Emergency surgically treated operatively non traumatic acute abdomens in nekemte referral hospital, oromia Ethiopia a retrospectivestudy (2003-2005e.c.)

Abstract

Background- Acute abdomen is an acute onset of abdominal disease entities that require immediate surgical intervention in most of the cases. The causes ofnon-traumatic surgical acute and their relative incidence varies in different populations. Intestinal obstruction and acute appendicitis are the leading causes ofnon-traumatic surgical acute abdomen in African countries and developed world respectively. Hernia and volvulus are the leading causes of intestinal obstruction in Africans whereas adhesion in the developed world. There are only few studies onnon-traumatic surgical acute abdomen in Ethiopia. . Objective:The aim of this study wasto determine the magnitude andthe common causes as well presenting features and the outcome ofnon-traumatic surgical acute abdomen.in NRH, Oromia region, Ethiopia. Methods:-A three years hospital based cross sectional study design was used from January 1, 2011 to December 31, 2013 and the data was collected from MAY;10-25,2014. The data of sampled patients’ records were collected from medical records. The collected data were checked for any inconsistency coded and entered into SPSS version 20.0 for data processing and analysis. Descriptive, binary and multivariate logistic regression analyses were used. On binary logistic regression analysis a p-value < 0.25 was used as a candidate for multivariate logistic regression analysis. Statistical significant association was tested at a p-value of < 0.05. Results: -There were 295 (71.95%) non traumatic surgical acute abdomens operatively treated from the total of 410 surgically treated acute abdomens. Out of 295 patients, 230were males and 65 were females. The age ranged from 6months to 80years with a mean age of 33.7±18.6years.Out of 295, (57.6%) was rural and 46.4% were urban dwellers. More than 50.80% of patients came within 2days of illness and 49.20% came more than 3days of illness. The three top causes ofnon-traumatic surgical acute abdomen were acute appendicitis 140 (47.46%), bowel obstruction 118 (40%) and Peritonitis36 (12.50%) (Other than gangrenousbowel obstruction and perforated appendicitis).Abdominal pain (99.66%), vomiting (95.25%), constipation (57.96 %) and distension (54.86%) were the main presenting symptoms. Most of patients came late and rural dwellers developed peritonitis. The three commonest early postoperative complications other than death were wound infection 23 (7.80%), pneumonia 9(3.06%) and sepsis 7(2.37%) and there were a total of 9(3%) deaths. Conclusion and recommendation: -Acute abdomen is a surgical condition with high rate of morbidity and mortality if not managed timely and appropriately. Complications were more in cases from rural area due to delay at presentation and no operation facility and surgeons for solutions. To alleviate this problem creation of health awareness on acute abdomen to the general population in general and to the low and mid-level health care providers for early referral has great importance. Assigning properly trained MSc emergency surgeons with full resources should be available at the periphery health institutions.