Epidemiological study of peritonitis among children and factors predicting mortality at a tertiary referral hospital in Rwanda

Abstract

Background: Peritonitis is a commonly encountered paediatric surgical emergency. We conducted this study to identify common causes of peritonitis among Rwandan children and factors affecting morbidity and mortality. Methods: The study sample consisted of children with peritonitis who underwent surgical treatment at a tertiary referral hospital in Rwanda from 1 September 2015 to 28 February 2016. Collected data included sociodemographic, clinical, paraclinical, management, and outcome information. The analysis included Pearson's chi-square test and multivariate logistic regression to determine factors associated with morbidity and mortality.Results : Of 63 patients, 28 were female. Ages ranged from 4 months to 15 years, with a mean of 8.8 years. Seventy-three percent of patients presented within the first week of symptom onset. Appendicular perforation (25.4%) and gangrenous intussusception (23.8%) were the most common causes of peritonitis. = 7.38; 95% CI = 1.20 to 45.3; P = 0.031). Fourteen patients (22.2%) died. On multivariate analysis, factors associated with mortality included sepsis (odds ratio [OR] = 11.60; 95% confidence interval [CI] = 2.15 to 62.5; P = 0.004) and intensive care unit (ICU) admission (OR Conclusions: Peritonitis among children is common and bears significant morbidity and mortality at our centre. Training of healthcare providers in district hospitals for early recognition of peritonitis, and improved ICU care availability may reduce mortality secondary to peritonitis in children.

Epidemiology and Management of Peritonitis at a Rural Hospital in Zambia

“…In cases of necrosis or dubious viability of the intestinal wall, the affected segment was resected. Peritonitis is a commonly seen surgical emergency on the African continent as well as in other countries (1,2,4). In this study, the principal etiological factors leading to the development of peritonitis were perforation of peptic ulcer (22.7%), acute appendicitis (21.9%), PID (18.5%) and spontaneous perforation of the small bowel (13.5%).…”

“…Wound infection is the most common postoperative complication in patients with peritonitis (20), and it ranges from superficial collection of pus to severe necrotizing infection. Rates for wound sepsis vary significantly from country to country, from 8 to 71.4% (4,21). In this study, postoperative wound sepsis developed in 16.9% of patients (22/130).…”

“…There is a paucity of research on complicated intra-abdominal infection in central and southern Africa. Second, studies originating from developing countries produce data predominantly from the tertiary referral hospitals of metropolitan areas (4,5). As a result, the rural population, which dominates in the developing countries, becomes under-represented in research with only isolated articles published (6)(7)(8).…”

A Critically Ill Child with Gangrenous Appendicitis Masquerading as Hollow Viscous Perforation

“…Peritonitis in children is a well-established entity, and appendicular perforation as a cause is also widely known [4,5]. The temporal profile in the natural history of appendicitis results in various stages of inflammation including complications like gangrene and perforation, the prediction of which is not easy [1].…”