Delay in presentation and challenges of treatment of complicated abdominal wall hernias in rural Southeast Nigeria

Emergency laparotomy at district hospitals in a developing nation: a review of indications and outcomes of treatment

“…The patients in the current series were predominantly males, young farmers and artisans aged 45 years and below who resided in the rural and semi-urban settlements with deplorable health-seeking behavior. The above findings are consistent with reports from similar studies carried out in Nigeria (9,16,18) and other developing nations like Tanzania (19), Rwanda (2), Zambia (20), Cameroon (17), India (21) and Pakistan (22). However, similar studies in Turkey (23), UK (24), USA (25) and Norway (26) showed that majority of the patients presented earlier in the course of their illness either to the family physician or surgeon and were more advanced in age; the vast majority being in the 6th-8th decades of live.…”

“…It is noteworthy that mortality rate was proportional to the duration of delay. The observation that mortality rates of 2.0%, 6.2% and 15.8% occurred in those who presented within 24 hours, 25-48 hours and beyond 48 hours, respectively supports earlier report that the danger lies with the delay and not in the operation (11,16,18,23,26). Other predictors that carried significantly higher risk of post-operative mortality were bowel resection (P = 0.000), high ASA score (P = 0.000) and comorbidities (P =0.041).…”

“…Appendix was the most common indication for emergency laparotomy and the most frequent cause of generalized peritonitis in this study. Hitherto, intestinal obstruction from strangulated external hernias was the most frequent indication in the West African subregion, but an epidemiological shift occurred in favor of appendicitis in a manner akin to the Western pattern (9,11,13,16,(27)(28)(29)(30). The reasons adduced included westernization of lifestyle, increased rates of elective repair of external hernia and general improvement in data documentation and access to surgical care in the sub-region (2,11,13,27).…”

“…Data on emergency abdominal operations in rural southeast Nigeria are scanty and the existing data from urban southeast Nigerian hospitals no longer satisfy the clamor by the World Health Organization (WHO) for robust clinical data on safe surgical and anesthesia care in the district hospitals in developing nations (1,4,8). More so, patients in developing nations (sub-Saharan African countries inclusive) commonly present late to the surgeon after several delays at prehospital stage and delay engendered by late referral by non-surgeon physicians (11,15,16). Therefore, delayed treatment of patients with acute abdominal conditions especially when accompanied with comorbid medical diseases, of which patients are often unaware, make management of abdominal emergencies very challenging in many communities across Africa and other LMICs (1,2,9,13,15).…”

Large Post-Surgical Incisional Hernias: Case Reports and a Review of Barriers Against Early Presentation and Refusal to Consent to Surgery

“…This trend, they attributed to the high cost of treatment and disappointment from previous failed surgeries and repairs. Also, Ogbuanya 12 and colleagues, in a review of 138 patients treated for complicated abdominal wall hernia in rural southeastern Nigeria, reported that the rate of morbidity and mortality is directly related to the length of delay in presentation while implicated financial constraints, conservative treatment by non-surgical health practitioners, feeling that hernia is harmless, management at alternative homes, and the long-distance between home and hospital are barriers militating against early presentation in patients with incisional hernias.…”