Emergency laparotomy at district hospitals in a developing nation: a review of indications and outcomes of treatment

Recently, emergency and essential surgical and anesthesia care at district hospitals is increasingly gaining recognition as a critical, though neglected element of health care system in Africa and other developing nations. Emergency laparotomy is a versatile procedure that can cure a great deal of acute abdominal conditions. The aim of this study was to document the indications and outcomes of laparotomy for emergency abdominal surgical conditions in our district hospitals.

This retrospective study was undertaken in district hospitals from January 2009 to December 2018. Associations between different variables were measured and compared using statistical tests of significance.

Of the 879 patients evaluated, appendicitis (n=361, 41.1%) was the most frequent indication for emergency laparotomy followed by complicated external hernias (n=120, 13.7%). Other indications were adhesive intestinal obstruction (n=111, 12.6%), typhoid perforation (n=98, 11.1%), perforated peptic ulcer (n=89, 10.1%), trauma (n=58, 6.6%), colorectal cancer (CRC) (n=18, 2.0%) and others (n=24, 2.8%). The vast majority of patients (n=726, 82.6%) were presented after 24 hours of the onset of disease. Approximately, one-third of patients (n=278, 31.6%) had comorbidities, 867 (98.6%) had high ASA scores (III and IV) and 105 (11.9%) received intestinal resection with or without stoma. The main independent predictors of mortality were late presentation (P=0.003), generalized peritonitis (P=0.001), bowel resection (P=0.000) and high ASA (III and IV) scores (P=0.000). Overall, the mortality rate was 10.6%. The commonest complication was wound infection (39.7%), followed by intra-abdominal collection (10.0%).

The most common indication for emergency laparotomy was appendicitis followed by complicated hernias. The major independent predictors of mortality included bowel resection, high ASA score, late presentation and generalized peritonitis.