Background: Acute bowel obstruction is one of the main causes of non-traumatic gastro—intestinal surgical emergencies. When they occur in elderly patients, they seem to induce higher morbi-mortality. The aim of our s...Background: Acute bowel obstruction is one of the main causes of non-traumatic gastro—intestinal surgical emergencies. When they occur in elderly patients, they seem to induce higher morbi-mortality. The aim of our study was to identify the causes of these bowel obstructions in elderly patients and to expose the results of their surgical management. Patients and Methods: Retrospective and analytical study of patients aged 65 years and over, operated on between January 2013 and December 2019 for acute bowel obstruction at the University Hospital of Bouake. Demographic, diagnostic, therapeutic and evolutionary data were analysed. Results: The study involved 36 men and 23 women (sex ratio = 1.6). The mean age of these patients was 70 ± 4.6 years (65 and 90 years). A history and/or co-morbidities were found in 67.8% of them. Patients were classified as ASA I (20.3%), ASA II (42.4%), ASA III (33.9%) or ASA IV (3.4%). The average consultation time was 5.3 ± 4.1 days (2 days and 28 days). Bowel obstructions were due to colonic volvulus (38.9%), colonic cancer (22%), postoperative adhesions (18.6%), strangulated groin hernia (16.9%) or internal bowel hernia (3.3%). Volvulated or necrotic bowel and resectable cancers were resected followed by immediate anastomosis or stoma. Near upstream stomas were performed for unresectable cancers. A herniorrhaphy for groin hernias and a mesenteric breach suture for internal hernia were performed after bowel disinterment. Adhesions were released. The time to surgery was 22.3 ± 12.4 hours (2 hours and 72 hours). The post-surgery morbidity was 32.2%, marked by parietal suppurations (47.4%). The post-surgery mortality was 16.9%. Hemodynamic or septic shock, ASA score ≥ III, bowel necrosis and ICU stay were the significant risk factors. Conclusion: Acute bowel obstructions in the elderly are dominated by colonic volvulus. The high mortality is related to various factors highlighting the frailty of the elderly. A multidisciplinary management involving the geriatrician could improve the prognosis.展开更多
Background: Peritonitis is one of the most common surgical emergency in tropical countries. It is still a significant cause of mortality and morbidity. This study aimed to describe the aetiology of acute non traumatic...Background: Peritonitis is one of the most common surgical emergency in tropical countries. It is still a significant cause of mortality and morbidity. This study aimed to describe the aetiology of acute non traumatic diffuse secondary peritonitis (ANDSP) and to report the outcome after treatment. Material and Methods: A retrospective survey of patients with ANDSP was carried out from January 2007 to December 2016 in the Digestive and General Surgery Service of Bouaké Teaching Hospital in the central part of Côte d’Ivoire. The hospital is a tertiary referral centre and serves urban and rural population from Bouaké’s agglomeration but also from the whole central and northern parts of the country. During the study period, all patients found to have at laparotomy ANDSP were included. The analysed variables include epidemiologic charts, clinical presentation, cause of peritonitis, surgical treatment, postoperative outcome and prognostic factors. Results: Over the studied period 626 cases of ANDSP were operated on. The main aetiologies were gastroduodenal peptic ulcer perforation (n = 252, 41.1%), typhoid ileal perforation (n = 207, 33%) and appendicular peritonitis (n = 123, 19.6%). The mean duration of hospital stay was 13.8 ± 9.6 days (range 8 - 87 days). The length of hospital stay was significantly influenced by postoperative complications (23.5 ± 5.4 days versus 10.8 ± 2.7 days P = 0.000000). Two hundred and sixty one postoperative complications were recorded in 242 patients (38.6%) with wound infection being the commonest postoperative complication. A repeat laparotomy was indicated in 73 patients. Eigthy (n = 80) patients died (mortality 11.2%). Risk factors for death were hemodynamic shock, ASA > II, Age ≥ 60 years, M PI > 29 and digestive sutures performed in septic environment below the transverse mesocolon. Conclusion: The spectrum of aetiology of ANDSP in this tropical area is different from the one observed in the Western countries. Proper treatment of typhoid fever and amoebiasis can reduce the incidence of peritonitis. Early consultation together with adequate resuscitation and surgical management can improve the prognostic which still remains poor.展开更多
