Aetiology and outcomes of operatively managed acute abdomen in adults, at Moi Teaching and Referral Hospital

Abstract

Background: Acute abdomen is responsible for up to 50% of surgical emergencies. Its aetiological patterns are thought to be changing in Africa. Despite its frequent occurrence, the aetiology and outcomes of operatively managed acute abdomen, in adults, is yet to be described at Moi Teaching and Referral Hospital (MTRH). This description of will be informative to clinical practitioners and improve care of patients Objective: To determine the aetiology and outcomes of operatively managed acute abdominal conditions, in adults at Moi Teaching and Referral Hospital MTRH. Methods: A prospective descriptive study was carried out in the general surgical and gynaecology wards. Fischer‟s statistical formula was used to determine sample size, and consecutive sampling was done until the sample size was achieved. A sample of 203 adult patients, 18 years and older, operated on for an acute abdomen between 29th March 2018 to 29th March 2019, were studied. Patients with abdominal trauma causing acute abdomen were excluded. A data sheet was used to record the aetiology and outcomes (early complications, mortality and duration of stay). Descriptive statistical analysis such as frequencies and percentages were used for categorical variables. Measures of central tendency such as mean and interquartile ranges were used for continuous variables. Univariate analysis was used to assess association between the outcome and the aetiology. Results: 203 patients with a median age of 29 years (IQR 23, 35.5) were studied. One hundred and twenty-one (59.6%) were female and eighty-two (40.4%) were male. The most common causes of operative acute abdomen included: ectopic pregnancy 72(35.5%), intestinal obstruction 46(22.7%) and appendicitis 37(18. 7%). Three (1.5%) patients died. Postoperative complication rate was 20.7%. Wound dehiscence (8.4%), surgical site infection (7.9%), pneumonia (3.4%), then sepsis (2.5%) were the most encountered complications. A majority of patients 124(63.5%) were discharged within a week of admission. Aetiology was found to be associated with likelihood of developing wound dehiscence (p 0.003) and surgical site infection (p 0.004) postoperatively. Conclusion: Ectopic pregnancy is the most frequently encountered cause of operative acute abdomen at MTRH. It is followed by intestinal obstruction, appendicitis, then bowel perforations in that order. Wound complications, pneumonia then sepsis are the commonly encountered complications. Recommendation: A 5-10 yearly review of acute abdominal aetiology should be carried out at MTRH to allow us to monitor for any future changes. Studies should be carried out on perioperative factors affecting wound dehiscence with the aim of reducing its occurrence.