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Epidemiology and Management of Peritonitis at a Rural Hospital in Zambia

Sergiy Karachentsev

Roan Antelope General Hospital, Zambia

Correspondence to: Dr. Sergiy Karachentsev; email: sergek69@yahoo.co.uk

Abstract

Background: Peritonitis is a common surgical emergency with varying etiologies encountered the world over. It is associated with significant morbidity and mortality despite intensive research and advances in management. Methods: Records of 119 patients operated on for peritonitis at a rural surgical hospital in Zambia over a 10-year period were retrospectively reviewed. Results: Common sources of peritonitis were perforated peptic ulcer, acute appendicitis, pelvic inflammatory disease, and perforated terminal ileum. Postoperative period became complicated in 42 patients (32.3%). Fourteen patients (11.8%) died postoperatively; the highest level of mortality was in patients with perforated peptic ulcer (26%). Organ failure was found in 29 patients (24.4%) and was associated with increased risk of death. Conclusion: Individual approach with identifying signs of organ failure is essential to determine the patient’s prognosis and decide on the level of care. Patients without organ dysfunction can be successfully managed in a rural surgical hospital.

Keywords: Peritonitis, Epidemiology, Morbidity, Mortality, Rural hospital, Zambia

 

Ann Afr Surg. 2020;17(3):120–125

DOI: http://dx.doi.org/10.4314/aas.v17i3.7

Conflicts of Interest: None

Funding: None

© 2020 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.

Submitted: 28 November 2019

Revised: 1 March 2020

Accepted: 30 March 2020

Online first: 29 May 2020

Introduction

Peritonitis continues to generate debate in the surgical community worldwide, as morbidity and mortality are still unacceptably high (1). This is especially true in a developing world setting with a huge burden of community-acquired urgent surgical conditions and limited access to modern diagnostic and therapeutic facilities (2). Despite its importance, the problem of peritonitis remains far from resolved and some areas of management have not been covered yet.

First, the spectrum of the disease in developing nations is different from that found in the western world and could vary from country to country (3). There is a paucity of