Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China.
Department of General Surgery, Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania.
BMC Gastroenterol. 2023 Mar 8;23(1):59. doi: 10.1186/s12876-023-02659-w.
Surgical acute abdomen is a sudden onset of severe abdominal symptoms (pain, vomiting, constipation etc.) indicative of a possible life-threatening intra-abdominal pathology, with most cases requiring immediate surgical intervention. Most studies from developing countries have focused on complications related to delayed diagnosis of specific abdominal problems like intestinal obstruction or acute appendicitis and only a few studies have assessed factors related to the delay in patients with acute abdomen. This study focused on the time from the onset of a surgical acute abdomen to presentation to determine factors that led to delayed reporting among these patients at the Muhimbili National Hospital (MNH) and aimed to close the knowledge gap on the incidence, presentation, etiology, and death rates for acute abdomen in Tanzania.
We conducted a descriptive cross-sectional study at MNH, Tanzania. Patients with a clinical diagnosis of the surgical acute abdomen were consecutively enrolled in the study over a period of 6 months and data on the onset of symptoms, time of presentation to the hospital, and events during the illness were collected.
Age was significantly associated with delayed hospital presentation, with older groups presenting later than younger ones. Informal education and being uneducated were factors contributing to delayed presentation, while educated groups presented early, albeit the difference was statistically insignificant (p = 0.121). Patients working in the government sector had the lowest percentage of delayed presentation compared to those in the private sector and self-employed individuals, however, the difference was statistically insignificant. Family and cohabiting individuals showed late presentation (p = 0.03). Deficiencies in health care staff on duty, unfamiliarity with the medical facilities, and low experience in dealing with emergency cases were associated with the factors for delayed surgical care among patients. Delays in the presentation to the hospital increased mortality and morbidity, especially among patients who needed emergency surgical care.
Delayed reporting for surgical care among patients with surgical acute abdomen in underdeveloped countries like Tanzania is often not due to a single reason. The causes are distributed across several levels including the patient's age and family, deficiency in medical staff on duty and lack of experience in dealing with emergency cases, educational level, working sectors, socioeconomic and sociocultural status of the country.
外科急腹症是一种突发的严重腹痛症状（疼痛、呕吐、便秘等），提示可能存在危及生命的腹腔内病理，大多数病例需要立即手术干预。大多数来自发展中国家的研究都集中在与特定腹部问题（如肠梗阻或急性阑尾炎）的延迟诊断相关的并发症上，只有少数研究评估了与急性腹痛患者延迟报告相关的因素。本研究侧重于从外科急腹症发作到就诊的时间，以确定在姆万扎国家医院（MNH）就诊的这些患者中导致报告延迟的因素，并旨在填补坦桑尼亚急性腹痛的发病率、表现、病因和死亡率方面的知识空白。
我们在坦桑尼亚的姆万扎国家医院进行了一项描述性的横断面研究。在 6 个月的时间里，连续招募了有外科急腹症临床诊断的患者，并收集了症状发作、到医院就诊的时间以及发病期间的事件等数据。
年龄与延迟就诊显著相关，年龄较大的组比年龄较小的组就诊时间更晚。非正规教育和未受教育是导致延迟就诊的因素，而受教育程度较高的组就诊时间较早，尽管差异无统计学意义（p=0.121）。与私营部门和自雇人士相比，在政府部门工作的患者延迟就诊的比例最低，但差异无统计学意义。家庭和同居者表现出晚期就诊（p=0.03）。值班医护人员不足、对医疗设施不熟悉以及处理紧急情况的经验不足与患者延迟手术治疗的因素有关。就诊延迟增加了死亡率和发病率，尤其是在需要紧急手术治疗的患者中。
在像坦桑尼亚这样欠发达国家，外科急腹症患者的外科治疗报告延迟往往不是由单一原因引起的。原因分布在多个层面，包括患者的年龄和家庭、值班医护人员的不足以及处理紧急情况的经验不足、教育程度、工作部门、国家的社会经济和社会文化地位。
