Emergency medicine
Shyam lal; Vinod Kumar Singh; Suhas Agarwal
Volume 8, Issue 1 , January 2022, , Pages 49-54
Abstract
Objective: Perforation peritonitis is a common surgical emergency which is treated bysurgery and antibiotics. Candida isolation in peritoneal fluid and antifungal treatment isnot a norm. The aim of this study was to determine the incidence of Candida in peritonealfluid and its role in the outcome of ...
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Objective: Perforation peritonitis is a common surgical emergency which is treated bysurgery and antibiotics. Candida isolation in peritoneal fluid and antifungal treatment isnot a norm. The aim of this study was to determine the incidence of Candida in peritonealfluid and its role in the outcome of patients with perforation peritonitis.Methods: This prospective observational study was conducted on 70 patients withperforation peritonitis from October 2016 to February 2018. Intraoperatively, peritonealfluid was taken and sent for microbiological culture and sensitivity. Perforation wasmanaged according to the site of perforation and condition of bowel.Results: The mean age of the patients was 38.74 years with male predominance (58,82.85%). Forty-seven (67.14%) patients had positive peritoneal cultures. Escherichia coliwas the most common bacteria (n=29), while Candida was found to be the most commonfungi and was found in 18 patients. The incidence of Candida was higher in upper gastroduodenal perforation (30, 42.85%). Patients found positive for Candida had APACHE IIseverity score 10 or more which was higher than the rest of the patients. The mortality washigher in patients with positive peritoneal cultures (10/47) as compare to negative ones(2/23, P<0.001). The mortality in mixed bacterial and fungal-positive cultures (7/18) wasalso higher as compared to isolated bacterial culture (3/29, P <0.001). The overall mortalityrate was 17.14%.Conclusion: Patients with Candida positive peritoneal culture had a significant mortalityand morbidity as compared to Candida negative. Peritoneal fluid culture and sensitivity forbacterial and fungal were helpful in the early diagnosis and treatment
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.
Emergency medicine
Julius Gbenga Olaogun; Amarachukwu Chiduziem Etonyeaku; Joshua Taye Ige; Obafemi Kayode Wuraola
Volume 6, Issue 1 , January 2020, , Pages 7-12
Abstract
Objective: There has been a worldwide rise in the prevalence of penetrating abdominal injury (PAI), and there are both inter-country and intra-country variations in frequencies. This study evaluates the mechanisms and pattern of penetrating abdominal injuries and the treatment outcome in our center.Methods: ...
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Objective: There has been a worldwide rise in the prevalence of penetrating abdominal injury (PAI), and there are both inter-country and intra-country variations in frequencies. This study evaluates the mechanisms and pattern of penetrating abdominal injuries and the treatment outcome in our center.Methods: This descriptive study of adult patients managed for PAI was conducted at the Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti from January 2015 to December 2018. Data were prospectively collected and analyzed by using descriptive statistics from Statistical Package for Social Sciences (SPSS) version 20.0.Results: There were 96 patients managed for abdominal injuries during the study period. Forty-six (47.9%) of them had PAI, while 50 (52.1%) others sustained blunt trauma. Patients ages ranged from 17-72 years (mean = 34.2±10.8 years; median = 34 years). Majority, 42 (91.3%), were males, while 4 (8.7%) were females (M: F=11:1). The most afflicted age group was in the 4th decade. Majority of the injuries were due to gunshot (60.9%) followed by stab (26.1%), unsafe abortion (6.5%), road traffic injury (4.3%) and fall (2.2%). Gastrointestinal injuries were the most common with small bowel perforations predominating. Solid organ injuries were only seen in 3 (7.9%) patients. Eight (17.4%) had associated extra-abdominal injuries. Thirty-eight (82.6%) patients required exploratory laparotomy, while 8 (17.4%) were managed non-operatively. The negative laparotomy rate was 2.6%. Seven (15.2%) patients developed complications which were mostly wound infection (10.8%). The duration of hospital stay was 1-58 days (mean 12.7±10.5). Three patients (6.5%) with gunshot injuries died.Conclusion: Gunshot wounds were the major variant of PAI, and the highest cause of mortality from it. Gut injuries were most common, and exploratory laparotomy remains the main-stay of treatment, while non-operative management is practicable in carefully selected cases.