Chichom-Mefire Alain, Fon Tabe Alain, Ngowe-Ngowe Marcelin
Department of Surgery, Faculty of Health Sciences, University of Buea and Regional Hospital Limbe, P.O. Box 25526, Yaoundé, Cameroon.
World J Emerg Surg. 2016 Apr 11;11:14. doi: 10.1186/s13017-016-0070-9. eCollection 2016.
Acute diffuse peritonitis is a common surgical emergency worldwide and a major contributor to non-trauma related death toll. Its causes vary widely and are correlated with mortality. Community acquired peritonitis seems to play a major role and is frequently related to hollow viscus perforation. Data on the outcome of peritonitis in the tropics are scarce. The aim of this study is to analyze the impact of tropic latitude causes of diffuse peritonitis on morbidity and mortality.
We retrospectively reviewed the records of 305 patients operated on for a diffuse peritonitis in two regional hospitals in the South-West Region of Cameroon over a 7 years period. The contributions of various causes of peritonitis to morbidity and mortality were analyzed.
The diagnosis of diffuse peritonitis was suggested on clinical ground only in more than 93 % of cases. The most common causes of diffuse peritonitis included peptic ulcer perforation (n = 69), complications of acute appendicitis (n = 53) and spontaneous perforations of the terminal ileum (n = 43). A total of 142 complications were recorded in 96 patients (31.5 % complication rate). The most common complications included wound dehiscence, sepsis, prolonged paralytic ileus and multi-organ failure. Patients with typhoid perforation of the terminal ileum carried a significantly higher risk of developing a complication (p = 0.002). The overall mortality rate was 15.1 %. The most common cause of death was septic shock. Differential analysis of mortality of various causes of peritonitis indicated that the highest contributors to death toll were typhoid perforation of terminal ileum (34.7 % of deaths), post-operative peritonitis (19.5 %) and peptic ulcer perforation (15.2 %).
The diagnosis of diffuse peritonitis can still rely on clinical assessment alone in the absence of sophisticated imaging tools. Peptic ulcer and typhoid perforations are still major contributors to death toll. Patients presenting with these conditions require specific attention and prevention policies must be reinforced.
急性弥漫性腹膜炎是全球常见的外科急症，也是非创伤性死亡的主要原因之一。其病因广泛多样且与死亡率相关。社区获得性腹膜炎似乎起主要作用，且常与中空脏器穿孔有关。热带地区腹膜炎结局的数据稀缺。本研究的目的是分析热带地区弥漫性腹膜炎病因对发病率和死亡率的影响。
我们回顾性分析了喀麦隆西南地区两家地区医院7年间305例因弥漫性腹膜炎接受手术治疗患者的记录。分析了腹膜炎各种病因对发病率和死亡率的影响。
超过93%的病例仅根据临床情况诊断为弥漫性腹膜炎。弥漫性腹膜炎最常见的病因包括消化性溃疡穿孔（n = 69）、急性阑尾炎并发症（n = 53）和回肠末端自发性穿孔（n = 43）。96例患者共记录到142例并发症（并发症发生率31.5%）。最常见的并发症包括伤口裂开、败血症、麻痹性肠梗阻延长和多器官功能衰竭。回肠末端伤寒穿孔患者发生并发症的风险显著更高（p = 0.002）。总体死亡率为15.1%。最常见的死亡原因是感染性休克。对腹膜炎各种病因死亡率的差异分析表明，导致死亡人数最多的是回肠末端伤寒穿孔（占死亡人数的34.7%）、术后腹膜炎（19.5%）和消化性溃疡穿孔（15.2%）。
在缺乏先进影像工具的情况下，弥漫性腹膜炎的诊断仍可仅依靠临床评估。消化性溃疡和伤寒穿孔仍是死亡的主要原因。患有这些疾病的患者需要特别关注，必须加强预防政策。
