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

Alain Chichom-Mefire,Marcelin Ngowe-Ngowe,Tabe Alain Fon

doi:10.1186/s13017-016-0070-9

Alain Chichom-Mefire, Marcelin Ngowe-Ngowe + Show 1 more

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https://doi.org/10.1186/s13017-016-0070-9

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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.

Highlights

Acute diffuse peritonitis is a common surgical emergency worldwide and a major contributor to non-trauma related death toll
Analysis of the contribution of various forms of perforative peritonitis to morbidity and mortality indicate that while results of treatment of peritonitis secondary to peptic ulcer perforation seem to have improved over the past decades [13,14,15], other frequent causes in the tropics such as typhoid fever related perforation of the small bowel still carry a heavy morbidity and mortality rates [4, 16,17,18]
– For the remaining 39 files, analysis of the operative notes indicated that no cause was identified for the peritonitis during surgical exploration and they were classified as primary peritonitis

Summary

Introduction

Acute diffuse peritonitis is a common surgical emergency worldwide and a major contributor to non-trauma related death toll. Acute generalized peritonitis is a common surgical emergency worldwide and has been reported as one of the major contributors to non-trauma deaths in the emergency department despite improvements in diagnosis, surgical treatment and intensive care support [4,5,6]. It is known that community acquired peritonitis represent the vast majority of cases and is largely related to bowel perforation [3, 9]. This latter cause of peritonitis seems to carry the highest mortality rate (10 to 32 %) [7, 9,10,11,12]. Analysis of the contribution of various forms of perforative peritonitis to morbidity and mortality indicate that while results of treatment of peritonitis secondary to peptic ulcer perforation seem to have improved over the past decades [13,14,15], other frequent causes in the tropics such as typhoid fever related perforation of the small bowel still carry a heavy morbidity and mortality rates [4, 16,17,18]

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