Peritonitis: Perioperative Care in Surgical Emergencies CHU Ignace Deen

Objective: Describe the perioperative management of peritonitis in surgical emergencies. Methodology: This was a prospective observational study of the descriptive type over a period of 12 months from January 01 to December 31, 2020 in the surgical emergency room at the CHU Ignace Deen. Included in the study were all patients admitted for peritonitis aged greater than or equal to 18 years. The parameters were epidemiological, clinical and anesthetic. Results: Of the 653 admissions to surgical emergencies in 2020, 185 cases presented with peritonitis, i.e. 29.3%. The average age was 38.6 ± 16.64 years with extremes of 18 and 90 years. The sex ratio was 1.89. The comorbidities were dominated by gastritis and hypertension, i.e. 22%. The patients were classified as ASA 3U (52.4%), ASA2 U (39.5%) and ASA 4 U (8.1%). Preoperative resuscitation was provided only with 100% saline. 25.5% of patients had received a blood transfusion. The response time was less than 48 hours, i.e. 77.6%. General anesthesia was performed for all patients. Ketamine was the most used IV hypnotic (56.3%) combined with 100% halothane. The curares used were suxamethonium at (81.6%), Atracurium (81.6%) and rocuronium at (18.3%). Fentanyl was the only morphine used. Senior anesthesia technicians provided anesthesia in (63.2%). Intraoperative incidents were dominated by hypotension, difficult intubation, cardiac arrest, respectively 10.3%, 8% and 0.5%. The immediate postoperative incidents were arterial hypotension, nausea and desaturation, respectively 52.9%, 80% and 32.4%. Mortality was 3.4%. Conclusion: The perioperative management of peritonitis in the emergency room must be as early as possible in order to reduce morbidity and mortality.

Management of Pediatric Abdominal Surgical Emergencies in Northern Benin

Background: Pediatric abdominal surgical emergencies are major causes of morbidity and mortality. The goal was to identify the main determinants of their management and access to assess their evolution. Patients and methods: This is a prospective, descriptive and analytical study performed at Parakou teaching hospital and Tanguieta district hospital. It has been conducted from January 1st to July 31st 2016. All children were included aged 0 to 15 years and admitted for an abdominal surgical emergency with a Clinical Classification of Emergency Patients listed from 3 to 5. Results: Pediatric abdominal surgical emergencies accounted for 42.8% of pediatric surgical emergencies. The average age was 9.3 ± 3.5 years old. The sex ratio was 1.7. The most encountered etiologies were peritonitis (36.76%), abdominal trauma (16.17%) and anorectal malformations (14.71%). The comparison of the delay in operative treatment with the World Society of Emergency Surgery shows a delay in 82.35% of cases. Mortality was high preoperatively and was related to the neonatal period (p = 0.027) and to a resuscitation length of stay higher than 36 hours (p = 0.035). Conclusion: Surgical care was delayed, mainly due to the lack of technical capacities. Morbidity and mortality were relatively low.

Tuberculous peritonitis complicated by an intraperitoneal tuberculous abscess: A case report

BACKGROUND Tuberculous peritonitis(TBP)is a chronic,diffuse inflammation of the peritoneum caused by Mycobacterium tuberculosis.The route of infection can be by direct spread of intraperitoneal tuberculosis(TB)or by hematogenous dissemination.The former is more common,such as intestinal TB,mesenteric lymphatic TB,fa-llopian tube TB,etc.,and can be the direct primary lesion of the disease.CASE SUMMARY We present an older male patient with TBP complicated by an abdominal mass.The patient's preoperative symptoms,signs and imaging data suggested a poss-ible abdominal tumor.After surgical treatment,the patient's primary diagnosis of TBP complicating an intraperitoneal tuberculous abscess was established by com-bining past medical history,postoperative pathology,and positive results of TB-related laboratory tests.The patient's symptoms were significantly reduced after surgical treatment,and he was discharged from the hospital with instructions to continue treatment at a TB specialist hospital and to undergo anti-TB treatment if necessary.CONCLUSION This case report analyses the management of TBP complicated by intraperitoneal tuberculous abscess and highlights the importance of early definitive diagnosis in the hope of improving the clinical management of this type of disease.

