Acute Generalized Peritonitis Research Articles

ETUDE DE LA MORTALITE POST OPERATOIRE AU SERVICE DE CHIRURGIE GENERALE DU CHU DE L’AMITIE SINO-CENTRAFRICAINE A BANGUI, RCA

Goal: To determine the postoperative mortality rate, identify the main causes and factors of postoperative morbidity and mortality in the general surgery department. Patients and method: This was a retrospective descriptive study covering the period from January 1, 2010 to December 31, 2019. The files of patients who died within 30 days following a surgical procedure were used. Results: A total of 812 deaths were recorded for 6,800 patients operated on in 10 years, or 11.9%. Only 200 files meeting the selection criteria were analyzed. The average number of deaths per year was 20 cases. The series included 63% male subjects. The average age was 41.4 years and the majority of deceased patients (51.5%) resided in Bangui. There were much more unemployed people (28%) and housewives (24.5%). Most deaths (82%) occurred after emergency surgery where acute generalized peritonitis (34%) and acute intestinal obstruction (25%) were the main indications. In 83% of cases, the deceased patients had a comorbidity, predominantly HIV infection (33.5%). The deceased patients were classified as ASA IV (45.5%) and Altémeier type III (34%). Postoperative deaths (80%) occurred in surgical intensive care 7 days on average after the operation following septic shock (55%). Conclusion: Post-operative mortality in Bangui remains high. It involves emergency surgery. The reorganization of emergency and surgical resuscitation services will help reduce this mortality rate.

Case Report: Acute peritonitis inaugurating Crohn's disease with spontaneous perforation in the peritoneal cavity

Background: Crohn's Disease is a chronic, idiopathic, and transmural inflammatory condition that mainly affects the distal ileum. It is characterized by intricate pathophysiology and numerous complications, some of which can be fatal. In this report, we present a case study of acute generalized peritonitis resulting from the perforation of a distal ileal loop, inaugurating the diagnosis of Crohn's disease. Case presentation: A 43-year-old patient presented with a clinical presentation of acute peritonitis. He had a one-year history of intermittent abdominal pain and diarrhea. As the maximum pain was in the right iliac fossa, an acute appendicitis complicated with peritonitis was considered and the patient underwent laparoscopic exploration, without morphologic exploration. Peroperative observation found an inflamed conglomerate of small bowel loops associated with sclerolipomatosis, and purulent peritonitis by perforation of a distal ileal loop, 40 cm from the ileocaecal valve. A peritoneal toilet, ileocaecal resection, and ileo-colostomy were performed. The postoperative course was uneventful. Discussion: Various complications may arise during the evolution of Crohn’s disease. However, fatal complication such as generalized peritonitis leading to the diagnosis is rare. The underlying pathophysiology of free perforation remains unknown. The most common site affected is the terminal ileum. The surgical treatment is based on a limited resection of the affected bowel segment, followed by a temporary stoma. A primary anastomosis can be performed in selected patients. Conclusion: Perforative peritonitis as an initial presentation of Crohn's disease is challenging. Surgery is obviously required for acute peritonitis, with limited resection with or without anastomosis.

Gut microbiota and changes in cytokine profile in animals with experimental acute disseminated peritonitis on the background of diabetes

In the pathogenesis of acute widespread peritonitis and accompanying diabetes, a vital link is an endogenous intoxication caused by the translocation of microorganisms and their toxins from the intestine into the blood, metabolic changes, and immunological reactivity of the body. Our work aimed to investigate the microbial composition in the parietal intestinal biotope and the features of the blood cytokine profile in animals with acute disseminated peritonitis on the background of streptozotocin-induced diabetes. The study was conducted on 56 sexually mature non-linear white male rats. Diabetes mellitus was modeled by a single intraperitoneal injection of streptozotocin (60 mg/kg). On the 14th day of the development of streptozotocin-induced diabetes mellitus, a 10% filtered fecal suspension (0.5 mL) was injected into the abdominal cavity of animals, and acute generalized peritonitis was initiated. Sowing on nutrient media was carried out for bacteriological research to isolate a pure culture of microorganisms and their identification. The concentration of TNF-α, IL-1β, and IL-6 was studied by solid-phase enzyme immunoassay. The research results demonstrate an imbalance of cytokines in the dynamics of experimental acute disseminated peritonitis against the background of diabetes and quantitative and qualitative changes in the microbiota of the parietal intestinal biotope. A decrease in the number of Escherichia coli strains isolated in monoculture and an increase in the number of two-component and three-component microbial associations were revealed, among which Enterobacter aerogenes, Escherichia coli, Bacteroides spp., Proteus mirabilis, Klebsiella spp. and Candida species prevailed.

