Management of Acute Abdominal Emergencies at the Niamey National Hospital

Objectives: The aim of this study was to evaluate the management of surgical acute abdominal emergencies at the National Hospital of Niamey. Methods: Prospective study was conducted in emergency unit of the Niamey National Hospital, from March to September, 2010. Data collected included: age, sex, mean of transportation used, clinical signs, indication of surgery, delay of admission, pre operative check, American Society of Anesthesiologists (ASA) physical status classification, preoperative prescriptions, delay of the intervention, technique of anesthesia, incidents, accidents and the outcome of the patient. Results: The sample included 255 patients. The functional signs were: abdominal pain and vomit. The delay of admission was 72 hours. The radiography of the abdomen has been realized in 58%. Seven patients have an abdominal computed tomography (CT). The indications of surgery were: peritoneal syndrome (38.4%), occlusive syndrome (24.5%) and appendicitis (15.9%). The abdominal contusions represented 10.9%, penetrating wounds 1.9%. The gynecological emergencies represented 2.7%. 54.5% of the patients were classified ASA E 1; 35.3% ASA E 2. The delay of the surgery was 8 hours. 220 patients have been operated. General anesthesia was performed in 94%. Anesthetic drugs used were: ketamine in 94% of cases, fentanyl was the only narcotic available. We have 36 cases of incidents or accidents during the anesthesia (16.3%). The average expenses occurred for the families were US$ 240. Duration of hospitalization average was 12 days and 7.4% of patients were deaths. Conclusion: The management of acute abdominal emergencies at the Niamey represents public health problem, the solution to this problem passed by the empowerment of the people, reforms in the management of emergencies in the peripheral medical centers and medically transportation of the patients. Central Chaibou et al. (2014) Email: Int J Clin Anesthesiol 2(1): 1024 (2014) 2/4 RESULTS The study included 255 patients, 220 of them were been operate (86.2%). Their average age was 27 years, ranging from 3 months to 72 years. 35.7% of patients had between 16 to 30 years. Males represented 73.1%, with a male-to-female ratio of 3:1. Eighty percent of patients came from health centre or districts hospitals, 20% consults directly in the hospital. Sixty percent of our patients were illiterates. Transportation means was taxis in 40.4%, ambulance in 36.4%. The functional signs were: abdominal pains in 98.4% vomit 77.2%, fever in 58.4%, bowel obstruction symptoms in 43.5%. Patients have hemodynamic shock in 34.1%, diarrhea in 16.5% of cases (Figure 1). The average delay of admission was 72 hours (ranged: 1 hour to 90 days). 32.2% of them were admitted in the 24 hours of the starting symptom. We explore the blood count and hemoglobin concentration in 99.2% of the patients, 4.7% of patients have severe anemia. The kidney function has been explored in 11.8%. The radiography of the abdomen without preparation has been realized in 58% and was contributory in 80% of cases, abdominal ultrasound in 16.9% of the cases. Seven patients have an abdominal CT. The diagnosis was: peritonitis (38.4%), occlusion (21.1%) and appendicitis (13.7%). The abdominal trauma represented 12.1% (31 patients: 24 contusions, five penetrating wounds of the abdomen and two no penetrating). The strangulated hernia incidence was 11.7%. Seven gynecological emergencies represented 3.1% (4 extra uterine pregnancy rupture and tree torsions of cyst) (Table 1) . 220 patients have been operated. All received preoperative evaluation. For the anesthesia risk,54.5% of the patients were classified as ASA E class 1; 35.3% ASA E class 2 while 8.2% and 2% of patients were classified as ASA E classes 3 and 4, respectively. In preoperative all received prescription of rehydration and 25 patients have been transfused blood. The delay between admission and surgery was 8 hours and 64.3% have been operated in the 12 hours after admission. General anesthesia was performed in 94%; spinal anesthesia was used in 6% of cases. For general anesthesia 94% of patients received crush induction. The anesthetic drugs used were: ketamine in 84% of cases (one case of used propofol). Fentanyl was the only available narcotic. We have 36 cases of incidents or accidents during the anesthesia (16.3%) including 11 deaths (Figure 2). Among the operated patients 95.4% were been admitted in Postanesthesia Care Unit (PACU) and 4.5% in the Intensive Care Unit (ICU). All patients received postoperative prescriptions of antibiotics and multimodal analgesia. The average expenses incurred for the families were US$ 240. Nineteen patients were deaths (7.4%): one in preoperative period, 11 in the operating room and 7 in postoperative period. The average duration of hospitalization was 12 days.