Emergency Surgical Unit Research Articles

KPC - 3 Klebsiella pneumoniaeST258 clone infection in postoperative abdominal surgery patients in an intensive care setting: analysis of a case series of 30 patients

BackgroundAbdominal surgery carries significant morbidity and mortality, which is in turn associated with an enormous use of healthcare resources. We describe the clinical course of 30 Intensive Care Unit (ICU) patients who underwent abdominal surgery and showed severe infections caused by Klebsiella pneumoniae sequence type (ST) 258 producing K. pneumoniae carbapenemase (KPC-Kp). The aim was to evaluate risk factors for mortality and the impact of a combination therapy of colistin plus recommended regimen or higher dosage of tigecycline.MethodsA prospective assessment of severe monomicrobial KPC-Kp infections occurring after open abdominal surgery carried out from August 2011 to August 2012 in the same hospital by different surgical teams is presented. Clinical and surgical characteristics, microbiological and surveillance data, factors associated with mortality and treatment regimens were analyzed. A combination regimen of colistin with tigecycline was used. A high dose of tigecycline was administered according to intra-abdominal abscess severity and MICs for tigecycline.ResultsThe mean age of the patients was 56.6 ± 15 and their APACHE score on admission averaged 22.72. Twenty out of 30 patients came from the surgical emergency unit. Fifteen patients showed intra-abdominal abscess, eight anastomotic leakage, four surgical site infection (SSI) and three peritonitis. The overall crude ICU mortality rate was 40% (12 out of 30 patients). Twelve of the 30 patients were started on a combination treatment of high-dose tigecycline and intravenous colistin. A significantly lower mortality rate was observed among those patients compared to patients treated with approved dose of tigecycline plus colistin. No adverse events were reported with high doses of tigecycline.ConclusionsCritically-ill surgical patients are prone to severe post-surgical infectious complications caused by KPC-Kp. Timely microbiological diagnosis and optimizing antibiotic dosing regimens are essential to prevent worse outcomes. Further studies and well-controlled clinical trials are needed to define the optimal treatment of infections by KPC-Kp and, more generally, carbapenem-resistant bacteria.

PTH-147 Audit of an In-Patient Teaching Hospital Gastroenterology Workload in 2012

IntroductionThe aim of this retrospective study was to evaluate the patient demographics, route of admission, main diagnosis, duration of stay and quality of discharge summaries on the two 25 bedded...

Traumatic Ossicle Extrusion into the External Auditory Canal

We report a rare case of incus dislocation into the external auditory canal following a head injury. The patient was a 35-year-old man who presented to the surgical emergency unit with a head injury that he had sustained during a traffic accident. An x-ray of the skull detected a longitudinal fracture of the right temporal bone. The ENT examination revealed the presence of a bony structure and a blood clot in the right external auditory canal. Computed tomography identified a disruption of the ossicular chain, with an incus-like bony shadow in the external canal. The wide opening of the fracture line and the impact of the accident were believed to have pushed the incus through the fracture and into the external canal. The patient was successfully treated with exploratory tympanotomy and ossiculoplasty.