Double Gastric and Duodenal Perforations at The Fousseyni Daou Hospital in Kayes in One Case

We report the observation of a patient presenting with acute generalized peritonitis. Emergency surgery found a double perforation, one on the stomach and the other on the duodenum. We performed a suture revival of the perforations plus a gastro-entero-anastomosis, then washed and drained the cavity. We discuss the diagnostic and therapeutic features of this rare condition.

Spontaneous uterine perforation presenting as acute abdomen: a diagnostic challenge

Spontaneous uterine perforation resulting in generalized peritonitis in postmenopausal women is a very rare entity usually caused by pyometra and is associated with high morbidity and mortality. The clinical picture of uterine perforation secondary to pyometra are similar to hollow viscus perforation which makes preoperative diagnosis difficult. Definitive diagnosis can be made with laparotomy or laparoscopy. We report a case of 62 years old female patient who presented with acute generalized peritonitis with pneumoperitoneum having history of pigtail insertion right kidney for right non-functional kidney with gross hydronephrosis two days back, which was more complicating the clinical picture. This case report aims to alert surgeons to the possibility that uterine perforation secondary to pyometra also shows air under diaphragm apart from hollow viscus perforation.

Oxidative modification of proteins and antioxidant status in blood of the rats with experimental acute generalized peritonitis against the background of streptozotocin-induced diabetes

Modern aspects of the pathogenesis of acute inflammation of the peritoneum that is concurrent with diabetes involves analysis of metabolic mechanisms, in particular peroxidaton of proteins – antioxidant defense. Therefore, the objective of our study was to examine the interrelation between the processes of free-radical oxidation of proteins and antioxidant system in the dynamics of development of acute generalized peritonitis against the background of streptozotocin-induced diabetes. The study was performed on 56 non-linear white mature male rats. Diabetes mellitus was modeled by a single intraperitoneal injection of streptozotocin (60 mg/kg). On the 14th day of the development of streptozotocin-induced diabetes, we injected 10% filtrated faeces suspension (0.5 mL) into the abdominal cavity, thus initiating acute generalized peritonitis. Oxidative modification of proteins in blood serum was studied using the I. F. Meshchyshen’s method and the condition of antioxidant protection was monitored according to the activities of superoxide dismutase, catalase, content of reduced glutathione, and the level of ceruloplasmin. The study of the parameters of free-radical oxidation of proteins and study of the condition of antioxidant system in blood of the rats with experimental acute generalized peritonitis against the background of streptozotocin-induced diabetes demonstrated that oxidative protein modification grew, while the parameters of the activity of antioxidant system were being inhibited, depending on the stage of acute inflammation of the peritoneum. We determined inverse correlation relationships between the products of free-radical oxidation of proteins and parameters of antioxidant system on the third and on the seventh days of modelling of combined pathology. Manifestation of acute generalized peritonitis concurring with streptozotocin-induced diabetes was accompanied by a gradual accumulation of the products of free-radical oxidation of proteins and exhaustion of the antioxidant defense during all stages of the development of acute inflammation of the peritoneum, peaking on the seventh day after administration of faecal suspension (terminal stage of peritonitis). The observed inverse correlations between the levels of oxidative modification of proteins and the activity of superoxide dismutase, catalase, reduced glutathione, and ceruloplasmin on the third and on the seventh days of modelling of combined pathology indicate a predictive role of the processes of free-radical oxidation of proteins in exhaustion of antioxidant-defense resources.

Is damage control surgery useful in the treatment of colorectal perforation? A single-center case-control study.

