dc.contributor.author | Nyaga, Patrick N | |
dc.date.accessioned | 2013-05-24T07:46:03Z | |
dc.date.available | 2013-05-24T07:46:03Z | |
dc.date.issued | 2009 | |
dc.identifier.citation | Master of medicine (surgery) | en |
dc.identifier.uri | http://erepository.uonbi.ac.ke:8080/xmlui/handle/11295/25174 | |
dc.description.abstract | Introduction
Unlike simple acute appendicitis, complicated appendicitis is challenging in
management and outcome unpredictable. Controversies surround some
aspects of its management like the right timing and type surgical
intervention, the antibiotics use and peritoneal drainage. This study focuses
on use of peritoneal drains post appendectomy.
Objective
To evaluate the management of complicated appendicitis at Kenyatta
national hospital and determine the value of peritoneal drains post
appendectomy in patients with various stages of complicated appendicitis.
Methodology
Patients suspected to have acute appendicitis were recruited from casualty
and admitting surgical wards. In theatre those with complicated acute
appendicitis were stratified according to the degree of peritoneal
contamination. All those with complicated acute appendicitis without
generalized peritonitis were randomized to two comparison groups; drains or
no drains. All patients received similar treatment in all other aspects; they
were followed up for complications, duration of antibiotic use and length of
hospital stay. Statistical analysis was used to compare the two groups.
Results
Over one year period, 216 patients were evaluated. 97 had various stages of
complicated acute appendicitis, 90 were randomized. Two patients died; one
of them had severe sepsis and the other developed pulmonary complications
post operation.
18 patients had wound sepsis, 6 patients had other complications including
fecal fistulae, abdominal abscess, and paralytic ileus. Out of those with
wound sepsis, 830/0 were of the drain group and 170/0 of the no drain group.
All patients with other complications were of the drain group. The patients
in the drain group had significantly longer duration of antibiotic use and
hospital stay.
Conclusions
Immediate surgical intervention, after resuscitation and with antibiotics is
the main mode of management of complicated appendicitis at Kenyatta
national hospital. The findings in this study do not lend any support for use
of drains post appendectomy in some stages of advanced appendicitis. The
management and role of drains in perforated acute appendicitis with
generalized appendicitis needs further review. | en |
dc.description.sponsorship | University of Nairobi | en |
dc.language.iso | en | en |
dc.title | The value of peritoneal drains in perforated appendicitis at Kenyatta National Hospital | en |
dc.type | Thesis | en |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |