PRISE EN CHARGE DES URGENCES CHIRURGICALES DIGESTIVES : ETUDE PROSPECTIVE A PROPOS DE 118 CAS
Authors: TENDENG, et al... JN 
Published: August 2024

INTRODUCTION Abdominal emergencies are any acute abdominal conditions requiring a quick surgical response. The abdominal emergencies require accurate diagnosis and treatment within a particular time limit to prevent mortality. They constitute a major part of the visceralist surgeon's activity in sub-Saharan Africa. They are still burdened with significant morbidity and mortality. The purpose of this study was to determine the prognostic factors of morbi mortality during the management of non-traumatic abdominal emergencies of the adult. MATERIALS AND METHODS We made a prospective, descriptive and analytical study over 1 year from May 1, 2017 to April 31, 2018 carried out at Saint-Louis regional hospital. All patients, aged at least 16 years old and received in an acute abdominal surgical nontraumatic table were included. Results were analyzed with Epi-Info 7; focused on sociodemographic, clinical, paraclinical, therapeutic and evolutionary data. Findings were significant if the p-value was less than 0,05 RESULTS 118 patients were included in our study, representing 39.5% of digestive surgery procedures. The average age of our patients was 35.9 years with extremes of 16 and 90 years and a standard deviation of 18.1. The sex ratio was 3.9. The average consultation time was 3.5 days. The delay of surgery was 18 hours with extremes of 05h to 10 days. There were 15.3% (n = 18) of comorbidity. Abdominal pain was the most common clinical sign (96.6%). Plain abdominal xray was the most prescribed imaging test (50%) followed by ultrasound (30.8%) and CT (19.2%). Acute bowel obstruction was the most common diagnosis 51 (43.2%) followed by acute peritonitis 33 (28%), appendicitis 23 (19.5%) and strangulated hernias 11 (9.3%). The initial diagnosis tallied at 97.4% with per operative diagnosis. Sigmoid volvulus represented 55% of occlusions, 54.5% of peritonitis was of appendicular origin, and 45.5% of strangulated hernias were inguinal. There were 23 (19.5%) cases of anesthetic incidents. There were 22 hemodynamic instabilities, 4 of which required the use of amines. There were 19 cases of surgical complications, 20.9% of operated patients, dominated by parietal suppuration (15 cases) and postoperative peritonitis (4 cases). Factors influencing this morbidity were: consultation delay (p = 0.02), comorbidity (p = 0.0006), and duration of surgery (p = 0.02). In addition, there was no significant relationship between the delay of intervention and morbidity. The mortality rate was 8.5% (10 cases including 7 occlusions) usually related to septic shock (90%). Mortality was significantly related to age (p = 0.01), consultation delay (p = 0.01), comorbidity (p = 0.00004), diagnosis of acute intestinal obstruction (p = 0.04) and perioperative hemodynamic instability (p = 0.04). CONCLUSION The management of surgical acute abdomens in Saint-Louis remains still intact. Morbidity and mortality factors are dominated by delayed consultation and comorbidity. However, improving the prognosis during adult non-traumatic abdominal emergencies requires consciousness-raising and multidisciplinary. KEYWORDS: morbidity, mortality, acute abdomen, Saint-Louis