From January 2013 to December 2019, 131 patients with colorectal perforation underwent emergency surgery at our hospital. Among these, 95 patients required postoperative intensive care unit management and were included in this study; of these patients, 29 (31%) underwent DCS, and 66 (69%) underwent primary abdominal closure (PC). Patients who underwent DCS had significantly higher Acute Physiology and Chronic Health Evaluation II (23.9 [19.5-29.5] vs. 17.6 [13.7-22]; P<0.0001) and Sequential Organ Failure Assessment (SOFA) (9 [7-11] vs. 6 [3-8]; P<0.0001) scores than did those who underwent PC. The initial operation time was significantly shorter for DCS than for PC (99 [68-112] vs. 146 [118-171]; P<0.0001). The 30-day mortality and colostomy rates were not significantly different between the two groups. The results suggest that DCS is useful in the management of acute generalized peritonitis caused by colorectal perforation.

Anesthesiological Management of Acute Generalized Peritonitis at Chu Kara

The aim of our work was to make an inventory of the anesthesiological management of acute generalized peritonitis at the CHU-Kara. To determine the frequency of acute generalized peritonitis; to describe their treatment in pre, per and postoperative; to analyze the postoperative follow-up. This work was a retrospective descriptive study carried out on the files of patients operated for acute generalized peritonitis from November 1, 2019 to October 31, 2020. The study was performed in the surgical resuscitation department and in the operating room. Fifty-eight cases of generalized peritonitis were selected for the study. Peritonitis represented 27.8% of abdominal surgical emergencies. The patients were male dominated with a mean age of 29.6 years. The average consultation time was 3.5 days. Fever was the predominant clinical sign on admission (72.4%). The average duration of preoperative resuscitation was 17 hours and 18 minutes. The combination of Ceftriaxone and Metronidazole was the most used antibiotic therapy. General anesthesia was standard. Spinal anaesthesia was the second technique used. Preoxygenation was systematic for general anesthesia. Pancuronium (72.2%) was the most used curare. The average duration of anesthesia was 105 minutes. Laparotomy, peritoneal cleansing and drainage were performed in all patients, followed by excision-suture of the stomach (43.1%). Peritonitis due to peptic ulcer perforation predominated (43.1%) followed by typhoid perforation of the small intestine (24.1%). The morbidity rate was 41.4%, dominated by parietal suppurations (15.5%). The mortality rate was 8.6%. The average length of stay in intensive care was 8.7 days. The anesthesiological management of acute peritonitis remains a real challenge for anesthesiologists, given the major volume disturbances, the delay in diagnosis with its corollary of septic shock, and the lack of qualified personnel with which they are faced. Peritonitis is a real public health problem because of its still very high mortality. It was carried out with insufficiencies related to the poverty of the population, the inexistence of universal health insurance, the insufficiency of the technical platform and the insufficiency of organization.

An Assessment of the Etiologies Associated With Acute Abdomen Subjected to Exploratory Laparotomy: A Study From a Rural Area of Himachal Pradesh.

Background The aim of this retrospective study is to establish a correlation between clinical features, surgical diagnosis, and the final diagnosis of laparotomies, as well as to establish the relationship between preoperative delay on the outcomes of surgery in the form of mortality and morbidity. Emergency surgery is high-risk in patients with acute abdomen with uncertain diagnosis. The results of surgery are remarkable and provide quick relief to the suffering and agony of patients with the dreadful condition of acute generalized peritonitis. Methodology Patients presenting with complaints of acute abdomen who needed laparotomy based on clinical judgment and investigations were included in this study. The study data were reviewed from April 2007 to January 2011 and March 2014 to February 2016 in a government hospital. Results A total of 174 patients with acute abdomen in whom there was an indication of laparotomy based on clinical judgment and radiological investigations were selected. Most patients had gastrointestinal perforation (n = 115) and acute intestinal obstruction (n = 23). The most important clinical features analyzed were abdominal tenderness (n = 160), guarding (n = 153), distention (n = 75), and tachycardia (n = 63). Conclusions Among the total patients, 150 underwent surgery within 24 hours of the presentation in the emergency and the remaining after 24 hours. The most common cause of laparotomy was a duodenal perforation in 79 patients and gastric perforation in 24 patients. A total of 114 patients developed no complications postoperatively. Among patients who developedpostoperative complications, wound sepsis and acute respiratory distress syndrome were the most common. Mortality was noted in three patients.