Recurrent differentiated thyroid cancer: to cut or burn

The term “relapse carcinoma” is used improperly to indicate either a local or loco-regional relapse or a systematic metastatsis [1]. Local relapse (LR) after thyroidectomy for cancer is “the repetition of the neoplastic lesion in proximity of the previous intervention of excision” [2]. According to Duren [3] relapses of thyroidal carcinoma need to be classified as: local (LR): that may present itself in the residual thyroid lobe or in the thyroid bed where surgery was performed; loco-regional (RLR): that may present in the cervical lymph nodes of the central compartment or lateral-cervical nodes; and metastasis in distance (MD). The MD are frequently synchronous with LR or RLR; they have haematogenous genesis and concern most frequently the lungs and skeleton. There is controversy over how to catergorize the relapse in the thyroidal bed with infiltrations of neighbouring organs (periodontal structures muscles, thyroidal cartilage, cricoid, laryngeal nerves, etc. and the neighbouring organs oesophagus, trachea, larynx). As per the classification proposed by Duren [3] these should be considered as LR, whereas according to Mozzillo and Pezzullo [1] they are categorised as RLR. The RLR at the level of the cervical lymphnodal stations represents an ulterior problem: are these true relapses, residual cancer, or recurrence in progression? Caraco [4], in his report to the ninety-fourth Congress of the Italian Society of Surgery, specified that local recurrences are only those recurrences that are characterized by the appearance of neoplastic tissue in the thyroidal lodge, in the residual parenchyma, and in the adjacent structures, excluding the lymph nodes [5,6]. In nearly 53% of cases the relapse is reported in RLR, in 28% in LR, and in 13% the MD is present of these 6% of cases have mixed relapses [7]; the prognosis of LR is however, better than that of the others [8]. The differentiated tumors of the thyroid are slow growing and due to this rarely reach notable dimensions or result in metastasis in lymph and/or haematic systems [2]. Only 10% of patients die from differentiated thyroid cancer [9]. Most of the local relapses occur within the first five years of the excision of the primary cancer [5,6,10-12], however, the recurrence can occur as late as 20 years after the initial diagnosis and treatment [13]. An accurate evaluation of incidence of LR is possible solely with a considerable number of treated patients and lengthy follow-up that is not available at most centres and hence this kind of information can be obtained from the date from centres that have high volume of thyroid carcinoma and good follow-up like Mayo Clinic or Lahey Clinic [5,6,13] or through observational studies at several other medical centres [14]. Currently relapses represent a rare event in patients who undergo removal of thyroidal carcinoma (3-13%) [5,6,10-12,15-17]. This is due to the ever increasing frequency of total thyroidectomy for management of cancer [18]. The complete excision of the thyroidal parenchyma prevents local recurrence. Giovanni Razzaboni in “Treatise on Prognostic Surgery” (1938) stated that “The most rational operating method, so long as not free from grave consequences of another kind, remains the total extra-capsular thyroidectomy, so as is used, when possible, for the surgical removal of whatever other tumour” [19]. he further emphasized in his work published after his death in 1956 entitled “Treatise on Clinical Therapeutic Surgery” that “Only an removal of this capacity justifies, in the face of a proven malignant tumour, surgical intervention, any other incomplete or partial demolition does nothing but accelerate the ready reoccurrences, even in a very short time” [20]. * Correspondence: cirocchiroberto@yahoo.it General and Emergency Surgical Unit. Department of Surgical Sciences, Radiology and Dentistry. University of Perugia, Perugia, Italy Full list of author information is available at the end of the article Cirocchi et al. World Journal of Surgical Oncology 2011, 9:89 http://www.wjso.com/content/9/1/89 WORLD JOURNAL OF SURGICAL ONCOLOGY

Pattern and trend of trauma in a tertiary health institution: an 8 year review

BackgroundTrauma is common and world wide, with varying causes and consequences. It constitutes a significant portion of presentation to the surgical accident and emergency units. Keeping databases enhance plans for...

Quality and Safety on an Acute Surgical Ward

To evaluate patient safety in an emergency surgical unit using process and outcome measures in parallel. Patient harm from errors in care is common in modern surgical practice. Measurement of the problem is essential to any solution, but current methods of evaluating patient harm are either impractical or inadequate. We have therefore analyzed compliance with safety-relevant care processes, with the aim of developing a process-based system for evaluating ward safety. Adverse events (AE), potential adverse events (PAE), and 7 safety-relevant processes were measured on a 38-bed surgical emergency unit over a 16-week period. AE, PAE, and process measures were studied by prospective direct observation in large convenience samples, using objective measures. Possible influences on AE and PAE risk were analyzed. Compliance with the 7 processes studied ranged from 23% to 89%. The AE and PAE rates were 11.9% and 13.8% in a 63% sample of admissions (n = 607). Length of stay was significantly associated with both AE (P < 0.001) and PAE (P < 0.001). Having an operation was also associated with AE (P = 0.001) but not with PAE. No other factors appeared to influence AE/PAE rates. Delays were the commonest causes of both AE and PAE. Compliance with individual care processes on a ward with average levels of patient harm is poor. Length of hospital stay increases the risk of both AE and PAE, suggesting a system defect. A bundle of care processes may be useful for monitoring safety improvement.

Is endoscopic band ligation superior to injection therapy for Dieulafoy lesion?

