General Peritonitis Research Articles

MORPHOLOGICAL CHANGES IN THE SMALL INTESTINE OF RATS WITH ACUTE GENERALIZED PERITONITIS

The main cause of mortality in acute generalized peritonitis (AGP) is the development of multiple organ insufficiency. The intestine is the organ where the first changes develop in this pathology.
 The aim of the study – to research and evaluate the morphological changes in the small intestine wall of animals with experimental AGP.
 Materials and Methods. 32 white rats were used in this study. Acute peritonitis was modeled by introduction of 10 % fecal suspension in the dosage of 0.5 ml per 100 g of the animal's weight into the abdominal cavity of rats by puncture. The terms of observation: the 1st, 3rd and the 7th days from the beginning of the peritonitis modeling. For histological study the intestinal tissue was taken. The resulting pieces of the organ were fixed in a 10 % neutral formalin solution, which were then stained with hematoxylin and eosin.
 Results and Discussion. On the 3rd day of the experiment in animals with a modeled AGP, vascular changes were manifested first of all by the rounding (retraction) of endothelial cells or their desquamation and the appearance of defects, that allow plasma proteins and the formed elements of blood to leave circulation boundaries of the vascular bed. On the 7 th day in animals with a modeled AGP increased vascular permeability of the mucous membrane of the small intestine was accompanied by a significant edema of the stroma of the villi and by focal hemorrhages.
 Conclusion. Consequently, the distinct inflammatory changes in all terms of the injury were seen in the wall of the small intestine at the simulated AGP. The significant expansion of the capillaries and venules against the background of inflammatory infiltration in the stroma of the glandular component of the small intestine was noted on the 1st day from the beginning of the experiment. An increase in the height of intestinal villus and a crypt with retraction and desquamation of endothelial cells in the wall of vessels, which caused platelet adhesion in the areas of destruction was observed on the 3rd day. The areas of focal necrosis of the superficial epithelium, which were accompanied by multiple hemorrhages per diapedesis in the perivascular space of the mucous membrane, were seen in the wall of the small intestine of animals with a simulated AGP on the 7th day.

Hartmann's procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or faecal peritonitis (LADIES): a multicentre, parallel-group, randomised, open-label, superiority trial

Previous studies have suggested that sigmoidectomy with primary anastomosis is superior to Hartmann's procedure. The likelihood of stoma reversal after primary anastomosis has been reported to be higher and reversal seems to be associated with lower morbidity and mortality. Although promising, results from these previous studies remain uncertain because of potential selection bias. Therefore, this study aimed to assess outcomes after Hartmann's procedure versus sigmoidectomy with primary anastomosis, with or without defunctioning ileostomy, for perforated diverticulitis with purulent or faecal peritonitis (Hinchey III or IV disease) in a randomised trial. A multicentre, randomised, open-label, superiority trial was done in eight academic hospitals and 34 teaching hospitals in Belgium, Italy, and the Netherlands. Patients aged between 18 and 85 years who presented with clinical signs of general peritonitis and suspected perforated diverticulitis were eligible for inclusion if plain abdominal radiography or CT scan showed diffuse free air or fluid. Patients with Hinchey I or II diverticulitis were not eligible for inclusion. Patients were allocated (1:1) to Hartmann's procedure or sigmoidectomy with primary anastomosis, with or without defunctioning ileostomy. Patients were enrolled by the surgeon or surgical resident involved, and secure online randomisation software was used in the operating room or by the trial coordinator on the phone. Random and concealed block sizes of two, four, or six were used, and randomisation was stratified by age (<60 and ≥60 years). The primary endpoint was 12-month stoma-free survival. Patients were analysed according to a modified intention-to-treat principle. The trial is registered with the Netherlands Trial Register, number NTR2037, and ClinicalTrials.gov, number NCT01317485. Between July 1, 2010, and Feb 22, 2013, and June 9, 2013, and trial termination on June 3, 2016, 133 patients (93 with Hinchey III disease and 40 with Hinchey IV disease) were randomly assigned to Hartmann's procedure (68 patients) or primary anastomosis (65 patients). Two patients in the Hartmann's group were excluded, as was one in the primary anastomosis group; the modified intention-to-treat population therefore consisted of 66 patients in the Hartmann's procedure group (46 with Hinchey III disease, 20 with Hinchey IV disease) and 64 in the primary anastomosis group (46 with Hinchey III disease, 18 with Hinchey IV disease). In 17 (27%) of 64 patients assigned to primary anastomosis, no stoma was constructed. 12-month stoma-free survival was significantly better for patients undergoing primary anastomosis compared with Hartmann's procedure (94·6% [95% CI 88·7-100] vs 71·7% [95% CI 60·1-83·3], hazard ratio 2·79 [95% CI 1·86-4·18]; log-rank p<0·0001). There were no significant differences in short-term morbidity and mortality after the index procedure for Hartmann's procedure compared with primary anastomosis (morbidity: 29 [44%] of 66 patients vs 25 [39%] of 64, p=0·60; mortality: two [3%] vs four [6%], p=0·44). In haemodynamically stable, immunocompetent patients younger than 85 years, primary anastomosis is preferable to Hartmann's procedure as a treatment for perforated diverticulitis (Hinchey III or Hinchey IV disease). Netherlands Organisation for Health Research and Development.

