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.
Citation
Degree of Master In Medicine(Surgery)Publisher
University of Nairobi School of Medicine
Description
A thesis submitted in part fulfillment for the Degree
of Master In Medicine(Surgery) University Of Nairobi