Dieulafoy lesion is a rare but serious cause of gastrointestinal system bleeding. An aberrant submucosal artery, which was described in 1884, causes the bleeding. The lesion can be located anywhere in the gastrointestinal tract but is most commonly found in the proximal stomach up to 6 cm from the gastroesophageal junction. Increased experience in endoscopy has led to an increased frequency of its proper diagnosis. Various methods are used to achieve successful hemostasis by endoscopy in Dieulafoy lesion; however, comparative studies about the success rates of these methods are still needed. In this study, we compared two of these endoscopic hemostatic methods: band ligation, and injection therapy in Dieulafoy lesions. In this prospective study, 18 patients admitted to the Emergency Surgical Unit between January 2002 and December 2005 with upper gastrointestinal bleeding diagnosed as Dieulafoy lesion were included. Diagnose of Dieulafoy lesion was made at initial or second-look endoscopy. Patients were randomized in two groups according to therapy method: injection therapy and band ligation groups. Therapy was applied immediately after recognizing the lesion at the same endoscopic procedure. Two groups were compared regarding demographical data, presence of comorbid diseases, history of medication and previous gastrointestinal system bleeding, hemodynamic status, laboratory values, need for transfusion, endoscopic findings, success rate of the treatment method, mean hospital stay, complications, and recurrence of bleeding. Of 588 patients admitted with upper gastrointestinal hemorrhage, Dieulafoy lesion was recognized in 18 cases (3.1%) at initial or second-look endoscopy. All patients were men with a mean age of 62.8 (range, 30-80) years. Band ligation was applied to ten patients and the remaining eight were treated by injection therapy. During the follow-up period, rebleeding occurred in six of the patients (75%) with injection therapy, whereas no rebleeding occurred for the patients in the band ligation group. The rebleeding rate and mean hospital stay was significantly higher for the injection therapy group. Our study suggests that of the endoscopic treatment methods, band ligation is superior to injection therapy for the treatment Dieulafoy lesions.

Management of pain in a surgical emergency unit—Underlying factors affecting its delivery

Pain is an important symptom in emergency departments. The purpose of this study was to evaluate possible obstacles to pain management in a surgical emergency department. All patients arriving in the ED (N = 100) during the time period were asked to participate in an interview. Information about medication, patient history, and documented pain intensity were extracted from patient records. In addition, a questionnaire with six demographic and 31 pain-related items was distributed to 50 physicians and 82 nurses. Pain was the most important symptom of 60.3% (N = 46) of the respondents. Severe pain was reported by 45.8% of the patients. Analgesics were administered to 46.6% of the respondents (N = 34). None of the patients received nonsteroidal anti-inflammatoric analgesics (NSAIDs). Male gender, lower educational level and high age correlated with reluctance to accept analgesics. Experience of pain and the healthcare system correlated with unwillingness to talk about pain. The nurses were more positive towards measurement of pain (p < 0.05) and encouragement (p < 0.001) than the physicians. The physicians were less concerned about problems with analgesics than the nurses (p < 0.01). The patients should be encouraged to talk about their pain. The emergency department personnel needs education about measurement of pain and pain medication.

Workplace Violence Directed at Nursing Staff at a General Hospital in Southern Thailand

This study aimed to document the characteristics of workplace violence directed at nursing staff, an issue which has rarely been studied in a developing country. Two study methods, a survey and a key informant interview, were conducted at a general hospital in southern Thailand. A total of 545 out of 594 questionnaires sent were returned for statistical analysis (response rate=91.7%). The 12-month prevalence of violence experience was 38.9% for verbal abuse, 3.1% for physical abuse, and 0.7% for sexual harassment. Psychological consequences including poor relationships with colleagues and family members were the major concerns. Patients and their relatives were the main perpetrators in verbal and physical abuse while co-workers were the main perpetrators in cases of sexual harassment. Common factors to incidents of violence were psychological setting, illness of the perpetrators, miscommunication, and alcohol use. Logistic regression analysis showed younger age to be a personal risk factor. Working in the out-patient unit, trauma and emergency unit, operating room, or medical or surgical unit increased the odds of violence by 80%. Training related to violence prevention and control was found to be effective and decreased the risk of being a victim of violence by 40%. We recommend providing training to high risk groups as a means of controlling workplace violence directed at nursing staff.