Non-Malformative Emergency Abdominal Surgery in Children Aged 0 - 5 Years

Childhood abdominal surgery emergencies are a major challenge and problematic for the surgeon. The objective is to assess the pattern of non-malformative emergency abdominal surgery in children under 5 years old and to evaluate their management. Patients and Methods: A retrospective study of children under five years of age operated between January 2015 and December 2019 who presented with non-malformative abdominal surgical emergency at the Niamey National Hospital. Results: We collected 327 patients aged 0 to 5 years who underwent surgery for abdominal emergency. The average age was 2.8 ± 0.7 years. Boys accounted for 70.64% (n = 231) of the cases. Non-traumatic emergencies accounted for 97% (n = 317) of the cases. They were dominated by peritonitis in 44.6% (n = 146) and strangulated hernia in 43.7% (n = 143). Peritonitis was attributed to ileal typhoid perforation in 85.61% (n = 125) cases. The strangulated hernias were umbilical at 87.41% (n = 125) and inguinal at 12.59% (n = 18). Abdominal trauma accounted for 3% (n = 10);including 6 cases of abdominal contusion and 4 cases of penetrating wound. Intestinal resection with or without stoma was performed in 28.44% (n = 93). Postoperative complications were observed in 8.5% (n = 28) of the cases and mortality was 5.5% (n = 18). Conclusion: Non-malformative emergency abdominal surgery for children under 5 years was dominated by peritonitis. The morbidity and mortality are high. Fight against disease due to dirty hands and fecal peril like such as typhoid fever will reduce their frequency, but also improve the prognosis.

Acute Peritonitis at the Reference Health Center of Commune I of the District of Bamako: Epidemiological, Clinical and Therapeutic Aspects

Acute peritonitis is most often secondary to perforation of the digestive organ and/or the spread of an intra-abdominal septic focus. The objectives of this work were to study acute peritonitis in the general surgery department of the Cs ref of commune I in Mali, to determine the frequency of peritonitis, to describe the epidemiological, clinical and therapeutic aspects in order to analyze the surgical consequences and to assess the additional cost of treating acute peritonitis. This study was prospective, descriptive, cross-sectional involving 40 patients received in the surgery department of the Cs ref of commune I for acute peritonitis from January 1, 2018 to December 31, 2018. There were 40 patients among whom 28 (70%) were men and 12 were women (30%), i.e. a sex ratio = 2.3. The average age was 25 years with extremes varying between 16 and 54 years and a standard deviation of 11.78. Abdominal pain was the main reason for consultation. Clinical examination alone made it possible to make the diagnosis in 75% of cases. Surgical treatment depended on the intraoperative etiology. The clinical diagnosis was supported by ASP and abdominal ultrasound;performed respectively in 10% and 90% of patients. Appendiceal peritonitis was the intraoperative diagnosis observed in 50% of cases. All our patients benefited from a peritoneal toilet with drainage. We noted a morbidity rate of 5% dominated by parietal suppuration. The average cost of care was 175,000 FCFA.

Peritonitis Management through Appendicular Perforation in the Department of Surgery Bougouni Hospital (Mali)

Introduction: Appendicular peritonitis is a complication of acute appendicitis characterized by the spread of the infectious process in the peritoneal cavity thus achieving wide spread or localized purulent peritonitis;it’s a medico-surgical emergency. Our objectives are to determine the frequency, describe the clinical, therapeutic and prognostic aspects of peritonitis by appendicular perforations. Patients-Method: This was a 24-month retro, prospective, descriptive study from January 1, 2018 to December 31, 2019;conducted in the Bougouni Reference Health Center Surgery Unit. All patients of appendicular peritonitis at the Bougouni Reference Health Centre were included. Results: During the study period, 68 cases of generalized acute peritonitis including 30 appendicular peritonitis cases were collected. Appendicular peritonitis accounted for 44.1% of surgical procedures. Males accounted for 71.0% with a sex ratio of 1.2 at risk of men, the average age was 26.07 years. Abdominal pain and vomiting were the reasons for consultation in 86.7% and 76.7% of cases. Physical examination was used in most cases to make the diagnosis. X-ray of the abdomen without preparation, and abdominal ultrasound were performed systematically. Surgical treatment consisted of an appendectomy with peritoneal toilet followed by drainage. The average length of hospitalization was 8.8 days with extremes of 1 - 44 days. Hospital mortality was 3.3%;morbidity and high mortality were related to delayed consultation. Conclusion: Appendicular generalized acute peritonitis is a medical-surgical emergency with a high mortality rate associated with delayed management.