STATUS OF THE HUMORAL LINK OF IMMUNITY AT EXPERIMENTAL PERITONITIS ON THE BACKGROUND OF DIABETES MELLITUS

Introduction. The combined course of acute peritonitis and diabetes increasingly leads to the development of secondary immunodeficiencies, which contribute to an increase in the percentage of postoperative complications and fatalities, the emergence of complexity of treatment and diagnosis.&#x0D; The aim of the study – to learn the peculiarities of humoral link of the immune response in the organism of experimental animals during simulated acute common peritonitis on the background of diabetes mellitus compared with animals with experimental acute peritonitis alone.&#x0D; Reserch Methods. 56 white rats were used in this work. Diabetes mellitus was modeled by intraperitoneal administration of Srethosotocin from “Sigma” firm with the rate of 7 mg per 100 g of animal mass, acute peritonitis – insertion of 0.5 ml of 10 % of the captured fecal suspension into the abdominal cavity of the animals. The concentration of immunoglobulins in serum was determined. Observation time points: 1, 3, and 7 days from the beginning of the peritonitis modeling.&#x0D; Results and Discussion. Analyzing the results of studies, it can be stated that there were observed directed changes in the concentration of immunoglobulins in blood serum of rats of different groups. Thus, on the first day after simulating acute common peritonitis on the background of diabetes, the level of Ig G decreased by 1.5 times, Ig M – by 1.3 times and Ig A – by 1.4 times (p&lt;0.05). On the seventh day of the experiment, levels of all classes of immunoglobulins were statistically significantly lower than those of the group with acute common peritonitis: Ig G level was lower by 21 %, Ig M and Ig A were lower by 17 % and 56 % respectively (p&lt;0.05). The results of our studies indicate that the presence of diabetes in acute general peritonitis leads to a decrease in the resistance of the humoral level of the immune system with antigenic stimulation and secondary immunodeficiency states.&#x0D; Conclusion. In animals with acute peritonitis, protective mechanisms of the humoral immunity level are substantially reduced on the background of diabetes, which is confirmed by statistically significantly lower levels of immunoglobulins of classes A, M, G compared to a group of animals with a pattern of acute peritonitis. The revealed functional impairment of humoral immunity indicates an appreciable weakening of the organism's protection factors in acute peritonitis on the background of diabetes mellitus with the development of secondary immunodeficiency.

Clinical, laboratory and ultrasonographic findings in 87 cows with type-4 abomasal ulcer

