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

Abstract

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.

Global epidemiology of acute generalised peritonitis: a protocol for a systematic review and meta-analysis

“…AGP is the most frequent cause of acute abdomens3 4 requiring broad-spectrum antibiotics and source control with laparotomy or laparoscopic surgery for definitive cure,5 6 except in case of spontaneous peritonitis which is a medical emergency treated with antibiotics only 7. Furthermore, AGP is a major contributor to non-trauma deaths in all emergency settings, and the second leading cause of sepsis in critically ill patients 8 9. Its pathophysiology involves an inflammatory process of the peritoneum caused by an infectious or chemical agent which irritates the peritoneal cavity by either haematogenous spread of infection from another body part to the peritoneal cavity, or by perforation of an intra-abdominal hollow viscus with resultant spillage of bacteria into the peritoneal cavity 3 4 7 10.…”

“…AGP affects about 9.3 patients per 1000 hospital admissions11 and requires adequate preoperative resuscitation to avert high perioperative morbidity and mortality 12 13. Although AGP is one of the most frequent surgical emergencies at the global level,8 14 it has been reported to disproportionately affect low-income and middle-income countries especially the sub-Saharan African (SSA) region both in terms of prevalence9 15 and mortality rates 16–18. The most common types of AGP in a recent series of 305 cases in SSA were perforated gastroduodenal ulcers, perforated appendicitis and typhoid ileal perforation 9.…”

“…Although AGP is one of the most frequent surgical emergencies at the global level,8 14 it has been reported to disproportionately affect low-income and middle-income countries especially the sub-Saharan African (SSA) region both in terms of prevalence9 15 and mortality rates 16–18. The most common types of AGP in a recent series of 305 cases in SSA were perforated gastroduodenal ulcers, perforated appendicitis and typhoid ileal perforation 9. The postoperative mortality rates of AGP vary between 8.4% and 34% from isolated studies 1 4 5 9 19.…”

“…The most common types of AGP in a recent series of 305 cases in SSA were perforated gastroduodenal ulcers, perforated appendicitis and typhoid ileal perforation 9. The postoperative mortality rates of AGP vary between 8.4% and 34% from isolated studies 1 4 5 9 19. Various aetiologies of AGP that contribute to the death toll in SSA have been described as follows; typhoid perforation of the terminal ileum (34.7 %), postoperative peritonitis (19.5 %) and peptic ulcer perforation (15.2 %), perforated appendicitis (8.7 %), and perforation of the sigmoid colon (8.7 %) 9.…”

Pattern of ileal perforation in our experience; a tertiary care centre in Eastern India

“…2 Traumatic perforation may be in the form of blunt abdominal trauma or penetrating injury causing perforation of ileum, may or may not associated with injury to other abdominal viscera. 3 Advanced medical facilities have changed the etiological patterns of non-traumatic ileal perforation but still nontraumatic perforation is commoner than traumatic perforation in developing countries. But in western countries the typhoid and tuberculous perforation is rare.…”