Spontaneous splenic rupture in the postpartum period

A 24-year-old woman, who was 8 weeks postpartum, presented to the surgical emergency unit with sudden onset of severe generalized abdominal pain. Apart from a previous ovarian cyst, there were no other significant past medical problems. She denied any recent abdominal trauma or strain. On examination, the patient had a very tender upper abdomen. Ultrasound scan demonstrated free fluid in both the abdomen and the pelvis. It also showed a large complex focal lesion in the spleen, close to the hilum, measuring 80×76 mm (Figure 1). Conservative management was planned initially, but surgery was performed as the patient developed signs of generalized peritonitis along with severe pain in both shoulders. A diagnostic laparoscopy revealed massive haemoperitoneum and bleeding from the upper pole of the spleen (grade II splenic rupture). Haemostasis could not be achieved, and hence a splenectomy was performed via an upper midline laparotomy. The patient made an uneventful recovery. Appropriate vaccinations were given post splenectomy (Haemophilus influenzae, Neisseria meningitides and pneumococcus). On macroscopic examination, the spleen measured 160×120×75 mm and weighed 342 g (Figure 2). Transverse section revealed a unilocular cyst of 85–90 mm in diameter containing haemorrhagic material. Histological examination revealed that the cyst was an epidermoid cyst and showed the presence of both old and new clots. Further additional history from the patient after splenectomy disclosed an admission to the medical ward 4 weeks after her delivery with left shoulder pain, left-sided chest pain and left-sided neck pain that was worse on movement and with cough. There was no history of trauma or fall. She was stable haemodynamically and all her haematological investigations were normal. She was treated as having musculoskeletal pain, given analgesics and was discharged home on the day of presentation. She had two further episodes of left shoulder pain that were treated similarly at a different hospital.

Successful Coil Embolization of a Ruptured Gastroduodenal Artery Aneurysm

Aneurysms of the gastroduodenal artery are rare. Reported here is the case of a 60-year-old woman suffering from the covered rupturing of a twin aneurysm of the gastroduodenal artery. The patient presented herself in the surgical emergency unit with abdominal discomfort. Diagnostics showed free fluid in the abdominal cavity together with anemia of 9.9 g/dL. A computed tomography scan and an angiography revealed the covered rupturing of a twin aneurysm of the gastroduodenal artery, which was treated by endovascular coiling of the gastroduodenal and pancreaticoduodenal arteries. The patient's hemoglobin level remained stable after treatment, and she was released from the hospital after 18 days. Visceral artery aneurysms are rare. Although endovascular therapy is preferred in cases involving active bleeding, surgery remains the primary therapy in those cases in which bleeding becomes uncontrollable.

Fournier′s gangrene in Mansoura Egypt

Fournier's gangrene (FG), caused by synergistic aerobic and anaerobic organisms, is a life-threatening disorder in which infection of the perineum and scrotum (can affect penis alone) spreads along fascial planes, leading to soft-tissue necrosis. Despite antibiotics and aggressive debridement, the mortality rate of FG remains high. We analyzed 74 patients admitted to our institution's emergency surgical unit presenting with FG between January 2002 and January 2007, considering the anatomical site of infective gangrene, predisposing factors, etiological agents, and outcomes. All the 74 patients included in this study were males; their mean age was 51+/-10.8 years (21-72 years). The mean duration from the onset of symptoms to admission to the hospital was 3.74+/-2.09 days (1-8 days). The mean hospitalization time was 9.2+/- 6.6 days (1-31). Forty patients (54.05%) had FG secondary to anorectal conditions. No etiologic factors for FG were found in 27 patients (36.5%). Diabetes mellitus as a predisposing factor was found in 38 patients (51.35%). There was no definite predisposing factor in 24 patients (32.43%). The microbiological finding was polymicrobial in 48 patients (64.8%) and monomicrobial in 26 patients (35.1%). The most frequent bacterial organisms were Escherichia coli (75.6%). Simple sigmoid loop colostomy was done in one patient (1.4%). Unilateral orchidectomy was done in one case (1.4%). The overall mortality rate was 16 patients (21.6%). FG is a rapidly progressive, fulminant infection. Even with aggressive surgical and medical treatment, mortality of the disease is high. In the present cases, such a high ratio of 21.6% means that this disease is still serious and fatal in Egypt.