BackgroundThis study evaluated the clinical, laboratory, ultrasonographic and pathological findings in 87 cows aged 2 to 10 years (4.5 ± 1.5 years) with type-4 abomasal ulcer.ResultsThe most common clinical findings were in decreasing order compromised health status accompanied by partial or complete anorexia (100%), abdominal guarding (81%), congested scleral vessels (77%), ruminal atony (73%), tachycardia (68%), tachypnoea (65%), positive foreign body tests (58%), decreased skin surface temperature (53%), fever (49%), reduction in negative intraabdominal pressure assessed transrectally (39%), poorly subdivided plant fragments in faeces (35%) and arched back (28%). The principal haematological abnormalities were hypokalaemia (72%), haemoconcentration (69%), azotaemia (56%), metabolic acidosis (49%), hyperfibrinogenaemia (45%), leukopenia (35%) and hypoproteinaemia (29%). Other abnormalities were aciduria (56%), haematuria (44%), increased chloride concentration in rumen fluid (34%) and abnormal peritoneal fluid (98%). Of 75 examined cows, 65 (87%) had ultrasonographic evidence of local or generalised peritonitis. On postmortem examination all cows had a type-4 abomasal ulcer and generalised peritonitis. In addition, 36 cows had type-1 ulcers, 6 had type-2 ulcers and one cow had a type-3 ulcer.DiscussionThe clinical signs in cows with type-4 abomasal ulcer are associated with generalised peritonitis. An increased haematocrit, indicating shock-induced haemoconcentration is characteristic in contrast to cows with traumatic reticuloperitonitis. Ultrasonography is useful for visualising and assessing generalised peritonitis.ConclusionsThe diagnosis of type-4 abomasal ulcer based on clinical signs alone is difficult and therefore requires additional diagnostic procedures including the determination of the haematocrit and plasma protein concentration, abdominal ultrasonography and analysis of peritoneal fluid. In most cases, these steps lead to a correct diagnosis and allow timely euthanasia of the cow to prevent further suffering and unnecessary treatment costs.MethodsThe cows underwent a clinical, laboratory, ultrasonographic and postmortem examination.

Application of APACHE II Score in assessing the severity and outcome in peritonitis due to hollow viscus perforation

Background: Acute generalized peritonitis from Gastrointestinal hollow viscus perforation is a potentially life threatening condition. The aim of the study was to assess the application of APACHE II score in assessing the severity and outcome in peritonitis due to hollow viscus perforation and to correlate morbidity and mortality patterns using the modified APACHE II Score and its significance on the outcome.Methods: A prospective survey of 50 patients with acute generalized peritonitis due to hollow viscus perforation was carried out in general surgical wards, CAIMS, Karimnagar. APACHE-II scores were assigned to all patients in order to calculate their individual risk of mortality before undergoing emergency surgery.Results: Total 50 patients were admitted during the study period. Age and sex distribution shows that perforation was common &gt;60 years in our study. Higher modified APACHE II scores statistically influenced mortality in all the patients irrespective of aetiology with p&lt;0.001 which is statistically significant.Conclusions: Modified APACHE II scoring predicts mortality which was significant irrespective of the aetiology.

Acute Genital Peritonitis in Brazzaville, Congo

Genital peritonitis is rare in daily surgical practice in Congo-Brazzaville. Clandestine abortions are incriminated. The purpose of the study is to analyze the epidemiological, etiological, diagnostic and therapeutic aspects of genital peritonitis. A retrospective and case series study was realized in departments of Digestive Surgery and Gynecology-Obstetrics of the University Hospital of Brazzaville. The inclusion criteria for the diagnosis of peritonitis were abdominal pain, fever, transit disturbances and signs of peritoneal irritation. The parameters studied were: age, etiological circumstances, anatomical lesions, type of surgical treatment and evolution. During the study period (July 1, 2015-December 31, 2017), 306 patients were admitted to both departments for acute generalized peritonitis. Among them, a genital cause was incriminated in 18 (5.9%) patients. The mean age was 27.6 ± 3.1 years. At the parity and gestational level, 93% of patients had at least two pregnancies, but not more than the second trimester. In addition, 50% of the patients had an induced miscarriage, due to uterine and intestinal lesions. Induced miscarriages accounted for half of etiological circumstances. Physical examination of the abdomen revealed abdominal contracture in 61.1% of cases. Main visceral lesions were uterine perforation (55.5%) followed by rupture of tubo-ovarian abscess (38.9%). The operative follow-up was simple in 83.33% of cases. In conclusion, genital peritonitis remains unfrequented. Median laparotomy has been the main therapeutic approach in our context where emergency laparoscopic surgery is not yet common.

