Urgences chirurgicales digestives en Afrique subsaharienne : étude prospective d’une série de 622 patients à l’Hôpital national de Zinder, Niger

Abstract

The purpose of this study was to describe the epidemiologic, therapeutic, and prognostic aspects of surgical acute abdomen at the National Hospital of Zinder (HNZ). This was a prospective study of patients undergoing digestive surgical emergencies in HNZ over 24 months (January 2013-December 2014). During the study period, 622 digestive surgical emergencies were operated. The mean age was 22.91 ± 18.14 years old, with a sex-ratio of 3:1. The average admission time was 64.31 ± 57.90 h. Abdominal pain was the main reason for admission in 61.90% (N = 385) of the cases, with or without fever throughout the course in 26.05% (N = 162) of the cases. The average time before surgery was 9.13 ± 5.97 h. Acute peritonitis accounted for 51.61% (N = 321) of cases, led by ileal perforation maybe from typhoid (N = 175). The acute intestinal obstruction and acute appendicitis accounted for 27.49% (N = 171) and 9.65% (N = 60) of the cases, respectively. Abdominal trauma had affected 53 patients (8.52%). The average length of hospital stay was 8.71 ± 5.29 days. Postoperative morbidity was 38.10% (N = 237). Septic complications (N = 187) were predominant. Overall lethality of 13.67% (N = 85), was associated with the delay of diagnosis and treatment (P < 0.001). The incidence and the high morbidity and lethality of digestive surgical emergencies in the Sub-Saharan context, could be avoided through prevention, early consultation, and adequate intra-hospital management.

Acute mechanical intestinal obstruction in children at zinder national hospital, Niger: Aetiologies and prognosis

“…Indeed, the process of care is related to several factors such as availability of blood products, delays in getting relevant laboratory results, the financial capacity of parents to honour prescriptions, inadequate technical facilities and staff negligence in the care chain. [ 4 10 14 ] This observation was made by other African studies on digestive surgical emergencies in children. [ 2 3 8 12 21 23 ]…”

“…In sub-Saharan African and tropical countries, children with AMIO were often admitted with delay. [ 2 3 4 8 10 14 23 ] If in advanced countries, the prognosis of bowel obstruction was significantly improved, in sub-Saharan African countries, from various series, lack of diagnostic capabilities may also be a contributor to high morbidity and mortality. [ 2 3 8 12 24 ] Early admission to hospital results in early diagnosis and adequate surgical management which lead to a better prognosis of AMIO.…”

“…[ 6 9 17 24 ] In this study, case fatality due to intussusception exceeds 20%; this confirms earlier data in Niger. [ 4 14 24 ] The delay of diagnosis and presentation might be factors to the poorer outcome of patients with intussusceptions. [ 14 15 16 17 21 23 24 25 ]…”

“…Acute intestinal obstruction (AIO) in children is a common cause of paediatric surgical emergency. [ 1 2 3 4 ] Causes of AIO not only vary from neonatal period to older children but also based on geographical distribution. [ 3 5 6 ] In the advanced countries, the prognosis is improved by rapid diagnosis and quality of perioperative care.…”

“…[ 3 6 7 8 ] Contrariwise, in sub-Saharan Africa and other developing countries, delay in admission or management, lack of neonatal and paediatric intensive care, hard access to hospital and limited resources have been responsible for the poor prognosis of AIO. [ 1 2 3 4 5 8 9 10 ] The aim of this study was to describe the aetiological and prognostic aspects of acute mechanical intestinal obstruction (AMIO) in children at Zinder National Hospital (ZNH) (Niger).…”