Effectivity of Qualitative Urinary Trypsinogen-2 Measurement in the Diagnosis of Acute Pancreatitis: a Randomized, Clinical Study

Background : There is no any definite diagnostic test for acute pancreatitis. In the present study we investigated the value of the qualitative urinary trypsinogen-2 measurement in the diagnosis of acute pancreatitis by an immuno-chromatographic dipstick test.Methods : A prospective, randomized, clinical trial was planned on 99 patients (53 male, 46 female; male/female: 1.11; age range: 16–83; mean age: 37.4). Patients were divided into two groups: 50 cases were referred to our emergency surgical unit due to abdominal pain and diagnosed with acute pancreatitis by abdominal computerized tomography (CT) (Group 1); 49 cases were referred to our emergency surgical unit due to abdominal pain and whose abdominal CTs did not show any sign of acute pancreatitis (Group 2). Qualitative urinary trypsinogen-2 measurement, abdominal CT and blood amylase values were obtained in all cases.Results : In group 1, urinary trypsinogen-2 measurement was found positive in 28 cases out of 50 cases diagnosed with acute pancreatitis (56% sensitivity). In group 2, results were found positive in 3 out of 49 patients with abdominal pain, who lacked an acute pancreatitis diagnosis (90.9% specificity). Severe intra-abdominal inflammation was present in three cases of group 2 where we obtained false positive results which may stimulate the pancreatic exocrine secretion. Conclusion : Qualitative measurements of urinary trypsinogen-2 in patients with abdominal pain may be useful in the diagnosis of acute pancreatitis. It is an easy, inexpensive, rapid and noninvasive method.

Laparoscopic Repair of Penetrating Injury of the Diaphragm: an Experience from a District Hospital

In this study we review our experience in using laparoscopy as a diagnostic and therapeutic tool in dealing with penetrating diaphragmatic injuries due to stab wounds and look at the feasibility of using this procedure in other similar institutions. Thirty patients, all of whom were males 20-30 years of age, presented to the surgical emergency unit of our hospital with upper abdominal and lower chest wall stab wounds between 01-05-1998 and 30-11-2006. Diagnosis of the diaphragm injury was either obvious with omentum herniating through the chest wall, or occult with confirmation of the injury at laparoscopy. All patients underwent diagnostic laparoscopy, which resulted in identification and efficient treatment of eight patients with diaphragmatic injury, and thereby laparotomy was avoided. The procedure converted to open surgery in one patient because of a small left-sided colonic tear. Laparoscopy is an efficient tool for the diagnosis and management of diaphragmatic injuries. It should be used routinely instead of exploratory laparotomy in haemodynamically stable patients with penetrating lower chest injuries.

Laparoscopic Repair of Penetrating Injury of the Diaphragm: An Experience from a District Hospital

In this study we review our experience in using laparoscopy as a diagnostic and therapeutic tool in dealing with penetrating diaphragmatic injuries due to stab wounds and look at the feasibility of using this procedure in other similar institutions. Thirty patients, all of whom were males 20-30 years of age, presented to the surgical emergency unit of our hospital with upper abdominal and lower chest wall stab wounds between 01-05-1998 and 30-11-2006. Diagnosis of the diaphragm injury was either obvious with omentum herniating through the chest wall, or occult with confirmation of the injury at laparoscopy. All patients underwent diagnostic laparoscopy, which resulted in identification and efficient treatment of eight patients with diaphragmatic injury, and thereby laparotomy was avoided. The procedure converted to open surgery in one patient because of a small left-sided colonic tear. Laparoscopy is an efficient tool for the diagnosis and management of diaphragmatic injuries. It should be used routinely instead of exploratory laparotomy in haemodynamically stable patients with penetrating lower chest injuries.

Chronic Leg Ulcer Presenting Through Emergency Surgical Unit

Objective: This study aims at evaluating chronic leg ulcers presenting via the emergency unit in a Nigerian University Teaching Hospital.

Hernias are the most common cause of strangulation in patients presenting with small bowel obstruction

Small bowel obstruction (SBO) is a leading cause of admission to surgical emergency units. Strangulation is associated with a 10-fold increase in mortality. The aim of the present study was to identify the most frequent causes of strangulation in patients presenting with small bowel obstruction. A prospective study was conducted of all patients presenting with SBO in one teaching hospital between 2003 and 2004. One hundred and sixty-one patients with symptoms and signs of small bowel obstruction were admitted. Eighty-three were confirmed with contrast studies. The male:female ratio was 1:1.6. The aetiology of obstruction was adhesions in 97 patients (60.2%), hernia in 29 (18%), malignancy in 17 (10.6%) and miscellaneous causes in 18 (11.2%). Operative procedures were performed on 74 patients (46%), 31 of them (42%) with adhesions, 25 (34%) with hernias and 18 (24%) due to other causes. Strangulated bowel occurred in 15 patients (9.3%); 12 had hernias whilst three had adhesions (P < 0.0001). Of the strangulated hernias, ten were femoral, one was inguinal and one was paraumbilical. There were seven deaths; three occurred in patients declared unfit for surgery, while four occurred post-operatively - two had strangulated bowel, the other two had advanced cancer. Whilst adhesions are the most common cause of small bowel obstruction, hernias remain the most frequent cause of strangulation in patients presenting with this condition.

