Predictors Of Relaparotomy For Persisting Intra Abdominal Infection In Secondary Peritonitis
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Date
2020-11
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Addis Abeba University
Abstract
Introduction: Peritonitis is one of the commonest causes of acute abdomen in Ethiopia with
high mortality and morbidity. One of the causes of high morbidity and mortality is persistent
intraabdominal infection. Persistent intraabdominal infection is usually managed by
relaparotomy in our setup. The two essential approaches for managing post op collection are
RL on-demand (“wait and see” approach) and planned RL. Despite multiple studies, both have
comparative mortality. These makes management of persistent intraabdominal infection
challenging. This study aimed to identify Preoperative and intra operative clinical variables that
are predictive of persistent intraabdominal infection.
Objectives: The aim of this study is to identify preoperative and intraoperative clinical factors
that may predict the need for relaparotomy in patients with complex intra-abdominal sepsis, in
order to assist clinicians to decide timely intervention.
Methods: A retrospective cross-sectional study was conducted on 172 cases of patients who
were operated from Sept, 2018 to April , 2020 at two affiliated referral hospital of AAU, collage
of Medicine, Addis Ababa; Yekatit 12 referral hospital and Minilik II referral Hospital. All of
patients were cases of secondary peritonitis. Clinical progress of the patients from admission to
discharge/death was documented. More than 20 preoperatve and intraoperative variables
were analyzed to identify predictive model using logistic regression analysis.
Results: Out of 172 patients with peritonitis included in this study, 70.9% were males. The
Median age group of patients was 25 yrs. 82% of patients were referred from Addis Ababa
(within the city). The median length of time from the onset of symptoms to seeking medical
care was 3 days. The most common cause of secondary peritonitis was complicated
appendicitis (52.9%), followed by perforated PUD (33.1%). Out of 172 laparotomy cases for
secondary peritonitis, 40 (23.3%) required relaparotomy for postop collection. From Patients
who developed postop collection, 45% of them were diagnosed after pus/Gi content leaked
through the surgical wound. In Our study, the mortality rate of patients who develop postop
collection and undergone relaparotomy was 27.5 % and 4.5% for those without postop
collection. Logistic regression identified the following 4 variables as having strong predictive
value: Duration of illness more than 5 days, Systolic BP </= 90 mmHg, Amount of peritoneal
fluid > 1000 ml and small bowel as source of contamination
Conclusion: Management of persistent intra-abdominal infection is challenging. Sign and
symptoms of persistent intra-abdominal infection are subtle, resulting late diagnosis after onset
of MODS. Delay in diagnosis results in high mortality and morbidity. We have identified 4
preoperative and intraoperative variables available at first laparotomy to predict persistant
intraabdominal infection requiring relaparotomy. These sets of variables can be a mile stone for
future validation study before inserted into day to day clinical practice
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Keywords
Relaparotomy , Abdominal Infection