A clinical study of generalised peritonitis and its management in a rural setup

Background: Generalised Peritonitis is a common surgical emergency and its treatment remains a challenge despite advances in surgical techniques, antimicrobial therapy and intensive care support. The commonest etiological factors are perforation of hollow viscus and appendicitis. The aim was to study the most common cause of perforation peritonitis, associated risk factors, modes of clinical presentation, management, postoperative complications, and comorbid conditions influencing the morbidity and mortality in rural set up.Methods: 50 patients of peritonitis of over 10 years of age managed in our institution from July 2015 to November 2016 were studied and followed up on a three-monthly basis for a period varying from 12 months to 2 years with an average of 18 months.Results: Appendicular perforation was the most common cause of peritonitis followed by peptic ulcer perforation. Perforation peritonitis constituted 26% of total emergency operations performed with a male to female ratio of 2.84:1 and age between 41-50 years. Patients presenting within 24 hours of perforation had an uneventful recovery whereas those presenting after 24 hours had significant postoperative complications. The serum CRP levels provided as good prognostic marker. It remained high in complicated cases. Out of 56% complication rate, wound infection was the commonest.Conclusions: Early diagnosis and surgical intervention plays a crucial role in early recovery, though the end result depends on many factors like age of the patient, degree of peritoneal contamination and presence of comorbid diseases. This study also highlights the role of CRP as a serum prognostic marker.

Clinical Evaluation of the Method of Active Abdominal Drainage in General Peritonitis Rancid

Acute general putrid peritonitis refers to the severe inflammation of the peritoneum. He is constantly accompanied by jendotoksicheskim shock and progressive multiple organ failure. Macro and micro blood circulation in tissues and organs of the abdominal cavity Portal vein system is blocked from the first minutes the development of pathological process and toxins and nedookislennye metabolic products accumulate in them. For their removal requires efferent methods of treatment, one of which suggests the author of this article. Technical and physical techniques against a backdrop of complex drug therapy perpetrated as cleansing and forcible blood vessels promotion portal system. In this way manage to restore homeostasis. For developing this method, he was extradited to USSR patent (No. 1787036, dated March 7, 1991). To confirm the effectiveness of the proposed method of treatment, the author describes the clinical observations.&#x0D;

Sex Disparities in Access to Surgical Care at a Single Institution in Malawi.

There is a paucity of data regarding sex-based disparities in surgical care delivery, particularly in low- and middle-income countries. This study sought to determine whether sex disparities are present among patients presenting with surgical conditions in Malawi. Hypothesis compared to men, fewer women present to Kamuzu Central Hospital (KCH) with peritonitis and have longer delays in presentation for definitive care. This study performs a retrospective analysis of prospectively collected data of all general surgery patients with peritonitis presenting to KCH in Lilongwe, Malawi, from September 2013 to April 2016. Multivariable linear and logistic regressions were used to assess the effect of sex on mortality, length of stay, operative intervention, complications, and time to presentation. Of 462 patients presenting with general surgery conditions and peritonitis, 68.8% were men and 31.2% were women. After adjustments, women had significantly higher odds of non-operative management when compared to men (OR 2.17, 95%CI 1.30-3.62, P = 0.003), delays in presentation (adjusted mean difference 136h, 95%CI 100-641, P = 0.05), delays to operation (adjusted mean difference 1.91days, 95%CI 1.12-3.27, P = 0.02), and longer lengths of stay (adjusted mean difference 1.67days, 95%CI 1.00-2.80, P = 0.05). There were no differences in complications or in-hospital or Emergency Department mortality. Sex disparities exist within the general surgery population at KCH in Lilongwe, Malawi. Fewer women present with surgical problems, and women experience delays in presentation, longer lengths of stay, and undergo fewer operations. Future studies to determine mortality in the community and driving factors of sex disparities will provide more insight.

