Predictors Of Relaparotomy For Persisting Intra Abdominal Infection In Secondary Peritonitis
| dc.contributor.advisor | Dr.T/Selase, Henock (General Surgeon, Assistant Professor) | |
| dc.contributor.author | Shiferaw, Abel | |
| dc.date.accessioned | 2021-01-31T06:59:02Z | |
| dc.date.accessioned | 2023-11-05T09:31:22Z | |
| dc.date.available | 2021-01-31T06:59:02Z | |
| dc.date.available | 2023-11-05T09:31:22Z | |
| dc.date.issued | 2020-11 | |
| dc.description.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 | en_US |
| dc.identifier.uri | http://etd.aau.edu.et/handle/123456789/24886 | |
| dc.language.iso | en_US | en_US |
| dc.publisher | Addis Abeba University | en_US |
| dc.subject | Relaparotomy , Abdominal Infection | en_US |
| dc.title | Predictors Of Relaparotomy For Persisting Intra Abdominal Infection In Secondary Peritonitis | en_US |
| dc.type | Thesis | en_US |