Management of surgical abdominal emergencies in Kara teaching hospital (Togo): 10-year retrospective study of 594 cases

Purpose: The aim of this study was to describe the epidemiologic, diagnostic, and therapeutic aspects of surgical abdominal emergencies in a teaching hospital in a developing country (Togo). Material and Method: This retrospective study included the medical files of all patients managed for surgical abdominal emergencies from March 1, 2002, to March 1, 2012. Results: The study included 594 patients, with a mean age of 30.3 years (range: 1 month to 80 years) and a 2.1 male: female sex ratio. The emergencies were acute generalized peritonitis (54.5%), intestinal obstruction (26.6%), acute appendicitis (14.5%), and abdominal trauma (4.4%). Plain abdominal radiographs were taken for 414 patients with acute generalized peritonitis (324 cases) and intestinal obstructions without a strangulated hernia (90 cases). Nine patients had abdominal ultrasounds for abdominal trauma (5 cases) and appendicular abscess (4 cases). No abdominal CT scan was performed. All patients underwent surgery, 316 (53.2%) by physician assistants and 278 (46.8%) by surgeons. Resuscitation and anesthesia were performed by nurse-anesthetists. The postoperative course was complicated in 182 cases (30.7%). These complications included parietal suppurations (18.2%), eviscerations (5.1%), ileal fistulas (4.4%), and postoperative peritonitis (3%). The death rate was 11.4%. Conclusion: Surgical abdominal emergencies at the Kara teaching hospital were both common and serious. Their particularly high morbidity and mortality might be reduced through the adoption of reasonably practicable measures: paramedical personnel training, public awareness, establishment of management protocols, and improvement of technical equipment (laboratory).