TITLE:
Post-Operative Peritonitis: Diagnostic Problems, Morbidity and Mortality in Developing Countries
AUTHORS:
Alhassane Traoré, Bakary Tientigui Dembélé, Adégné Togo, Lassana Kanté, Madiassa Konaté, Ibrahima Diakité, Simo Notue Fabienne Laurence, Boubacar Karembé, Abdoulaye Diarra, Amadou Traoré, Mahamane Djibo Diango, Gangaly Diallo
KEYWORDS:
Peritonitis, Postoperative Morbidity and Mortality, Surgery
JOURNAL NAME:
Surgical Science,
Vol.5 No.8,
August
15,
2014
ABSTRACT:
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.