Research Article

Acute Generalized Peritonitis: Management in the General Surgery Department of Ignace Deen University Hospital

by Mamadou Sakoba Barry1,2*, Camara Mariama1,2, Houssein Fofana1,2, Fatimatou Diallo1, Aboubacar Toure1,2

1Department of General Surgery, Ignace Deen National Hospital, Conakry University Hospital, Conakry, Guinea

2Faculty of Health Sciences and Technology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea

*Corresponding author: Mamadou Sakoba Barry, Department of General Surgery, Ignace Deen National Hospital, Conakry University Hospital, Conakry, Guinea

Received Date: 01 July 2024

Accepted Date: 05 July 2024

Published Date: 08 July 2024

Citation: Barry MS, Mariama C, Fofana H, Diallo F, Toure A (2024) Acute Generalized Peritonitis: Management in the General Surgery Department of Ignace Deen University Hospital. J Surg 9: 11078 https://doi.org/10.29011/2575-9760.11078

Abstract

Introduction: The aim was to contribute to the management of acute generalized peritonitis (AGP) in the general surgery department of the Hôpital National Ignace Deen, Conakry.

Methods: This was a 6-month dynamic descriptive study (June 1 - November 30, 2021) in the general surgery department of the Hôpital National Ignace Deen, CHU de Conakry. All patients received, operated on and followed up in the department for acute generalized peritonitis during the study period were included.

Results: During the study period, we collected 245 cases of abdominal surgical emergencies, of which 62 were PAG, i.e. 25.3% of cases. The mean age was 33.9. The sex ratio was 3.13 in favor of men. Clinical signs included abdominal pain and abdominal contracture/defensiveness in all patients.

An unprepared abdominal X-ray (UPX) was performed in 95.2% (n=59). Peptic ulcer perforation accounted for 41.9% (n=26) of cases. Cleansing followed by drainage was performed in all patients (100%). Excision and suturing of perforations were performed in 77.4% (n=48) of cases. Post-operative management was straightforward in 80.6% (n=50) of cases. We recorded 11.3% (n=7) surgical site infection and 6.4% (n=4) stercoral fistula. Mortality was 8.1% (n=5). Average hospital stay was 16.5 days.

Conclusion: PAG is a frequent abdominal emergency. Their etiologies are multiple. Management is medical-surgical. Good resuscitation and peritoneal cleansing could improve the management of acute generalized peritonitis.

Keywords: Acute Generalized Peritonitis Management

Introduction

Acute generalized peritonitis is an acute disseminated inflammation of the peritoneum caused by septic inoculation, most often from an intraperitoneal organ, and more rarely after systemic contamination [1]. They may be primary, secondary or tertiary. Peptic ulcer perforation is the most frequent etiology. Ileal perforations are also found to a lesser extent in series from tropical countries [2]. In sub-Saharan Africa, they pose a real public health problem, due to the morbidity and mortality they entail [3]. Management combines pre-, intra- and postoperative resuscitation, surgical eradication of intraperitoneal infection and appropriate antibiotic therapy [4]. It is a serious medical and surgical emergency. Its severity depends on the patient’s age, general condition, associated defects, etiology and the time required for treatment [5]. The aim of this study was to contribute to the improvement of the management of acute generalized peritonitis in the General Surgery Department of the Ignace Deen National Hospital- University Hospital of Conakry.

Methodology

This was a dynamic descriptive study lasting six (6) months from June 1 to November 30, 2021, carried out in the General Surgery Department of the Ignace Deen National Hospital, University Hospital of Conakry. We targeted all patients received and operated on for abdominal surgical pathology in our department during the study period. All patients admitted to the department for acute generalized peritonitis during the study period were included. All patients received, operated on and followed up in the department for acute generalized peritonitis during the study period were included. Our study variables were quantitative and qualitative. Our data were collected through individual interviews, consultation registers, operative report registers and individual medical records, and recorded on an established survey form.

Results

During the study period, 245 patients were taken into care in the department. Among them, we noted 62 (25.3%) cases of acute generalized peritonitis. The mean age of patients was 33.9 years, with extremes of 12-72 years, and the age group most affected was 15-29 years, i.e. 46.8% (see Table 1). Males were most affected, with 75.8% (n=47) of cases and a sex ratio of 3.1. In terms of consultation delay, 46.8% (n=29) of patients consulted after 4 days (see Table 2). The clinical picture was dominated by abdominal pain and abdominal defense/contraction in all patients (100%) (see Table 3). An X-ray of the abdomen without preparation was performed in 95.2% (n=59) of patients. The findings were dominated by diffuse grayness in 95.2% (n=59) of cases, pneumoperitoneum in 61.3% (n=38) of cases, and hydroaerosal levels in 19.4% (n=12) of cases. All patients had a complete blood count (100%). Hyperleukocytosis of more than 13,000 globules/ mm3 was noted in 46.8% (n=29) of cases, and anemia in 17.7% (n=11).

All our patients benefited from preoperative, intraoperative and postoperative resuscitation medication (rehydration fluids, analgesics, antibiotics, urinary catheter and nasogastric tube). Six (6) patients received a blood transfusion (9.7% of cases). The surgical approach was median laparotomy above and below the umbilicus in all patients (100% of cases). Surgical procedures included peritoneal cleansing and drainage of the Douglas, followed by treatment of the cause in all cases. Surgical treatment of the cause was dominated by excision-suture of perforations in 77.4% (n=48) of cases, and appendectomy in 24.2% (n=15). Etiologies were dominated by peptic ulcer perforation in 41.9% (n=26) of cases, followed by appendicular peritonitis in 24.2% (n=15) (see Table 4). Post-operative management was straightforward in 80.6% (n=50) of cases. Morbidity included surgical site infection in 11.3% (n=7) of cases, and digestive fistula in 6.4% (n=4). Mortality was 8.1% (n=5). The average hospital stay was 16.5 days, with extremes of 3 and 61 days (Figures 1,2).

Age groups (in years)

Headcount

Percentage

< 15

3

4.8

15-29

29

46.8

30-44

13

21

45-59

13

21

≥ 60

4

6.4

Total

62

100

Table 1 : AGP frequency by age group.

Consultation time (in days)

Count

Percentage

01-Feb

9

14.5

03-Apr

24

38.7

>4

29

46.8

Total

62

100

Average consultation time: 4.8 ± 2.6 j Extremes: 1 et 11 j

Table 2: Distribution of patients by consultation time.

Clinical signs

Count

Percentage

Functional:

-                  Abdominal pain

62

100

-                  Vomiting

39

62.9

-                  Stoppage of matter and gas

34

54.8

Physiques:

-                 Abdominal defense/contraction

62

100

-                  Umbilical cry

55

88.7

-            bulging and pain of the Douglass

52

83.9

-                  Sloping dullness of flanks

46

74.2

-                  Disappearance of pre-hepatic dullness

38

61.3

Table 3: Distribution of patients by reason for consultation.

Etiologies

Count

Percentage

Peptic ulcer perforation

26

41.9

Appendicular peritonitis

15

24.2

Non-traumatic ileal perforation

11

17.8

Post-operative peritonitis

8

12.9

Colonic perforation

1

1.6

Pyosalpinx rupture

1

1.6

Total

62

100

Table 4: Distribution of patients by AGP etiology.