Adult Surgical Emergencies in a Developing Country: The Experience of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria

Abstract

The goal of this study was to examine the adult surgical emergencies seen at the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, with a view to proffering preventive solutions where appropriate and improving outcome. From the register of patients seen at the Casualty department and from the operations register in the main operation room of NAUTH, names and hospital numbers of adult patients treated as emergencies over a 5-year period, from 7 September 1998 to 6 September 2003, were obtained. The hospital folders were then retrieved from the Records Department. From each folder, the following details about each patient were extracted: age, sex, diagnosis at presentation, causative factors, treatment given, and outcome. A total of 902 adult patients were treated during the period. The commonest emergency operation was appendectomy for acute appendicitis in 139 patients (97 women and 42 men), followed closely by road traffic accidents (RTAs) involving 137 patients (103 men and 34 women). Gunshot injuries, which resulted mainly from armed robbery attacks, accounted for 127 cases. More men (113) sustained gunshot injuries than women (14). Of the 92 cases of acute intestinal obstruction seen, 62 occurred in women and 30 in men. Some 126 men presented with acute urinary retention, and two others presented with priapism. Governments at various levels should provide modern diagnostic tools for the accurate preoperative diagnosis of surgical emergencies in hospitals. Governments should also inculcate strict discipline into drivers using the highways, particularly in relation to abuse of alcohol and drugs. Good roads and adequate security should be provided for the people. The need for Pre-Hospital Care for the efficient evacuation of accident victims is emphasized. These measures will help to improve the management and outcome of surgical emergencies, and decrease the number of surgical emergencies resulting from RTAs and gunshot wounds.

The range of abdominal surgical emergencies in children older than 1 year at the komfo anokye teaching hospital, Kumasi, Ghana

“…[13] This obviously indicates that complication rate of acute appendicitis is increasing in children in our environment, mainly due to ignorance on the part of parents about the disease, self-medication and delay in reporting to hospital. According to reports from the same hospital [14] and also from Nigeria, [15] in adults the most common abdominal emergency was acute appendicitis, accounting for over 22% and 15%, respectively, of all acute surgical admissions for abdominal pain; this was followed by typhoid ileal perforation [14] -a reversal of the situation seen in children in this study. This may be due to the fact that acute appendicitis is less common in young children, especially children under the age of 5 years.…”

Histopathological study and audit of the spleen in Nigerians

“…In all these and similar reports, abdominal injury with splenic damage was very common both in children as well as in adults [10,11]. In the report of Chinakwana et al [12] in Eastern part of Nigeria, RTA accounted for the second most common emergency operation after acute appendicitis. Smith et al in Liverpool [13] and Sayes et al in Birmingham [14], both in the United Kingdom reported RTA as the main cause of abdominal trauma in their studies.…”

Emergency, anaesthetic and essential surgical capacity in the Gambia

“…[5][6][7][8][9][10] This is the first survey to assess the status of essential and emergency surgical care and of anaesthesia services in the Gambia. The most striking finding was the absence of any facilities equipped with all of the physical resources needed to provide emergency and essential surgical care.…”