Surgery
Mirko Barone; Massimo Ippoliti; Felice Mucilli
Articles in Press, Accepted Manuscript, Available Online from 13 April 2024
Abstract
Intra-abdominal infections still represent a challengefor surgeons. The systemic physiopathological effects ofinfection rapidly progress, leading to sepsis and multiorganfailure, whose prognosis is often dramatic. Mortality riskstratification using scoring systems would unequivocallyaid the early identification ...
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Intra-abdominal infections still represent a challengefor surgeons. The systemic physiopathological effects ofinfection rapidly progress, leading to sepsis and multiorganfailure, whose prognosis is often dramatic. Mortality riskstratification using scoring systems would unequivocallyaid the early identification of patients at risk of diseaseprogression.
Emergency medicine
Aloysius Ugwu-Olisa Ogbuanya; Nonyelum Benedett Ugwu
Volume 7, Issue 2 , July 2021, , Pages 111-117
Abstract
Objective: Recently, emergency and essential surgical and anesthesia care at district hospitals is increasingly gaining recognition as a critical, though neglected element of health care system in Africa and other developing nations. Emergency laparotomy is a versatile procedure that can cure a great ...
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Objective: Recently, emergency and essential surgical and anesthesia care at district hospitals is increasingly gaining recognition as a critical, though neglected element of health care system in Africa and other developing nations. Emergency laparotomy is a versatile procedure that can cure a great deal of acute abdominal conditions. The aim of this study was to document the indications and outcomes of laparotomy for emergency abdominal surgical conditions in our district hospitals.Methods: This retrospective study was undertaken in district hospitals from January 2009 to December 2018. Associations between different variables were measured and compared using statistical tests of significance.Results: Of the 879 patients evaluated, appendicitis (n=361, 41.1%) was the most frequent indication for emergency laparotomy followed by complicated external hernias (n=120, 13.7%). Other indications were adhesive intestinal obstruction (n=111, 12.6%), typhoid perforation (n=98, 11.1%), perforated peptic ulcer (n=89, 10.1%), trauma (n=58, 6.6%), colorectal cancer (CRC) (n=18, 2.0%) and others (n=24, 2.8%). The vast majority of patients (n=726, 82.6%) were presented after 24 hours of the onset of disease. Approximately, one-third of patients (n=278, 31.6%) had comorbidities, 867 (98.6%) had high ASA scores (III and IV) and 105 (11.9%) received intestinal resection with or without stoma. The main independent predictors of mortality were late presentation (P=0.003), generalized peritonitis (P=0.001), bowel resection (P=0.000) and high ASA (III and IV) scores (P=0.000). Overall, the mortality rate was 10.6%. The commonest complication was wound infection (39.7%), followed by intra-abdominal collection (10.0%).Conclusion: The most common indication for emergency laparotomy was appendicitis followed by complicated hernias. The major independent predictors of mortality included bowel resection, high ASA score, late presentation and generalized peritonitis.