Appendicular Peritonitis in the General Surgery Department of Gabriel TOURE CHU

The appendicular peritonitis is complications of acute appendicitis which are characterized by the diffusion of the infectious process to the peritoneal cavity thus carrying out a generalized or located purulent peritonitis. It can appear from the start or follow the stage of appendicular abscess. Our objectives were to determine the frequency, to describe the clinic and para clinic aspects, to identify the principal germs and their sensitivities to antibiotics and to describe the operative continuations. Our prospective and descriptive study focused on patients treated for appendicular peritonitis, from January 1st to December 31st 2016, in the General Surgery Department of the Hospital of Sikasso. During the period of our study, 31 cases of appendicular peritonitis were collected, which represented 4.36% of surgical interventions, 19.25% of urgent surgeries. The male sex accounted for 71.0% with a sex-ratio of 2.44 at the risk of males, the average age was of 20 years ± 12.99, the abdominal pain + vomiting was the reason for consultation in 54.8% of cases. The physical examination allowed in most cases to make the diagnosis. In doubtful cases some additional examinations have been requested (abdomen without preparation, abdominal ultrasound). The surgical treatment consisted of an appendectomy with peritoneal lavage followed by drainage. The average length of hospital stay was 8.8 days with extremes of 1 - 44 days. Hospital mortality was 9.7%. Delay in consultation and age were factors of morbidity and high mortality.

急诊一体化手术治疗腹部创伤为主严重多发伤患者效果分析

目的探讨急诊一体化手术治疗腹部创伤为主严重多发伤患者的效果。方法选取医院2022年6月至2023年10月收治的腹部创伤为主严重多发伤患者58例,依据奇偶数原则分为对照组和观察组,各29例。对照组患者采取常规治疗,观察组患者采取急诊一体化手术治疗。结果观察组患者的并发症发生率为6.90%,显著低于对照组的24.14%(P<0.05);急诊室滞留时间和入院至急诊时间均显著短于对照组;抢救成功率为96.55%,显著高于对照组的89.66%(P<0.05)。结论急诊一体化手术治疗腹部创伤为主严重多发伤,可显著提高患者的临床疗效,缩短救治时间,降低并发症发生风险。

急性肠系膜上动脉栓塞的诊断和治疗

急性肠系膜上动脉栓塞是一种临床少见、病情极危重的急腹症。临床医生常因对本病认识不足而延误治疗 ,是该病治愈率低的主要原因之一。本文回顾性分析了 2 5例急性肠系膜上动脉栓塞的诊断和治疗方法 ,指出对有心脏及动脉硬化病史 ,突发剧烈腹痛 ,持续加重 ,一般止痛剂无效 ,同时伴有胃肠道出血 ,应视为急性肠系膜上动脉闭塞的早期征兆。在 2 3例的手术治疗中 ,肠系膜上动脉取栓及部分小肠切除 5例 ,坏死肠襻切除 18例 ;10例痊愈 ,围手术期死亡 13例 ,死亡率 5 7%。肠系膜上动脉栓塞虽然危重 ,但并非不能治疗 ,只要对本病有足够的警惕和认识 。

损伤控制理念在腹部急诊与外伤中的应用经验(附120例报告)

目的 :探讨损伤控制理念在腹部外伤与继发性腹膜炎病人中的应用价值。方法 :回顾性分析2008年1月至2013年2月应用损伤控制手术救治120例腹部急诊与创伤病人的临床资料。结果:共完成消化道穿孔、继发性腹膜炎病人急诊溃疡穿孔修补术97例,十二指肠造瘘5例,平均手术时间(65±12)min,平均术中出血量(50±21)m L。无围术期死亡发生。术后并发症包括肺部感染8例,切口感染4例,无消化道漏、腹腔感染的发生。完成腹部损伤病人十二指肠造瘘术6例,胰腺损伤快速止血、清创及引流术5例,创伤性肝破裂肝深部缝扎及大网膜填塞术7例。平均手术时间为(100±28)min,术中平均出血量(250±65)m L。8例病人术后入ICU复苏。1例严重胰腺损伤病人术后3 d死亡。围术期并发症包括肺部感染4例,肾功能不全2例,胰漏1例,胆漏1例,肝脓肿1例。结论 :行损伤控制手术病人,围术期死亡率和并发症发生率低。在外科创伤和急诊病人中疗效满意。