A Rare Colonization in Peritoneum After Blunt Abdominal Trauma: S. putrefaciens and S. cerevisiae

Background: Shewanella spp. are gram-negative bacteria, saprophytes, and rarely pathogenic. Saccharomyces cerevisiae is the well-known yeast used for fermentation in industry and molecular biology for research. In humans, it is a very rare pathogen which colonizes the digestive tract, and its utility has been linked to the treatment and prevention of diarrhea associated with Clostridium difficile.Case Report:A 27-year-old male, victim of aggressive, blunt trauma with a 4-day history of symptoms was admitted to our surgery unit. Abdominal sonography revealed peritoneal fluid in all spaces with fibrin. We performed laparotomy and observed perforations on the ileum and general peritonitis with pus. Following surgery, patient was admitted to the intensive care unit with septic shock. The antibiogram from the peritoneal liquid revealed S. putrefaciens and S. cerevisiae.Conclusion:Although very rare, S. putrefaciens and S. cerevisiae may colonize in the peritoneum after blunt abdominal trauma.

SYNDROME DE ROSAÏ-DORFMAN REVELE PAR UNE APPENDICITE AIGUE : A PROPOS D’UNE OBSERVATION

Rosaï Dorfman (RD) syndrome is form of non Langerhans cell sinus histiocytosis. The main symptoms are cervical adenopathy, fever and fluctuating hepatosplenomegaly.It is a rare pathology described in 1969 by Rosa and Dorfman. The isolate intraabdominal localization remains exceptional. It can be confused with ganglionary tuberculosis especially in our region where tuberculosis is common. On the other hand, thinking about it in front of a surgical abdomen table is not obvious. It would be a possible incidental discovery to the histology of the operative parts and the mesenteric lymph nodes. We report an observation in an 11-year-old boy who presented peritoneal irritation syndrome with pain beginning in the right iliac fossa in a febrile context. The peripheral ganglionic areas were free. This clinical picture led to suspected acute generalized peritonitis of appendicular origin. Biology had recovered microcytic hypochromic anemia. Radiography of the abdomen without preparation (ASP) showed a diffuse grayness and chest x-ray was normal. Emergency laparotomy after transfusion and brief resuscitation resulted in serous peritoneal effusion, inflammatory appendix, hepato-splenomegaly, and mesenteric polyadenopathy (suggestive of mesenteric adenolymphitis). The histological study of the appendix and the lymph nodes taken revealed a syndrome Rosa Dorfman Destombes (RDD). The sequences were favorable after bi-antibiotic therapy without corticosteroid therapy. Keywords : Destombes Rosaï Dorfman syndrome, mesenteric adenolymphitis, appendicectomy

Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis.

Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer from postoperative complications. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial.This is an update of the review first published in 2015. To assess the safety and efficacy of abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 6), Ovid MEDLINE (1946 to 30 June 2017), Ovid Embase (1974 to 30 June 2017), Science Citation Index Expanded (1900 to 30 June 2017), World Health Organization International Clinical Trials Registry Platform (30 June 2017), ClinicalTrials.gov (30 June 2017) and Chinese Biomedical Literature Database (CBM) (1978 to 30 June 2017). We included all randomised controlled trials (RCTs) that compared abdominal drainage and no drainage in people undergoing emergency open appendectomy for complicated appendicitis. Two review authors identified the trials for inclusion, collected the data, and assessed the risk of bias independently. We performed the meta-analyses using Review Manager 5. We calculated the risk ratio (RR) for dichotomous outcomes (or a Peto odds ratio for very rare outcomes), and the mean difference (MD) for continuous outcomes with 95% confidence intervals (CI). We used GRADE to rate the quality of evidence. We included six RCTs (521 participants), comparing abdominal drainage and no drainage in patients undergoing emergency open appendectomy for complicated appendicitis. The studies were conducted in North America, Asia and Africa. The majority of the participants had perforated appendicitis with local or general peritonitis. All participants received antibiotic regimens after open appendectomy. None of the trials was at low risk of bias.There was insufficient evidence to determine the effects of abdominal drainage and no drainage on intra-peritoneal abscess at 14 days (RR 1.23, 95% CI 0.47 to 3.21; 5 RCTs; 453 participants; very low-quality evidence) or for wound infection at 14 days (RR 2.01, 95% CI 0.88 to 4.56; 5 RCTs; 478 participants; very low-quality evidence). The increased risk of 30-day overall complication rate (morbidity) in the drainage group was rated as very low-quality evidence (RR 6.67, 95% CI 2.13 to 20.87; 1 RCT; 90 participants). There were seven deaths in the drainage group (N = 183) compared to one in the no drainage group (N = 180), equating to an increase in the risk of 30-day mortality from 0.6% to 2.7% (Peto odds ratio (OR) 4.88, 95% CI 1.18 to 20.09; 4 RCTs; 363 participants; moderate-quality evidence). There is 'very low-quality' evidence that drainage increases hospital stay compared to the no drainage group by 2.17 days (95% CI 1.76 to 2.58; 3 RCTs; 298 participants).Other outlined outcomes, hospital costs, pain, and quality of life, were not reported in any of the included studies. The quality of the current evidence is very low. The effect of abdominal drainage on the prevention of intra-peritoneal abscess or wound infection after open appendectomy is uncertain for patients with complicated appendicitis. The increased rates for overall complication rate and hospital stay for the drainage group compared to no drainage group is also subject to great uncertainty. Thus, there is no evidence for any clinical improvement by using abdominal drainage in patients undergoing open appendectomy for complicated appendicitis. The increased risk of mortality with drainage comes from eight deaths observed in just under 400 people recruited to the studies. Larger studies are needed to determine the effects of drainage on morbidity and mortality outcomes more reliably.