S2515 Chicken Bone Causing Gastric Perforation With Liver Penetration: Successfully Managed With Endoscopic Removal and Clipping

Introduction: Perforation of gastric wall by a chicken bone has rarely been reported. Most foreign bodies (FB) pass through the gastrointestinal tract uneventfully within one week. However, we report a case of chicken bone-induced gastric perforation managed by endoscopic retrieval and closure with clips. Case Description/Methods: A 70-year-old-man presented with sharp epigastric abdominal pain with nausea and vomiting 4 hours after eating chicken wings. He was hemodynamically stable. The abdomen was soft and non-tender, with normoactive bowel sounds on examination. CT scan revealed a small pneumoperitoneum in the upper abdomen and a 3.4 cm linear radiopaque density within the lumen of the gastric antrum and partially outside directed posteriorly, abutting the left hepatic lobe. An EGD revealed a 3.5 cm long, narrow bone with a hollow center protruding through the antral wall along the lesser curvature. One endoclip was placed adjacent to the FB for easier identification of the location of the perforation. The FB was then extracted from the wall with rat tooth forceps. The gastric wall defect was then closed with 6 endoclips in a zipper-like fashion. Finally, the FB was retrieved with rat tooth forceps by allowing the sharp end to trail with the withdrawal of the gastroscope. Post-procedure, the patient was started on a clear liquid diet 48 hours later, which he tolerated well, and was discharged on post-procedure day 4 (Figure). Discussion: Accidental foreign body (FB) ingestion is common. Most ingested FB pass spontaneously, with only 10%-20% requiring non-operative intervention. Serious complications include impaction or perforation. A foreign body that perforates the bowel wall may have a wide spectrum of clinical manifestations, from acute generalized peritonitis to chronic abscess formation. Patients with foreign bodies in the stomach, duodenum, and large intestine rarely have perforation due to thick walls and may have delayed presentation. We report the second case of endoscopic retrieval of a chicken bone causing gastric perforation managed endoscopically. Endoclips are often used as a hemostatic tool or to close endoscopic mucosal resection sites. Endoscopic intervention is more likely to be successful in cases of FB ingestion in the absence of peritonitis. In this case, the endoscopic removal of FB resulted in successful non-surgical management of gastric perforation. Placement of initial endoclip prior to bone removal allowed successful closure despite loss of gas after FB removal.Figure 1.: A-Upper Endoscopy shows a sharp hollow chicken bone in gastric antrum. B-Upper Endoscopy showing removal of chicken bone followed by endoscopic clipping. C- CT Abdomen/Pelvis without contrast shows a foreign body perforating the gastric wall and penetrating the liver.

Incomplete Situs Inversus Associated with Common Mesentery and Splenic Duplicity: About A Case and Literature Review

Situs inversus is a rare congenital malformation characterized by the inverted position of the thoracic and abdominal organs relative to the sagittal plane. It can be complete or incomplete. We report an incomplete case of situs inversus associated with a common mesentery and splenic duplicity, revealed by acute generalized peritonitis by ileal perforation of typhic origin.

Impact of the first wave of the COVID-19 pandemic on emergency surgical activities at the National Reference University Hospital of N'Djamena.

An evaluation of Covid-19 pandemic impact on emergency surgical activities at the CHU-RN in N'Djamena, Chad. A retrospective study of patients admitted to the surgical emergency room during the first wave of the pandemic (April-June 2020). The data were compared to those of patients admitted during the same period in 2019 (control group). Results: A total of 3248 patients were received: 2366 in 2019 and 882 in 2020. Respective reduction of 50% of admissions and 31% of emergency operations were observed. The average age (30 years) and male predominance remained unchanged. The average admission time went from 72 hours in 2019 to 7 days in 2020. We also noticed that digestive emergencies, such as acute generalized peritonitis (6.6% vs 14.4%, p < 0.1) and strangulated hernias (6.6% vs 15.2% p: 0.07) were more severe in 2020. COVID-19 had reduced admissions and urgent surgical interventions.

