The pattern of emergency laparotomies in the division of surgery at Kenya-tta National Hospital

Abstract

371 patients' files for patients who had undergone emergency laparotomy in the division of surgery Kenyatta National Hospital between 1st July 1989 and 30th June 1990 were reviewed to determine the pattern of indications for laparotomy. Appendicitis was the commonest (32.3%) indication followed by trauma (19.94%) and intestinal obstruction (15.3%). The male to female ratio was 1.5:1. A prospective study of 120 patients who had emergency laparotomies done on them were also studied. In these Appendicitis accounted for 37.5%, intestinal obstruction 28.3% and abdominal trauma 22.5%. Perforated duodenal ulcer accounted for 6.6%. Other less common indications included ascitis and peritonitis. Of the 45 patients with appendicitis 28 had appendicitis only (62.5%), 9 had a ruptured appendix (20%), 6 had an appendicular abscess (13.3%) and 2 had an appendicular mass (4.5%). The diagnosis of appendicitis was mainly clinical due to limitations of available investigations.

Intestinal obstruction occurred because of adhesion and bands and sigmoid volvulus in 8 patients each, intussusception 9 patients, due to worms 3, strangulated hernia 2 patients, colorectal tumours 2, and anorectal malformations 2 patients. Intussusception was mainly a paediatric problem, 6 of the patients being children of less than 5 years. The children got ileocaecal intussusception while the adults got ileoileal intussusception. X-rays were very helpful in diagnosing intestinal obstruction due to the various causes. They were not very helpful in appendicitis. Most of the patients operated on because of adhesions and bands were young, all being of less than 50 years of age. One patient developed a faecal fistula postoperatively. Sigmoid volvulus occurred in 8 patients all of who were males. 3 patients had ileo sigmoid knotting and 3 had simple volvulus. One patient died postoperatively. X-rays showed the signs of sigmoid volvulus in 4 patients. Mean age of presentation was 32.25 years. SigmoidoscoPY was not done due to non availability of a sigmoidoscope. Various forms of treatment were given. These were derotations alone,

resections and primary anastomosis, resections plus a Hartmans colostomy, and resections plus double barrel colostomy. Adhesion and bands occurred in 8 patients, 5 males and 3 females. The oldest was 40 years old and the youngest 3~ years. 2 patients had gangrenous small bowel at laparotomy and 3 had perforations. Postoperatively 1 patient developed a faecal fistula. other causes of inguinal hernia malformations 2. intestinal obstruction were strangulated 3, colorectal tumours 2, and anorectal Abdominal trauma occurred in 27 patients, 23 of them males and 3 females. 20 of them were due to assault, 3 due to road traffic accidents and 4 due to domestic acciden-ts. The highest incidence was in the 20-29 years age group. Two patients operated on due to abdominal- trauma following severe shock from the initial haemorrhage. average hospital stay was 10-92 days. died The Perforated duodenal ulcer accounted for 6.67% of the emergency laparotomies done. All patients were between 30 and 44 years of age with a mean of 33.75 years. Plain abdominal X-rays

diaphragm in one patient. One patient a perforated duodenal ulcer died postoperatively because of shock. The patient was already in shock preoperatively. other indications for laparotomy done as an emergency included retroperitoneal abscess peritonitis and ascitis, each with two patients. The two patients operated for retroperitoneal abscess were children aged 8 and 9 years respectively. In one patient the retroperitoneal abscess followed perineal injury. In the second patient the cause was not known. Two patients originally thought to have intestinal obstruction were on laparotomy found to have only ascitis. This constituted a negative laparotomy. One of the patients died. Two patients were found to have peritonitis at laparotomy. The cause of the peritonitis could not be established although the patient was later found to be HIV positive and could have had primary peritonitis.