Audit of venous thromboembolic prophylaxis in emergency general surgical admissions

Objective: The aim was to audit venous thromboembolic disease (VTE) prophylaxis in emergency surgical admissions and, given the reducing number of available surgical beds, to compare protocol violation rates between surgical and outlying wards. Method: Study 1: Prospective data collected on VTE prophylaxis in emergency surgical patients over a two-week period during or after the post-take ward round. Provisional diagnoses were recorded and drug charts were reviewed looking for prescription of standard unfractionated heparin 5000 IU and/or thromboembolic deterrent stockings. Following presentation at the governance meeting, departmental protocols were circulated to the emergency surgical unit and outlying wards that received emergency surgical patients. Study 2: Carried out two months later. Data on VTE prophylaxis collected over a two-week period in emergency surgical admissions in the same manner as study 1. Results: Study 1: A total of 70 patients were studied, 42 of which were women. The median age of the group was 47 years (range 19–90). There were 36 patients (51.2%) who violated VTE prophylaxis protocol. Of the 60 patients admitted to surgical wards, 29 violated VTE protocol (48.3%). Of the 10 patients admitted to outlying wards, seven violated VTE protocol (70%). This difference was not statistically significant. Study 2: A total of 70 patients were studied, 40 of which were women. The median age was 46 years (range 17–101). Eleven patients (15.7%) violated VTE prophylaxis recommendations. This improvement was statistically significant, P&lt;0.0001. Some 56 patients were admitted to general surgical wards; nine violated VTE protocol (16.1%). In the fourteen patients admitted to outlying wards, there were two protocol violations (14.3%). This difference was not statistically significant. Conclusions: VTE is a potentially fatal complication of hospital admission. This audit highlighted that VTE prophylaxis rates in our emergency admissions were unacceptable at 51.2%, but were improved through audit and clinical governance. No significant difference in protocol violation was found between surgical and outlying wards. In the absence of national guidelines, VTE prophylaxis is the responsibility of individual general surgical departments and requires a documented, circulated departmental protocol, education of staff and regular audit to ensure appropriate compliance.

Prognosis of cocaine body-packers

To study the prognosis and complications of cocaine body-packing (concealment of cocaine in the body for transportation between countries). We retrospectively reviewed the files of all cocaine body-packers hospitalized during a 4-year period in a medico-judiciary emergency unit. Subjects included in the survey were identified from the hospital databases using ICD-10 codes. The Medico-Judiciary Emergency Unit of Hôtel-Dieu university hospital in Paris is a unique medical and surgical emergency unit receiving all patients in legal custody arrested at the two Paris international airports and suspected of body-packing. All the cases of cocaine body-packers (n=581) hospitalized between January 1999 and December 2002 were studied. They had been arrested at Paris airports while arriving from drug-producing countries. The mean number of carried packets was 70.0+/-20.4 (range 18-150). The mean duration of hospitalization was 5.0+/-1.6 days (range 1-18). No complication occurred in 573 body-packers cases. Eight subjects developed a complication requiring admission to an intensive care unit: six acute cocaine intoxications due to packet rupture and two intestinal occlusions. No one died. Surgical treatment was necessary in six cases. Good prognosis observed in these body-packers cases is due to the careful monitoring of asymptomatic patients, allowing early detection and treatment of complications. Surgical removal of the packets when complication occurs is warranted.

Causes of acute peritonitis in 1188 consecutive adult patients in Ghana

In a five-year prospective study, 1188 consecutive adult patients were admitted and treated for acute generalized peritonitis at the Surgical Emergency Unit of the Komfo Anokye Teaching Hospital, Kumasi, Ghana. Appendicitis and typhoid ileal perforation were the commonest causes, occurring in 43.1% and 35.1% of patients, respectively. Other conditions (gastroduodenal perforations, ruptured abscesses, traumatic bowel perforations and amoebic colonic perforations) accounted for fewer than 25% of cases.