Accuracy of ultrasonography for the diagnosis of acute generalized peritonitis in children: A two-year review

In atypical presentations, ultrasonography may be helpful to confirm the diagnosis of acute generalized peritonitis. Our study aimed to evaluate its accuracy at Albert Royer National Children’s Hospital Centre of Dakar, in Senegal. We conducted a two-year (2018-2020) retrospective cross-sectional study, with an analytical aspect. Fifty-one patients were included in our study. In 56.7% of cases, a radiologist realized the ultrasonography. The sensibility and specificity of ultrasonography for the diagnosis of acute generalized peritonitis were 70 and 75% respectively. Accuracy of diagnosis was reduced proportionally to the operator's experience, ranging from 82% for radiologists, 66% for interns in radiology to 46% for trainees in radiology (p=0,0145). In our environment, the accuracy of ultrasonography for the diagnosis of acute generalized peritonitis is poor, and largely influenced by the operator's experience, which relegates this investigation to the second line, behind clinical suspicion.

Morphological features of the large intestine in experimental acute generalized peritonitis against the background of streptozotocin-induced diabetes

The work is a fragment of the research project “Pathogenetic features of the allergic and inflammatory processes course and their pharmacocorrection”, conducted by the Department of Pathological Physiology, Danylo Halytskyi Lviv National Medical University (state registration No. 0116U004503).&#x0D; The aim of the work: to study the morphological features of the colon in the dynamics of the development of experimental acute peritonitis on the background of streptozotocin-induced diabetes mellitus.&#x0D; Materials and Methods. The experiment used 48 white male rats. Diabetes mellitus in experimental animals was simulated by a single intraperitoneal injection of streptozotocin (Sigma) at a rate of 60 mg/kg, acute disseminated peritonitis – the introduction of 0.5 ml of 10 % filtered fecal suspension into the abdominal cavity. A morphological study of the colon in animals removed from the experiment on the first, third and seventh days of acute peritonitis on the background of concomitant diabetes mellitus was performed.&#x0D; Results and Discussion. Morphological examination of the colon of animals on the first day of experimental acute peritonitis in conditions of concomitant streptozotocin-induced diabetes mellitus revealed an increase in the size of the crypts due to stroma edema and lymphohistiocytic infiltration, slight perivascular edema in the subclavian edema. On the third day, thickening of the mucous membrane of the colon, a sharp increase in the depth of the crypts, uneven blood supply to the vessels in the submucosal layer with a predominance of perivascular edema were verified. On the seventh day, a decrease in the thickness of the mucous membrane due to the expansion of the crypts was visualized. Part of the epitheliocytes was in a phase of increased secretory activity, the other part was dystrophically altered, which stimulated increased lymphocytic and histiocytic infiltration.&#x0D; These changes were accompanied by activation of reactive processes and hyperplasia of lymphoid follicles on the first day of peritonitis on the background of streptozotocin-induced diabetes mellitus, and as the severity of purulent inflammation – hypoplasia of the lymphoid tissue and a decrease in local reactivity(the third and seventh days of the development of acute peritoneal burning in conditions of combined pathology).

THE STATE OF MICROBIOTS AND MORPHOLOGICAL CHANGES OF THE SMALL INTESTINE IN EXPERIMENTAL ACUTE GENERALIZED PERITONITIS ON THE BACKGROUND OF STREPTOSOTOCIN-INDUCED DIABETES MELLITUS

