Outcome of laparotomy for peritonitis in 302 consecutive patients in Ibadan, Nigeria

Abstract

Background: Peritonitis is a life-threatening condition and requires urgent surgical
management. Despite improvements in the care of patients with peritonitis, its
management is still challenging and associated with significant morbidity and
mortality. The aim of this study was to determine factors influencing the outcome
in patients managed for peritonitis in a tertiary health institution in Nigeria.
Methods: A retrospective study involving 302 patients managed for peritonitis
over a 3- year period. The biodata, clinical findings, diagnosis, pre-operative care,
mode of anaesthesia, cadre of the surgeon, intraoperative findings, postoperative
care, and the outcomes were retrieved from their records.
Results: Three hundred and two patients were operated on for peritonitis during
the period. The mean age of the patients was 48 ± 12 years. Twenty (6.6%) patients
had other co-morbidities, with hypertension being the most frequent. Ruptured
appendicitis was the most common cause of peritonitis, 83(27.5). Twenty-eight
(9.2%) patients had complications, 19 patients (6.5%) required intensive care unit
admission, 25 patients (8.4%) required a second exploratory laparotomy. The
mortality rate was 2.4%. There was a statistically significant association between
an adverse outcome and presentation with shock, anaemia, jaundice and oliguria
Conclusion: The factors influencing outcome are similar to those of other Africa
countries. However, the mortality rate in our study is lower. Peri-operative specific
organ support and prompt surgical intervention should be instituted to improve
outcome. We suggest a prospective study to elucidate the effect of these factors,
and to determine the predictive power of the various scoring systems.