Peritonitis following unsafe abortion: a retrospective study in a tertiary health facility in North Central Nigeria

Abstract

Introduction surgical complications following unsafe abortion (UA) are not uncommon and are associated with high morbidity and mortality in developing countries. The commonest need for the general surgeon following UA is after a diagnosis of peritonitis which can occur following use of sharp objects introduced through the vagina. This study aims to highlight the presentation, management types and outcome of patients who presented with peritonitis following UA. Methods this study is a retrospective review of cases of peritonitis following UA seen over 4 years from January 2015 to December 2019 in a tertiary health facility in North Central Nigeria. Results a total of 14 patients with peritonitis following UA were included in the study. The mean age of patients who presented was 27.4 years (19-40 years) with a mean estimated gestational age at abortion of 7.8 weeks. The average time from the UA procedure till presentation at the hospital was 8.6 days. There were 9 bowel injuries and 5 pelvic abscesses. A total of 3/9 patients had primary resection and anastomosis while 6/9 had stoma formed as part of their management. Pelvic abscesses were drained. In patients with bowel injury, those who had primary anastomosis had a 100% incidence of enterocutaneous fistula formation with associated sepsis requiring repeat exploration and formation of stoma. Mortality in this group was 67% (2/3) compared to the 0% (0/6) mortality rate seen in patients who had stoma. The overall mortality was four out of fourteen patients (28.6%). Conclusion peritonitis following UA is associated with marked morbidity and mortality as many of the patients present late. Initial preoperative resuscitation and stabilization should be followed by a swift laparotomy. Patients with bowel injury who had primary anastomosis had higher morbidity, reoperation rates and mortality than patients who had stomas.

Unsafe abortions: the plight of the womb

“…This was congruent with findings of other studies. 7 All but 2/16 patients developed surgical site infection after laparotomy. Other studies have shown similar results with rates as high as 73%-93%.…”

“…6 As per study patient spent an average of 7 days before presenting to facility with complications similar to findings of study conducted in Nigeria. 7 It could be due to no awareness on danger signs, financial concerns, stigma associated with abortion, lack of access to gynecologist and ignorance by family. 3,8 In our study, majority (85%) of the patients had an induced abortion, similar to the findings of Chopra et al (84%).…”

“…Other studies have shown similar results with rates as high as 73%-93%. 5,7 Surgical site infection rates are high in the backdrop of sepsis, anemia, immunocompromised state and leads to prolonged hospital stays and in itself is a substantial burden on economy. 10 The percentage mortality among study participants was 25% less than that of Adenuga et al who described a case series on post abortal patients managed jointly by surgery and gynecology team where mortality was 28%.…”

Fulminant Peritonitis Following Second Trimester Spontaneous Abortion; Case Report, 2023

“…These unskilled personnel use unsanitary sharp instruments, exposing patients to the highest form of injury and trauma. There is no consensus on the particular procedure to be done in the setting of bowel injury following unsafe abortion [4].…”

“…Complications like peritonitis, endo-septic shock, renal failure and disseminated intravascular coagulation may endanger life following severe post-abortal sepsis [3]. Perforation of the uterus and entry into the peritoneal cavity with these heavily contaminated devices/ agents kickstarts a long and turbulent septic illness which may require the intervention of the general surgeon [4]. A rare fatal combination of disseminated tuberculosis peritonitis and ARDS following spontaneous abortion was reported [5].…”