Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
Department of Community Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
Pan Afr Med J. 2020 Dec 18;37:354. doi: 10.11604/pamj.2020.37.354.22775. eCollection 2020.
surgical complications following unsafe abortion (UA) are not uncommon and are associated with high morbidity and mortality in developing countries. The commonest need for the general surgeon following UA is after a diagnosis of peritonitis which can occur following use of sharp objects introduced through the vagina. This study aims to highlight the presentation, management types and outcome of patients who presented with peritonitis following UA.
this study is a retrospective review of cases of peritonitis following UA seen over 4 years from January 2015 to December 2019 in a tertiary health facility in North Central Nigeria.
a total of 14 patients with peritonitis following UA were included in the study. The mean age of patients who presented was 27.4 years (19-40 years) with a mean estimated gestational age at abortion of 7.8 weeks. The average time from the UA procedure till presentation at the hospital was 8.6 days. There were 9 bowel injuries and 5 pelvic abscesses. A total of 3/9 patients had primary resection and anastomosis while 6/9 had stoma formed as part of their management. Pelvic abscesses were drained. In patients with bowel injury, those who had primary anastomosis had a 100% incidence of enterocutaneous fistula formation with associated sepsis requiring repeat exploration and formation of stoma. Mortality in this group was 67% (2/3) compared to the 0% (0/6) mortality rate seen in patients who had stoma. The overall mortality was four out of fourteen patients (28.6%).
peritonitis following UA is associated with marked morbidity and mortality as many of the patients present late. Initial preoperative resuscitation and stabilization should be followed by a swift laparotomy. Patients with bowel injury who had primary anastomosis had higher morbidity, reoperation rates and mortality than patients who had stomas.
不安全人工流产（UA）后的手术并发症并不罕见，在发展中国家与高发病率和死亡率相关。普通外科医生在 UA 后最常见的需求是在诊断腹膜炎后，这可能是由于阴道内使用锐器引起的。本研究旨在强调 UA 后出现腹膜炎的患者的表现、治疗类型和结局。
本研究是对 2015 年 1 月至 2019 年 12 月在尼日利亚中北部一家三级医疗机构中，UA 后出现腹膜炎的病例进行的回顾性研究。
共有 14 名 UA 后出现腹膜炎的患者纳入研究。患者的平均年龄为 27.4 岁（19-40 岁），流产时的平均估计胎龄为 7.8 周。从 UA 手术到医院就诊的平均时间为 8.6 天。有 9 例肠损伤和 5 例盆腔脓肿。3/9 例患者行一期切除吻合术，6/9 例患者行造口术。盆腔脓肿引流。在肠损伤患者中，行一期吻合术的患者吻合口瘘发生率为 100%（2/3），且伴有脓毒症，需要再次探查和造口。该组死亡率为 67%（2/3），而行造口术的患者死亡率为 0%（0/6）。总的死亡率为 14 例中的 4 例（28.6%）。
UA 后腹膜炎发病率和死亡率均较高，因为许多患者就诊较晚。初始术前复苏和稳定后应迅速进行剖腹手术。行一期吻合术的肠损伤患者的发病率、再手术率和死亡率高于行造口术的患者。