A prospective study of Mannheim peritonitis index as a prognostic scale in analysis of outcome in hollow viscus perforation

Background: MPI as a prognostic index helps in analysis of prognosis in peritonitis in hollow viscus perforation. The factors that are considered in MPI index are routinely used in assessment of surgical patients, they are easily available, routinely performed, and helps in arrival at a prognosis in fast and effective way.Methods: A prospective survey of patients with acute generalized peritonitis due to hollow viscus perforation was carried out in general surgical wards of our institute during the period starting from January 2014 to December 2015. Study population consisted of 150 consecutive patients with performative peritonitis, which confirmed on emergency laparotomy.Results: The Mannheim peritonitis index emerged as a reliable marker for assessing the severity and prognosis of intra-abdominal infection with sensitivity and specificity comparable to APACHE II score which has been adopted as the gold standard by Surgical Infection Society. The score designed specifically for peritonitis, combines preoperative and operative data and is easy to apply. MPI scores were consistent with low scores among survivors and higher scores among non-survivors.Conclusions: MPI scores in the analysis were sharp predictor of mortality.

Anastomotic leakage after rectal cancer surgery: classification and management

Many studies have focused on the identification of risk factors and prevention of anastomotic leakage following rectal cancer surgery. However, there is little knowledge regarding classification and management of anastomotic leakage in clinic. Herein, we reviewed and summarized the classification and management of anastomotic leakage after rectal cancer surgery. The relevant treatments of anastomotic leakage should be chosen based on patient's manifestation, including general and local reactions, anatomical location, and nature of the leakage (contained or free, controlled or uncontrolled leakage). 1) Surgery is imperative for anastomotic leakage with acute general peritonitis and sepsis. 2) Circumscribed peritonitis and the pelvic abscess can be managed conservatively with complete drainage. During the conservative management, diverting stoma, minimally invasive techniques of seal or repair should be implemented at an appropriate time, if necessary. 3) Subclinical leakage seldom requires surgical intervention promptly. 4) For persistent anastomotic leakage after diverting stoma, we should consider whether chronic presacral abscess, epithelialized sinus, fistula or local recurrence of cancer is present. With regard to definitive salvage surgery, reconstruction of the coloanal anastomosis or permanent stoma is usually required under these circumstances. 5)Complicated fistula often necessitates surgical repair with advancement tissue flap or tissue interposition under the condition of diversion. Reconstructing the coloanal anastomosis is the alternative management, whereas other treatments are invalid, including ultra-low anterior resection, intersphincteric resection, proctectomy with colon pull-through, and primary or staged coloanal anastomosis. 6) During the surgical repair of recto-vaginal fistula and recto-urinary fistula, colorectal surgeons may require the cooperation of gynecologists, urologists, and orthopedists. 7) For anastomotic leakage with local recurrence of cancer after conservative management, diverting stoma should be performed promptly to facilitate the subsequent chemoradiotherapy. Surgeons should pay more attention to systemic knowledge and understanding of the classification and management of anastomotic leakage following rectal cancer surgery. Accordingly, we can follow the principles of management, individualize the treatments, apply the concepts of damage control and minimally invasive surgery, and enhance the recovery of anastomotic leakage. Prevention remains more important than remedies. To prevent the occurrence of permanent injuries, not only early diagnoses and treatments should be performed, but also the timing of cancer treatments is warranted for anastomotic leakage.

