Management of Postoperative Peritonitis (POP) in a Disadvantaged Environment

Abstract

The aim of this work was to describe the management of POP in a precarious environment. It was a retrospective study of descriptive type from January 2007 to December 2012 on the records of patients with POP. Gender, age, qualification of the operating physician, time to management, initial diagnosis, type of initial surgery, treatment, prognosis were the parameters studied. We noted 32 cases of POP out of 4656 laparotomies, i.e. a frequency of 0.7%. The mean age of our patients was 37.7 years. The sex ratio was 1.3 in favor of the male sex. The majority of our patients were referred from other centers with a rate of 78%. Emergencies accounted for 84% of the initial surgical procedures. Initial diagnoses were dominated by acute appendicitis with a rate of 37.5%. Clinical signs were dominated by abdominal pain 87.5%; vomiting 53.1%; tachycardia 68.7% and fever 75%. The main causes were the release of digestive sutures. The management was multidisciplinary. We noted 41% of favorable follow-up; 9% of morbidity and 50% of death. The delay of the operative recovery, the number of visceral failures, the number of iterative and close reoperations were factors that influenced the prognosis. Post-operative peritonitis rapidly challenges the integrity of most major vital functions. Early diagnosis is the key to improving prognosis.