Causes and determinants of outcome of intestinal perforations in a semiurban African community

Abstract

Background: Intestinal perforations are common causes of generalized peritonitis, it is often severe because of faecal contamination and overwhelming sepsis resulting in high morbidity and mortality. The purpose of the present study was to determine the causes and factors affecting the prognosis in patients with generalized peritonitis as a result of intestinal perforation.Study design: Patients with acute generalized peritonitis from intestinal perforation were prospectively studied during a 6‐year period from 1995 to 2000. Personal, preoperative and postoperative clinical information of all the patients was entered into a predesigned proforma. Data were analysed and the effect of individual causes of peritonitis on the postoperative outcome was determined.Results: More males were affected by a ratio of 3 : 1, with the overall mean age of 27.6 ± 18.3 years (SD). The mean age in patients with typhoid perforation was 21 ± 14 years (SD) and highest in traumatic intestinal perforations (47.2 ± 17.6 years, SD). Typhoid perforation occurred in 75 (58%) patients, acute appendicitis in 21 (16.3%), peptic ulcer disease in 18 (14%), trauma in eight (6.3%), five were idiopathic and one malignant sigmoid carcinoid tumour. Wound infection occurred in 74 (58.3%) and mortality in 24 (18.8%) of the patients. Mortality was high in traumatic and typhoid intestinal perforation than other causes of intestinal perforation. Factors such as age, cause of intestinal perforation, and amount of pus drained during operation independently predicts the postoperative morbidity and mortality rates.Conclusion: Typhoid intestinal perforation was the most common cause of acute generalized peritonitis, followed by perforated acute appendicitis. Prognostic factors include age, the causes of perforation, amount of pus, wound infection, wound dehiscence, faecal fistula, and intra‐abdominal abscess.