Hamadi Hija, Mbena Happiness, Kiritta Richard F, Ottoman Oscar, Silago Vitus, Mirambo Mariam M, Mshana Stephen E
Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences (CUHAS), Mwanza, Tanzania.
Department of Pathology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences (CUHAS), Mwanza, Tanzania.
East Afr Health Res J. 2023;7(2):147-157. doi: 10.24248/eahrj.v7i2.726. Epub 2023 Nov 30.
Pelvic peritonitis is a rarely reported pathological condition in literature and emergency laparotomies are a common surgical procedure performed for these conditions in developing countries. This study was designed to investigate factors that are associated with short-term surgical outcomes among women with pelvic peritonitis.
The study included retrospective and prospective data obtained between November 2021 and May 2022 from Bugando Medical Centre (BMC). Standardized data collection tool was used to capture clinical, surgical and laboratory data. Descriptive data analysis was done using STATA version 13.
A total of 101 participants were recruited; 22 prospectively and 79 retrospectively. The median age was 29[Interquartile range (IQR) 24 to 35] years. Majority (76.2%) of participants were referred patients. Obstetric related peritonitis 82.2% (83/101) was the most frequently detected with a necrotic and or dehiscent lower uterine segment (LUS) that necessitated a subtotal abdominal hysterectomy (STAH) being the commonest (40.8%) intraoperative finding. Postoperative complications were reported in 36.7% (36/98) and were significantly associated with pulse rates >100b/min () and platelets <150 × 10 mm (). The median length of hospital stay was 19[IQR: 7 to 35] days and temperature >37.5°C (aOR=5.08, 95% CI 1.23-20.97, P=.025) independently predicted prolonged hospital stay. Death occurred in 9.2% of patients and having ASA score of 5 () was associated with death. Multi-drug resistant (MDR) gram-negative bacteria (85.2%) were the predominant pathogens causing pelvic peritonitis.
A significant proportion of patients with pelvic peritonitis and deranged sepsis markers develop short-term surgical complications with a significant number of those with fever stay more than 14 days. There is a need of timely complete sepsis work up of the patients with pelvic peritonitis to ensure appropriate management is instituted to prevent associated morbidity and mortality.
盆腔腹膜炎是文献中报道较少的一种病理状况，在发展中国家，急诊剖腹手术是针对这些情况进行的常见外科手术。本研究旨在调查与盆腔腹膜炎女性短期手术结局相关的因素。
该研究纳入了2021年11月至2022年5月期间从布甘多医疗中心（BMC）获取的回顾性和前瞻性数据。使用标准化数据收集工具收集临床、手术和实验室数据。使用STATA 13版进行描述性数据分析。
共招募了101名参与者；22名是前瞻性招募，79名是回顾性招募。中位年龄为29岁[四分位间距（IQR）24至35岁]。大多数（76.2%）参与者为转诊患者。产科相关腹膜炎82.2%（83/101）是最常检测到的，坏死和/或子宫下段裂开（LUS）需要次全子宫切除术（STAH）是最常见的（40.8%）术中发现。36.7%（36/98）报告了术后并发症，且与脉搏率>100次/分钟（）和血小板<150×10⁹/mm³（）显著相关。中位住院时间为19天[IQR：7至35天]，体温>37.5°C（调整后比值比=5.08，95%置信区间1.23 - 20.97，P = 0.025）独立预测住院时间延长。9.2%的患者死亡，美国麻醉医师协会（ASA）评分为5分（）与死亡相关。多重耐药（MDR）革兰氏阴性菌（85.2%）是引起盆腔腹膜炎的主要病原体。
相当一部分盆腔腹膜炎和脓毒症指标紊乱的患者会出现短期手术并发症，相当数量发热患者住院时间超过14天。需要对盆腔腹膜炎患者及时进行全面的脓毒症检查，以确保采取适当的管理措施来预防相关的发病率和死亡率。