The aim of the work: to analyze the microbiota and to study the morphological structure of the small intestine in the dynamics of acute peritonitis on the background of streptozotocin-induced diabetes mellitus.&#x0D; Materials and methods. Experimental researches were performed on 52 adult white male rats. The main group of animals was divided into three subgroups, on which bacteriological examination of parietal intestinal biotope and morphological examination of the small intestine on the first, third and seventh days of acute peritonitis on the background of concomitant diabetes were carried out. Diabetes mellitus was simulated by a single intraperitoneal injection of streptozotocin (60 mg / kg). On day 14 of diabetes mellitus, rats were injected with 0.5 ml of 10 % filtered fecal suspension into the abdominal cavity and acute generalized peritonitis was initiated. The control group consisted of rats (n=8), which were injected subcutaneously with saline 0.9 % NaCl.&#x0D; Results and discussion. Bacteriological examination of the parietal intestinal biotope and morphological examination of the small intestine were performed. In the first subgroup of animals with acute peritonitis on the background of streptozotocin-induced diabetes mellitus, the dominant microbiota isolated from the parietal intestinal habitat was represented by Escherichia coli (70 %), Candida spp. (20 %) and Staphylococcus spp. (20 %). A monoculture of microorganisms was identified in 40 % of animals. In the second subgroup, the number of microbial associations increased to 78 %. Three-component associations predominated in the third subgroup, dominated by Escherichia coli (57 %) and Enterobacter aerogenes (43 %). In the control group of animals Bifidibacterium spp., Lactobacillus spp., Escherichia coli, Staphylococcus spp were found. The progression of the inflammatory process on the background of hyperglycemia was accompanied by the increase in the number of Enterobacter aerogenes, Bacteroides spp, Candida spp. and by the decrease in the number of Escherichia coli. The results of morphological examination of the mucous membrane of the small intestine of rats at different stages of development of this combined pathology indicate the development of an active inflammatory reaction, which is the basis for the deterioration of absorption function and enteral insufficiency syndrome. Alterative changes manifested by uneven vacuolation of villi epithelial cells, areas of epithelial desquamation, as well as severe infiltration of the mucous membrane by neutrophilic granulocytes, monocytes and lymphocytes increased throughout the experiment and were most characteristic of animals of the third subgroup, mortality in which reached 38 %.&#x0D; Conclusions. The results of bacteriological examination of the parietal intestinal biotope of animals with acute peritonitis on the background of streptozotocin-induced diabetes mellitus indicate the dominance of Escherichia coli (65 %), Enterobacter aerogenes (23 %), Candida spp. (23 %), Bacteroides spp (19 %) among the representatives of the microbiota of the small intestine.&#x0D; The development of the inflammatory process of the peritoneum on the background of hyperglycemia is accompanied by a decrease in the height and thickness of the villi, crypt depth, dystrophic changes of mucosal cells, which indicates the decrease in the barrier function of the small intestine and is the cause of bacterial translocation, which is enhanced by qualitative and quantitative changes in microbes (predominance of associations of pathogens of aerobic gram-negative microorganisms and fungi of the genus Candida).

Relationship between lipid peroxidation and antioxidants in rats with experimental acute generalized peritonitis against the background of streptozotocin-induced diabetes

Introduction. There are evidence that oxidative stress is involved in the pathogenesis of the acute generalized peritonitis and diabetes mellitus.The aim of study was to examine levels of the products of lipid peroxidation and the antioxidants in rats with experimental acute generalized peritonitis against the background of streptozotocin-induced diabetes.Material and methods. The experiment was performed on 66 adult white male rats weighing 220-300 g. Diabetes mellitus in experimental animals was simulated by a single intraperitoneal injection of streptozotocin (Sigma) at the dose of 60 mg/kg. Acute generalized peritonitis was induced with 10% faecal suspension in a dose of 0.5 ml per 100 g of animal weight in the abdominal cavity of laboratory animals by puncture method. The thiobarbituric acid reactive substances (TBARS), lipid hydroperoxides (LOOHs), superoxide dismutase (SOD) activity, catalase (CAT) and ceruloplasmin (CP) were estimated and compared.Results. Our results showed that during all stages of development of acute generalized peritonitis on the background of streptozotocin-induced diabetes there is the LOOHs decrease and the TBARS increase. We observed statistically significant inverse correlations between the level of LOOHs and SOD in the animals of subgroup 1 (r = -0.88; p &lt;0.05) and inverse correlations between the TBARS level and the SOD level in the subgroup 3 of animals (r = -0.74; p &lt;0.05). We also found a statistically significant inverse correlation between the CAT level and the TBARS level (r = -0.86; p &lt;0.05) and between the CP level and the TBARS level in the blood of animals in the subgroup 3 (r = -0.87; p &lt;0.05).Conclusion. Negative statistically significant correlations between the TBARS level and the antioxidants (SOD, CAT, CP) in the blood of animals with acute generalized peritonitis on the background of streptozotocin-induced diabetes indicate a predictor role of lipid peroxidation processes in the depletion of antioxidant resources