文摘Background: Acute bowel obstruction is one of the main causes of non-traumatic gastro—intestinal surgical emergencies. When they occur in elderly patients, they seem to induce higher morbi-mortality. The aim of our study was to identify the causes of these bowel obstructions in elderly patients and to expose the results of their surgical management. Patients and Methods: Retrospective and analytical study of patients aged 65 years and over, operated on between January 2013 and December 2019 for acute bowel obstruction at the University Hospital of Bouake. Demographic, diagnostic, therapeutic and evolutionary data were analysed. Results: The study involved 36 men and 23 women (sex ratio = 1.6). The mean age of these patients was 70 ± 4.6 years (65 and 90 years). A history and/or co-morbidities were found in 67.8% of them. Patients were classified as ASA I (20.3%), ASA II (42.4%), ASA III (33.9%) or ASA IV (3.4%). The average consultation time was 5.3 ± 4.1 days (2 days and 28 days). Bowel obstructions were due to colonic volvulus (38.9%), colonic cancer (22%), postoperative adhesions (18.6%), strangulated groin hernia (16.9%) or internal bowel hernia (3.3%). Volvulated or necrotic bowel and resectable cancers were resected followed by immediate anastomosis or stoma. Near upstream stomas were performed for unresectable cancers. A herniorrhaphy for groin hernias and a mesenteric breach suture for internal hernia were performed after bowel disinterment. Adhesions were released. The time to surgery was 22.3 ± 12.4 hours (2 hours and 72 hours). The post-surgery morbidity was 32.2%, marked by parietal suppurations (47.4%). The post-surgery mortality was 16.9%. Hemodynamic or septic shock, ASA score ≥ III, bowel necrosis and ICU stay were the significant risk factors. Conclusion: Acute bowel obstructions in the elderly are dominated by colonic volvulus. The high mortality is related to various factors highlighting the frailty of the elderly. A multidisciplinary management involving the geriatrician could improve the prognosis.
文摘Background: Peritonitis is one of the most common surgical emergency in tropical countries. It is still a significant cause of mortality and morbidity. This study aimed to describe the aetiology of acute non traumatic diffuse secondary peritonitis (ANDSP) and to report the outcome after treatment. Material and Methods: A retrospective survey of patients with ANDSP was carried out from January 2007 to December 2016 in the Digestive and General Surgery Service of Bouaké Teaching Hospital in the central part of Côte d’Ivoire. The hospital is a tertiary referral centre and serves urban and rural population from Bouaké’s agglomeration but also from the whole central and northern parts of the country. During the study period, all patients found to have at laparotomy ANDSP were included. The analysed variables include epidemiologic charts, clinical presentation, cause of peritonitis, surgical treatment, postoperative outcome and prognostic factors. Results: Over the studied period 626 cases of ANDSP were operated on. The main aetiologies were gastroduodenal peptic ulcer perforation (n = 252, 41.1%), typhoid ileal perforation (n = 207, 33%) and appendicular peritonitis (n = 123, 19.6%). The mean duration of hospital stay was 13.8 ± 9.6 days (range 8 - 87 days). The length of hospital stay was significantly influenced by postoperative complications (23.5 ± 5.4 days versus 10.8 ± 2.7 days P = 0.000000). Two hundred and sixty one postoperative complications were recorded in 242 patients (38.6%) with wound infection being the commonest postoperative complication. A repeat laparotomy was indicated in 73 patients. Eigthy (n = 80) patients died (mortality 11.2%). Risk factors for death were hemodynamic shock, ASA > II, Age ≥ 60 years, M PI > 29 and digestive sutures performed in septic environment below the transverse mesocolon. Conclusion: The spectrum of aetiology of ANDSP in this tropical area is different from the one observed in the Western countries. Proper treatment of typhoid fever and amoebiasis can reduce the incidence of peritonitis. Early consultation together with adequate resuscitation and surgical management can improve the prognostic which still remains poor.