老年腹部外科急症患者全身性炎症反应综合征和多器官功能不全综合征的临床分析

作者回顾性研究了２９２例老年腹部外科急症患者的全身性炎症反应综合征（ＳＩＲＳ）和多脏器功能不全综合征（ＭＯＤＳ）的临床资料，分析ＳＩＲＳ向ＭＯＤＳ的发展过程，探索ＭＯＤＳ的防治策略。结果：老年腹部外科急症患者入院时ＳＩＲＳ的发生率是４１．１％，其后ＭＯＤＳ的发生率是１４．２％，病死率是１１．７％。经治疗４８小时后（包括手术和保守治疗），仍伴有ＳＩＲＳ的病例中，４０．５％（１７／４２）发展为ＭＯＤＳ。２９２例老年腹部外科急症患者中，１９例发生ＭＯＤＳ（６．５％），１６例死亡（８４．２％），结论：早期诊断ＳＩＲＳ，特别注意分析治疗４８小时后仍伴有ＳＩＲＳ的患者的原因，积极调控机体炎症反应。

严重腹部创伤伴颅脑损伤患者急诊一体化外科手术策略及预后分析

目的分析急诊一体化外科救治策略在严重腹部创伤伴颅脑损伤患者急救中的应用效果。方法回顾性分析2016年1月—2019年6月亳州市人民医院急诊外科收治的112例严重腹部创伤伴颅脑损伤患者临床资料,其中男性60例,女性52例;年龄20~53岁,平均48.5岁;脑挫裂伤12例,脑干挫伤12例,硬膜下及硬膜外血肿2例,单纯硬膜外血肿36例,腹部伤经剖腹后确诊:肝破裂5例,脾破裂6例,胃肠破裂12例,其中有7例为实质、空腔脏器均有破裂伤,网膜、系膜血管破裂伤6例;其他合并伤有血气胸3例,肾挫裂伤2例,四肢骨折5例,骨盆骨折、后腹膜血肿4例。将接受常规化急诊外科手术策略的56例患者纳入常规化外科组,实施气道控制、循环监测等措施,及时进行创伤止血包扎固定;将接受急诊一体化外科救治策略的56例患者纳入一体化外科组,行修复创伤一期手术治疗,术后送ICU监护观察,并继续抗休克、抗感染等治疗。对比两组的基线资料、术中出血量、术中红细胞输注总量、术后体温恢复时间、术后抗凝血酶(AT)、血浆凝血酶原(PT)恢复时间和术后乳酸恢复时间、术后美国国立卫生研究院卒中量表(NIHSS)、预后及并发症发生率的差异。结果两组性别分布、平均年龄、致伤原因、脑伤类型、脑伤表现、腹伤类型、腹伤表现等基线资料比较,差异无统计学意义(P>0.05)。一体化外科组的急诊室滞留时间(10.73±2.14)min、多学科会诊等待时间(7.53±1.95)min、辅助检查等待时间(12.62±3.19)min、急诊转至手术室时间(10.83±2.62)min均短于常规化外科组[(15.91±3.05)min、(10.48±2.32)min、(19.65±4.30)min、(16.77±3.48)min,P<0.05],一体化外科组的良好恢复率高于常规化外科组(64.29%vs.23.21%,P<0.05),而一体化外科组的轻度伤残率、重度伤残率、植物生存(或病死)率均低于常规化外科组(28.57%vs.48.21%,5.36%vs.17.86%,1.79%vs.10.71%,P<0.05)。结论给予严重腹部创伤伴颅脑损伤急诊一体化外科救治策略的整体救治效果显著,可提高救治成功率,改善临床预后。

外科急腹症腹腔感染的细菌学研究

目的:研究外科急腹症腹腔感染致病菌的主要类型、药物敏感性变化,指导外科临床合理应用抗生素。方法:从复旦大学附属华山医院普外科2003年9月-2005年3月急腹症患者中随机选取80例,均在手术中取腹腔标本行细菌学检测,并对患者的临床情况进行随访观察。结果:①术中腹腔细菌培养阳性率51．3％。不同急腹症的细菌培养阳性率有差异。②腹腔感染革兰阴性(G-)菌前4位是大肠埃希菌、铜绿假单胞菌、变形杆菌和肺炎克雷伯菌;革兰阳性(G+)菌以肠球菌为主。③G-菌对第三代头孢菌素已有部分耐药,可能与产超广谱酶(ESBL)菌株的增多有关;G+菌对常用抗生素耐药,但对多肽类抗生素万古霉素和替考拉宁100％敏感。结论:①内源性感染和混合感染仍是急腹症外科感染性疾病的主要特征。②应重视临床合理应用抗生素,降低细菌耐药的发展速度。