Epidemiological, Etiological, Therapeutic and Evolutionary Aspects of Acute Surgical Abdomens Operated at the University Hospital of Bobo-Dioulasso

Surgical acute abdomens represent a significant proportion of surgical emergencies in terms of frequency, morbidity and mortality. The aim of our study was to describe the epidemiological, diagnostic, therapeutic and evolutionary aspects of acute surgical abdomens operated in the surgical emergency department of the Centre Hospitalier Universitaire Souro Sanou (CHUSS). This was a retrospective descriptive study of 426 cases of surgical acute abdomens operated in the CHUSS surgical emergency department from 1 January to 31 December 2015. These 426 cases accounted for 24.14% of the emergency interventions carried out in the CHUSS surgical emergency department. These were 314 (73.7%) men and 112 (26.3%) women with an average age of 30 years. Among the causes, there were 187 (43.9%) cases of acute generalized peritonitis, 71 (16.7%) cases of acute intestinal occlusions, 49 (11.5%) cases of acute appendicitis, 38 (9.4%) cases of strangulated parietal hernias, 16 (3.8%) cases of abdominal contusions, and 15 (3.5%) cases of penetrating wounds of the abdomen. The appendectomy was the most performed gesture with 112 (26.3%) cases. The time to surgery was greater than 48 hours in 29 (6.8%) cases. Complications were observed in 68 (16%) cases with 35 (8.2%) cases of parietal infections, 18 (4.2%) cases of postoperative peritonitis. The death occurred in 37 (8.7%) patients. The average hospital stay was 8.7 days. Improving the prognosis of acute surgical abdomens requires early diagnosis and treatment, as well as better postoperative follow-up.

Prise En Charge Des Péritonites Aiguës Dans Un Hôpital De District En Afrique Sub-saharienne : Cas Du Bénin

Introduction: Peritonitis remains a public health problem in Africa. We aim to describe the epidemiological, etiological and therapeutic aspects of acute peritonitis in a district hospital in Sub Saharan Africa. Methods: This was a descriptive study with prospective data collection over a period of 15 months from May 1 st 2015 to July 31st 2016 in Bembereke district hospital. It has taken into account all the patients managed in the general surgery department for acute generalized peritonitis that has been confirmed at laparotomy. Results: Fifty-three patients, 38 men (71.7 %) and 15 women (28.3 %) had been registered. The average age of the patients was 19.8 ± 16.9 years. The main etiologies were: non-traumatic ileal perforation from typhoid infection 52.8%; perforated gastric or duodenal ulcer 17%; complicated appendicitis and abdominal traumas 11.3% each one. Twenty nine patients (54.7%) have been operated by a surgeon and the 24 remaining (45.3%) by a general practitioner with surgical skills. Twenty one patients (39.6%) had postoperative complications of which 11 cases of parietal suppurations (52.4%). The mortality rate was 11.3%. The mean hospital stay was 22.5 ± 4 days. Conclusion: In northern-Benin, peritonitis remains dominated by the complications of typhoid fever. The mortality rate remains high. Prevention requires good hygiene and awareness of early consultations.

Results after surgical management of ileal perforation due to typhoid fever, about 29 cases in Ouahigouya (Burkina Faso)

The aim of this study was to determine the results of management of typhoid perforations. This was a descriptive cross-sectional study carried out from January 1, 2016 to December 31, 2016 in the General Surgery Department of the Regional Teaching Hospital Center of Ouahigouya (Burkina Faso). It involved 29 operated patients, in whom the diagnosis of typhoid perforation was confirmed at laparotomy: age, sex, admission time, clinical, therapeutic and prognostic aspects were analyzed. Typhoid perforations accounted for 20% of acute generalized peritonitis and 38.1% of digestive perforations. Twenty-three patients were males and six were females (sex-ratio: 3.8). The average age of patients was 19 years. The mean diagnostic time was 9.8 days. The excision-suture of the perforation was the most used technique with 62% of the cases. The treatment lead to complications in 10 cases with a morbidity of 34.5%. Four deaths were recorded, representing an overall mortality of 13.8%. Prognostic factors were diagnostic delay, age, number of perforations and resection-anastomosis.

