Coulibaly M, Traoré D, Togola B, Sanogo S, Bengaly B, Kanté A, Ouattara D, Coulibaly B, Ba Babou, Diallo S, Ongoiba N
Hôpital de Koutiala, MALI.
Faculté de médecine de l'USTTB, Bamako, MALI.
Mali Med. 2019;34(4):11-14.
To describe the epidemiological, clinical and therapeutic aspects of acute surgical abdomens at the Koutiala Reference Health Center.
This was a prospective and descriptive study from August 1, 2017 to May 31, 2018. It included all patients operated on for acute abdomen in the General Surgery Department of the Koutiala Reference Health Center. The study did not include the nonoperated surgical acute abdomens, the non-surgical acute abdomens. Clavien-Dindo classification was used to evaluate complications.
One hundred patients were registered. Acute surgical abdomens accounted for 8.4% of consultations (n = 1190), 27.7% of surgical procedures (n = 361) and 70% of surgical emergencies (n = 142). The average age was 34.4 years ± 18.5. Men were in the majority with 70%. The mean duration of change in symptomatology was 4.8 days ± 5.4. Patients consulted for abdominal pain (100%), fever (60%), vomiting (88%) and discontinuation of materials and gases (32%). The physical examination noted abdominal distension (53%), abdominal contracture (36%), abdominal defense (56%) and pain in the cul de sac of Douglas (95%). X-rays of the abdomen without preparation and abdominopelvic ultrasonography contributed to the diagnosis in 46% of cases and 18% of cases, respectively. Acute appendicitis (35%) was the most common etiology followed by acute peritonitis (31%) and acute intestinal obstruction (15%). We performed an appendectomy in 45 patients (45%), resection anastomosis (15%) and excision-suture (13%). The average duration of hospitalization was 4.7 days. The morbidity was 12%. According to the Clavien-Dindo classification, 9 patients were grade III and 3 grade V. The mortality was 3%.
Acute surgical abdomens are the most common emergencies in our practice. The diagnosis is clinical and para-clinical most often. Morbidity and mortality remain elevated. The outcome of treatment depends on early management and mastery of abdominal surgery techniques.
描述库蒂亚拉参考卫生中心急性外科急腹症的流行病学、临床和治疗方面。
这是一项从2017年8月1日至2018年5月31日的前瞻性描述性研究。研究对象包括在库蒂亚拉参考卫生中心普通外科接受急性腹部手术的所有患者。该研究不包括非手术治疗的外科急性腹症、非外科急性腹症。采用Clavien-Dindo分类法评估并发症。
共登记了100例患者。急性外科急腹症占会诊病例的8.4%（n = 1190）、外科手术的27.7%（n = 361）以及外科急诊的70%（n = 142）。平均年龄为34.4岁±18.5岁。男性居多，占70%。症状改变的平均持续时间为4.8天±5.4天。患者因腹痛（100%）、发热（60%）、呕吐（88%）及停止排气排便（32%）前来就诊。体格检查发现腹胀（53%）、腹部挛缩（36%）、腹部压痛（56%）以及Douglas窝疼痛（95%）。未做准备的腹部X线检查和腹部盆腔超声检查分别在46%和18%的病例中有助于诊断。急性阑尾炎（35%）是最常见的病因，其次是急性腹膜炎（31%）和急性肠梗阻（15%）。我们对45例患者（45%）实施了阑尾切除术，15%进行了切除吻合术，13%进行了切除缝合术。平均住院时间为4.7天。发病率为12%。根据Clavien-Dindo分类法，9例患者为Ⅲ级，3例为Ⅴ级。死亡率为3%。
急性外科急腹症是我们临床实践中最常见的急诊情况。诊断大多依靠临床和辅助检查。发病率和死亡率仍然较高。治疗效果取决于早期处理以及对腹部手术技术的掌握。
