L. Ndayizeye1,3, C. Ngarambe1,3, B. Smart5, R. Riviello1,2, J. Majyambere4, J. Rickard1,2 1University Teaching Hospital Of Kigali,Kigali, , Rwanda 2Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 3University of Rwanda,College Of Medicine And Health Sciences,Kigali, , Rwanda 4Kibungo Referral Hospital,Kibungo, , Rwanda 5Rush University Medical Center,Chicago, IL, USA
Introduction:
Peritonitis is a common surgical emergency, but there are few studies detailing causes and outcomes of peritonitis in low- and middle-income countries. This study sought to describe the epidemiology and outcomes of patients undergoing operation for peritonitis at a major referral hospital in Rwanda.
Methods:
This report describes data on all patients presenting to a Rwandan referral hospital with clinical features of peritonitis over a six-month period. Data were collected on demographics, clinical presentation, laboratory and radiographic studies, operative findings, and complications. The primary goal was to describe the epidemiology and etiology of peritonitis at a referral hospital in Rwanda.
Results:
There were 281 patients presenting with peritonitis over a six-month period of which 217 (77%) were adult and 64 (23%) were pediatric. Most patients were male (68%). Localized peritonitis accounted for 32% of cases while 68% were generalized. 72 (26%) of patients presented to the hospital with symptoms lasting for more than a week. The most common cause of peritonitis was intestinal obstruction (39%), followed by appendicitis (17%) and trauma (14%). Females were more likely to be diagnosed with appendicitis (29% versus 10%, p<0.001) or tumor (7.8% versus 2.6%, p=0.046) whereas males were more likely to be diagnosed with a traumatic injury (18% versus 4%, p=0.002) or peptic ulcer perforation (210% versus 3%, p=0.042). 46 (16%) patients were admitted to the intensive care unit postoperatively and 27 (10%) patients required vasopressors. The mean length of hospital stay was 9.8 days (standard deviation 9.1). Major complications were seen in 25% of patients, with 36 (13%) patients requiring a return to the operating room. The post-operative mortality rate was 17%.
Conclusion:
Peritonitis is a common surgical emergency in Rwanda and patients presenting with peritonitis have a relatively high morbidity and mortality. In contrast to reports from high-income countries, peritonitis was most commonly associated with intestinal obstruction, appendicitis and trauma. Many patients presented in a delayed fashion, with symptoms for over a week. Focusing interventions on early recognition and management in these patients could potentially improve outcomes.