologies were: 22.9% anastigmatic leak (n = 34), the phoenix abscess in 17.6% (n = 26), iatrogenic perforation 13.5% (n = 20) and digestive fistula 25% (n = 37). Other causes were the stoical necrosis 12.2% (n = 18) and evisceration 8.8% (n = 13). We performed a digestive stoma in 61% (n = 89), a closure of the abdomen bolsters in 8.8% (n = 13), a suture in iatrogenic perforation in 13.5% (n = 20) and washing with drainage in patients with phoenix abscess in 17.6% (n = 26). Morbidity was 22.3% and 53.4% mortality. Conclusion: The diagnosis of post-operative peritonitis is difficult in a developing country. Morbidity and mortality is high. Improved diagnostic tools are needed.

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Section: Discussioncontrasting

confidence: 56%

Post-Operative Peritonitis: Diagnostic Problems, Morbidity and Mortality in Developing Countries

Traoré¹,

Dembélé²,

Aoyama³

et al. 2014

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“…In 2009, a retrospective study by Chichom-Mefire et al [228] analyzed aspects of re-operative abdominal surgery in an economically disadvantaged environment with respect to indications, operative findings, treatment modalities, and outcomes. Mortality in this series was 18%, increasingly significant when the initial operative procedure was for peritonitis and re-operation was due to septic complications.…”

Section: Post-operative Peritonitismentioning

confidence: 99%

The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections

et al. 2017

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Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide.The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important.In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs.The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.

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“…The prevention of persistent intra-abdominal infection currently opposes two strategies: on-demand re-laparotomy and systematic planned relaparotomies. Current literature seem to favour the on-demand approach in terms of length of hospitalization and intensive care unit stay [ 3 , 49 – 51 ].…”

Section: Discussionmentioning

confidence: 99%

Which cause of diffuse peritonitis is the deadliest in the tropics? A retrospective analysis of 305 cases from the South-West Region of Cameroon

2016

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BackgroundAcute diffuse peritonitis is a common surgical emergency worldwide and a major contributor to non-trauma related death toll. Its causes vary widely and are correlated with mortality. Community acquired peritonitis seems to play a major role and is frequently related to hollow viscus perforation. Data on the outcome of peritonitis in the tropics are scarce. The aim of this study is to analyze the impact of tropic latitude causes of diffuse peritonitis on morbidity and mortality.MethodsWe retrospectively reviewed the records of 305 patients operated on for a diffuse peritonitis in two regional hospitals in the South-West Region of Cameroon over a 7 years period. The contributions of various causes of peritonitis to morbidity and mortality were analyzed.ResultsThe diagnosis of diffuse peritonitis was suggested on clinical ground only in more than 93 % of cases. The most common causes of diffuse peritonitis included peptic ulcer perforation (n = 69), complications of acute appendicitis (n = 53) and spontaneous perforations of the terminal ileum (n = 43). A total of 142 complications were recorded in 96 patients (31.5 % complication rate). The most common complications included wound dehiscence, sepsis, prolonged paralytic ileus and multi-organ failure. Patients with typhoid perforation of the terminal ileum carried a significantly higher risk of developing a complication (p = 0.002). The overall mortality rate was 15.1 %. The most common cause of death was septic shock. Differential analysis of mortality of various causes of peritonitis indicated that the highest contributors to death toll were typhoid perforation of terminal ileum (34.7 % of deaths), post-operative peritonitis (19.5 %) and peptic ulcer perforation (15.2 %).ConclusionThe diagnosis of diffuse peritonitis can still rely on clinical assessment alone in the absence of sophisticated imaging tools. Peptic ulcer and typhoid perforations are still major contributors to death toll. Patients presenting with these conditions require specific attention and prevention policies must be reinforced.

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Réinterventions de chirurgie abdominale en milieu défavorisé : indications et suites opératoires (238 cas)

Cited by 11 publications

References 14 publications

Post-Operative Peritonitis: Diagnostic Problems, Morbidity and Mortality in Developing Countries

Post-Operative Peritonitis: Diagnostic Problems, Morbidity and Mortality in Developing Countries

The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections

Which cause of diffuse peritonitis is the deadliest in the tropics? A retrospective analysis of 305 cases from the South-West Region of Cameroon

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