损伤控制性手术在非创伤腹部外科危急重症中的应用及护理

目的总结损伤控制性手术(DCS)在非创伤腹部外科危急重症中的应用效果及护理重点。方法回顾性分析71例行DCS患者(DCS组)和35例行传统手术患者(传统组)的临床资料,对2组患者术后体温(T)、pH值、凝血酶原时间(PT)、激活部分凝血酶原时间(APTT)、术后并发症发生率和病死率进行比较。结果 2组患者术后pH、PT、APTT比较差异有统计学意义(P<0.05);DCS组术后并发症发生率及病死率明显低于传统组,差异均有统计学意义(P<0.05)。结论 DCS的合理应用及护理能有效降低危重患者术后并发症和病死率,明确护理重点是患者成功实施DCS的保证。

腹部刀刺伤21例诊治的临床分析

目的探讨腹部刀刺伤的临床特点、诊断要领、手术治疗的指征、手术方式及术中应注意的事项。方法对我院2002年1月-2006年12月收治的21例腹部刀刺伤病例的诊断及手术方法进行回顾性分析。结果全组21例均明确诊断为腹腔穿透伤,经急诊手术探察,仅阴性探查1例。21例全部痊愈出院,无并发症发生。结论积极抗休克、及时剖腹、谨慎探查、严防漏诊是救治成功的关键。

急诊腹部创伤患者B超与CT诊断的临床价值分析

目的将B超检查方法和CT检查方法运用在急诊腹部创伤患者的诊断中,分析以及评价两种检查方法的临床价值。方法选取2015年5月—2017年10月本医院收入且予以临床治疗的30例急诊腹部创伤患者作为研究对象,对30例患者均实施B超检查和CT检查,统计并关注30例患者的临床诊断效果。结果 30例患者经由手术病理探查确诊率为93.33%,腹内脏器损伤的部位共检出34处。B超与CT诊断准确率比较,差异无统计学意义(P> 0.05);B超与CT检查脾损伤检出数目、肝损伤检出数目、肾脏损伤检出数目、小肠或是十二指肠损伤检出数目、胰腺损伤检出数目、腹膜血肿检出数目比较,差异无统计学意义(P> 0.05)。结论在急诊腹部创伤患者的诊断中采取B超检查方法和CT检查方法均呈现良好效果,展示重要临床价值。

急诊严重腹部创伤患者损伤控制外科手术治疗效果分析

目的研究急诊严重腹部创伤患者损伤控制外科手术的手术治疗效果。方法在本院选取2017年1—10月患有急诊严重腹部创伤的患者60例,按照随机数字表法分为对照组(行常规外科手术)和实验组(行损伤控制外科手术),对比两组治疗效果。结果治疗后,实验组手术指标、并发症发生率与临床指标均优于对照组,P <0.05,差异存在统计学意义。结论急诊严重腹部创伤患者损伤控制手术的临床治疗效果确切。

损伤控制外科技术在严重腹部创伤急救中的临床应用

目的分析损伤控制外科技术在严重腹部创伤急救中的临床作用。方法将2014年3月—2016年11月期间收治的98例严重腹部创伤患者分为观察组和对照组,每组各49例;对照组行传统急救术,观察组接受损伤控制外科技术。记录、比较两组复苏前后的APACHEⅡ评分、体温、血氧饱和度、pH值、抢救成功率和并发症情况。结果对照组抢救成功率明显低于观察组(83.67%对95.92%,P<0.05),并发症发生率明显高于观察组(28.57%对12.24%,P<0.05)。复苏前两组APACHEⅡ评分、血氧饱和度、pH值、体温无差异;复苏后,观察组体温、血氧饱和度、pH值和APACHEⅡ评分均优于对照组(P<0.05)。结论损伤控制外科技术在严重腹部创伤急救中的疗效较好,并发症较少,值得临床推广。

急诊外科处理急性腹痛患者的临床效果

目的总结急性腹痛急诊外科处理方法以及临床效果,为急诊科工作提供参考。方法选择我院急诊外科2016年9月至2017年10月采取急诊外科处理的80例患者,总结临床效果。结果经明确诊断以及处理后无死亡患者,严重并发症患者4例。结论在了解急性腹痛患者病史等信息的基础上以影像学等辅助检查合理进行外科处理是保证患者治疗效果的关键。

小儿急性阑尾炎70例临床分析

小儿阑尾炎有其发病特点，因不能或说不清腹痛部位，查体不合作等因素易导致误诊，增加死亡率。作者总结经验重视查体时小儿的反应，反复检查，结合化验，B超，必要时腹穿，与相关疾病鉴别，提高诊断正确率。采用手术治疗，对婴幼儿及异位阑尾炎手术治疗应放宽适应症，以减少死亡率。