Etiology, treatment outcome and prognostic factors among patients with secondary peritonitis at Bugando Medical Centre,
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WORLD JOURNAL OF EMERGENCY SURGERY
RESEARCH ARTICLE
Open Access
Etiology, treatment outcome and prognostic factors among patients with secondary peritonitis at Bugando Medical Centre, Mwanza, Tanzania Amri Mabewa1,2, Jeremiah Seni3*, Phillipo L. Chalya1,2, Stephen E. Mshana3 and Japhet M. Gilyoma1,2
Abstract Introduction: Secondary peritonitis due to perforation of the gastrointestinal tract is one of the most common surgical emergencies all over the world and is associated with significantly morbidity and mortality. Previous studies conducted at Bugando Medical Centre (BMC) were retrospective and each was focused on single etiology; therefore there was an obvious need to evaluate the etiologies, treatment outcome and their prognostic factors altogether. Methods: This was a descriptive cross-sectional study involving patients with secondary peritonitis admitted at BMC from May 2014 to April 2015. Sociodemographic and clinical characteristics among consented patients were collected using questionnaires. Peritoneal aspirate, biopsy and blood were collected perioperatively and processed using standard operating procedures. Analysis was done using STATA version 11 software. Results: The study enrolled 97 patients with the female to male ratio of 1:1.8 and approximately 41.2 % (40/97) were in their third and fourth decades of life. Only 3 (3.09 %) patients arrived to the hospital within 24 hours of onset of illness, 26 (26.80 %) patients presented with shock and HIV seropositivity among all patients was 13.40 % (13/97). The common etiologies of secondary peritonitis were perforated appendicitis 23 (23.71 %), peptic ulcer disease 18 (18.56 %), ischemia 18 (18.56 %) and typhoidal perforation 15 (15.46 %). Of the 97 patients, 35 (36.08 %) had complications and 15 (15.46 %) died. Presence of premorbid illness and post-operative complication were found to be associated with death (p values = 0.004 and 90 mmHg
71 (73.20)
Below 100 bpm
30 (30.93)
Above 100 bpm
67 (69.07)
Below 30 brpm
87 (89.69)
Above 30 brpm
10 (10.31)
Below 36 °C
2 (2.06)
36-38 °C
39 (40.21)
Above 38 °C
56 (57.73)
Yes
27 (27.84)
No
70 (72.16)
a
HIV (12); Puerperal sepsis (4); Severe anemia (4); Hypertension (4); Tumor (1); Heart failure (1); Renal failure (1) and HIV & Hypertension (1)
Table 2 The investigation findings of patients with secondary peritonitis at BMC Investigations
Number (%) or (IQR)
Hemoglobin
9.2 (7.3-11) g/dl
Widal test
HIV
CD4
14 (19.72) 57 (80.28)
Reactive
13 (13.40)
Non reactive
84 (86.6)
a
X ray
Ultrasound
a
Suggestive Not suggestive
250 (150–330) Normal
51 (52.58)
Abnormal
46 (47.42)
Fluid seen
32 (32.99)
No fluid
3 (3.09)
Not done
62 (63.92)
Only HIV positive patients were included
Mabewa et al. World Journal of Emergency Surgery (2015) 10:47
Page 4 of 7
appendectomy in 21 (21.65 %), Grahams omental patch in 18 (18.56 %) patients and perforation were repaired in 16 (16.49 %). The median time for operation (IQR) was 2 (1.5-2) hours, with the shortest time being 45 minutes and lo
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