Department of Surgery, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania.
Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
World J Emerg Surg. 2012 Sep 1;7(1):29. doi: 10.1186/1749-7922-7-29.
Bowel perforation though rarely reported is a serious complication of induced abortion, which is often performed illegally by persons without any medical training in developing countries. A sudden increase in the number of patients in our centre in recent years prompted the authors to analyze this problem. The study was conducted to describe our own experiences in the surgical management of these patients.
This was a retrospective study involving patients who were jointly managed by the surgical and gynecological teams at Bugando Medical Centre (BMC) for bowel perforation secondary to illegally induced abortion from January 2002 to December 2011. The statistical analysis was performed using SPSS version 17.0.
A total of 68 patients (representing 4.2% of cases) were enrolled in the study. Their ages ranged from 14 to 45 years with a median age of 21 years. Majority of patients were, secondary school students/leavers (70.6%), unmarried (88.2%), nulliparous (80.9%), unemployed (82.4%) and most of them were dependent member of the family. Previous history of contraceptive use was reported in only 14.7% of cases. The majority of patients (79.4%) had procured the abortion in the 2nd trimester. Dilatation and curettage (82.4%) was the most common reported method used in procuring abortion. The interval from termination of pregnancy to presentation in hospital ranged from 1 to 14 days (median 6 days ). The ileum (51.5%) and sigmoid colon (22.1%) was the most common portions of the bowel affected. Resection and anastomosis with uterine repair was the most common (86.8%) surgical procedure performed. Complication and mortality rates were 47.1% and 10.3% respectively. According to multivariate logistic regression analysis, gestational age at termination of pregnancy, delayed presentation, delayed surgical treatment and presence of complications were significantly associated with mortality (P<0.001). The overall median length of hospital stay (LOS) was 18 days (1day to 128 days ). Patients who developed complications stayed longer in the hospital, and this was statistically significant (P=0.012).
Bowel perforation following illegally induced abortion is still rampant in our environment and constitutes significantly to high maternal morbidity and mortality. Early recognition of the diagnosis, aggressive resuscitation and early institution of surgical management is of paramount importance if morbidity and mortality associated with bowel perforation are to be avoided.
肠穿孔虽罕见，但也是发展中国家无医学培训人员非法施行人工流产术的严重并发症。近年来，我们中心此类患者突然增多，促使我们分析这一问题。本研究旨在描述我们在这类患者的外科治疗方面的经验。
这是一项回顾性研究，纳入了 2002 年 1 月至 2011 年 12 月期间，因非法人工流产导致肠穿孔而在布干达医疗中心（BMC）由外科和妇科联合治疗的患者。使用 SPSS 版本 17.0 进行统计分析。
共有 68 例患者（占病例的 4.2%）入组本研究。其年龄 14 至 45 岁，中位数 21 岁。多数患者为中学生/辍学者（70.6%）、未婚（88.2%）、未产妇（80.9%）、无业（82.4%），且多为家庭依赖成员。仅 14.7%的患者有避孕史。多数患者（79.4%）在妊娠中期施行流产。扩张刮宫术（82.4%）是最常见的流产方法。从终止妊娠到就诊的时间间隔 1 至 14 天（中位数 6 天）。最常累及的肠段为回肠（51.5%）和乙状结肠（22.1%）。最常见的手术方法为肠切除吻合术联合子宫修补术（86.8%）。并发症和死亡率分别为 47.1%和 10.3%。多变量 logistic 回归分析显示，终止妊娠时的孕龄、就诊延迟、手术治疗延迟和并发症与死亡率显著相关（P<0.001）。总体中位住院时间（LOS）为 18 天（1 天至 128 天）。发生并发症的患者住院时间更长，且差异具有统计学意义（P=0.012）。
在我们的环境中，非法人工流产术后肠穿孔仍很常见，导致产妇发病率和死亡率显著升高。如果要避免肠穿孔相关的发病率和死亡率，早期诊断、积极复苏和尽早进行外科治疗至关重要。