Etiological, clinical, and therapeutic aspects of acute generalized peritonitis in N'Djamena, Chad.

Our aim was to define the epidemiological profile of acute generalized peritonitis in N'Djamena, Chad. This retrospective study, conducted in the general surgery department of the National Reference General Hospital, examined the files of 492 patients who underwent surgery for acute generalized peritonitis from June 2007 to December 2012. Epidemiological, clinical, paraclinical, and therapeutic characteristics were described. Acute generalized peritonitis accounted for 35.2% of all visceral surgical emergencies. Male patients were at highest risk (sex-ratio 6.5). The patients' mean age was 25.8 years (range 1 to 70 years). All patients had abdominal pain. The leading cause was traumatic visceral perforation by stabbing or a firearm in 226 cases (46%), followed by diffuse appendiceal peritonitis. Primary peritonitis was rare. The principal procedure was surgical excision and suture. The mean time to consultation was 3 days and the mean hospital stay 8.5 days. The morbidity rate was 16.8%, dominated by wound infection. The mortality rate was 6.8%. Abdominal trauma is the major cause of acute generalized peritonitis in N'Djamena. Prognosis depends on time to surgical management.

Spontaneous cecal perforation in a 40-year-old pregnant woman treated by primary repair and omental patch: a case report

BackgroundSpontaneous colonic perforations are scarce, and cecal perforations even more so. Preoperative diagnosis of the latter in a pregnant woman is particularly difficult because of physiologic changes and restrictions on some diagnostic imaging techniques, such as X-rays. Furthermore, management of these patients is a big challenge.Case presentationWe present a case of a spontaneous cecal perforation in a 40-year-old pregnant black woman in the Regional Hospital of Bafoussam in Cameroon. The results of clinical examination and ultrasonography on admission were in line with acute generalized peritonitis in a woman at 20 weeks of a viable pregnancy, indicating an urgent laparotomy. Operative findings were a 1 × 1-cm perforation on a distended cecum with minimal fecal contamination. The treatment consisted of excision of the edges, primary suture of the perforation, and omentoplasty. The recovery of the patient was uneventful.ConclusionsThe management of spontaneous cecal perforation in a pregnant woman was a big challenge. The perforation was repaired by primary suture and omentoplasty. Further studies comparing this approach with right hemicolectomy are recommended.

Outpatient Appendectomy in an Emergency Outpatient Surgery Unit 24h a Day: An Intention-to-Treat Analysis of 194 Patients.

To evaluate the feasibility and outcomes of patients operated on for uncomplicated acute appendicitis (UAA) in our 24-h emergency outpatient surgery unit. This was a prospective observational study with intention-to-treat (ITT) analysis. From 12/2013 to 03/2015, all consecutive patients admitted for acute appendicitis (AA) were prospectively screened. A computed tomography or abdominal ultrasound confirmed the diagnosis of AA. Eligibility criteria for outpatient appendectomy were: UAA, no comorbidity, no physical or mental condition preventing participation in the study, absence of pregnancy, age older than 15years, an accompanying adult person available for the hospital discharge and place of residence within 1h of our hospital. In the case of intraoperative complication (abscess, local or general peritonitis) or complication of general anesthesia, patients were excluded from the outpatient pathway. The primary endpoint was the feasibility of outpatient appendectomy among all consecutive patients admitted for UAA. Of the 194 screened patients, 150 (77%) presented an UAA and 102 (68%) were eligible for an outpatient procedure. Thirteen eligible patients (13%) were excluded from the outpatient circuit (7 intraoperative and 6 postoperative contraindications). Outpatient appendectomy was performed in 89 patients, representing 59% (89/150) of the ITT population and 87% (89/102) of the eligible patients. The median length of hospital stay was 13h. Postoperative complications were observed in six patients (6%). This study reports a safe and feasible management of UAA. Our organization allows a short hospitalization for postoperative recovery without using conventional surgery beds and enables discharge throughout the night.