Contribution of imaging to the management of acute generalized peritonitis in the visceral surgery department of the Sino-Guinean hospital

Introduction: Acute generalized peritonitis is a life-threatening emergency. It is most often secondary to a perforation of the digestive organ and or to the spread of an intra-abdominal septic area. Methodology: We carried out a descriptive retrospective study lasting from January 1, 2018 to December 31, 2018 on the contribution of imaging in the management of acute generalized peritonitis general surgery department of the hospital Chinese-Guinean. Were included in our study, all records of patients with acute generalized peritonitis will be confirmed by imaging. We carried out an exhaustive recruitment of all complete files. Our variables were analyzed using the Epi-info 7.2 software. Result: Out of 578 hospitalized patients, peritonitis represented 8.8% of cases. We noted a male predominance with 60.8% and a Sex-ratio: M / F = 1.6 whose mean age was 41.9 ± 13.5 years; extremes ranging from 17 and 67 years with a modal class ≥ 30 years or 88.3%. Housewives were the most collected with 25.5% Abdominal pain was the main reason for consultation, i.e., 90.2%, the physical sign was dominated by a convex and sensitive Douglas-fir, i.e., 27.5%. The clinical diagnosis was supported by abdomen without preparation and abdominal ultrasound; performed in 84.3% and 15.7% of patients, respectively. We noted a morbidity rate of 15.7% dominated by septic shock (15.7%). Conclusion: Our study made it possible to determine the contribution of imaging in the management. In addition, in our study, the abdomen without preparation and the abdomino-pelvic ultrasound were revealed as a key link in the management of acute generalized peritonitis.

Contribution of imaging to the management of acute generalized peritonitis in the visceral surgery department of the Sino-Guinean hospital

Contribution of imaging to the management of acute generalized peritonitis in the visceral surgery department of the Sino-Guinean hospital

Mannheim Peritonitis Index: usefulness in a context with limited resources: Prognosis of acute peritonitis.

Background: The objective of this study is to evaluate the Mannheim Peritonitis Index (MPI) usefulness for acute generalized peritonitis management in a clinical limited resources context. Methods: This is a prospective study from 1 January to 31 October 2019 including patients admitted to a sub-saharan hospital for acute generalized peritonitis. Perioperative variables and outcomes were considered. Results: 70 patients were included. Mean age was 32.6 ± 14.6 years with a sex ratio of 1.33. The mean time to patients’ hospital admission was 3.9 ± 2.1 days. Most patients had ileal and gastric perforations (27.1% and 18.6%). Twenty six patients (37.1%) developed complications and thirty-day mortality rate was 14.3%. Positive predictive value of MPI was 63.6% and negative predictive value was 83, 8%. Sensitivity of MPI ≥ 26 was 77.8%; Specificity of MPI < 25 was 72.1%. Conclusion This experience shows that MPI is a good predictor of morbidity and mortality for patients with acute peritonitis even in a difficult context with few resources and many patients. Identifying the most critical patients, a more careful surgical staff involvement may improve patients outcome.

Acute generalized peritonitis of appendicular origin: Epidemiological, clinical and therapeutic aspects at the Sino-Guinean Friendship Hospital

Introduction: The aim of this study is to investigate, the etiologies, the results of management of acute generalized peritonitis of appendicular origin. Acute generalized peritonitis of appendicular origin is defined as acute inflammation of the peritoneum resulting from either perforation of the appendix or spread of a peri-appendicular abscess. Methodology: The visceral surgery department of the Sino-Guinean Friendship Hospital served as the framework for this work. All patients admitted and operated on for acute generalized peritonitis of appendicular origin whose records were complete were included in this study. Results: During our study we recorded 23 cases of appendicular peritonitis, the sex ratio of nearly 3.6 reflected a clear male predominance of the condition. We noted 15 cases of appendicular perforation, 8 cases of appendicular gangrene, 2 cases of surgical site infection, 2 cases of evisceration and 2 cases of death. Conclusion: Appendicular peritonitis is a frequent disease, the management is medico-surgical.