Acute Peritonitis Generalized at the Koutiala Reference Health Center, Mali: Epidemiological, Etiological and Therapeutic Aspects

Abstract

History: In Mali, several studies have been carried out on acute peritonitis but in the Koutiala circle it is a first. Aim: To evaluate the epidemiological, etiological and therapeutic aspects of generalized acute peritonitis at the Koutiala reference health center. Method: This was a 14-month prospective and descriptive study from August 1, 2017 to November 30, 2019, covering all patients admitted and operated for generalized acute peritonitis. The parameters studied were age, sex, frequency, clinical aspects, etiologies, treatment and postoperative operations. Result: The number was 93 cases, 72 men and 21 women. The average age was 34.2 years (Extremes: 2 - 75 years). The hospital frequency was 2.0%. The incidence rate of generalized acute peritonitis in the circle was 12.4 cases per 100,000 population. The clinical picture was still of peritonitis. The Widal-Félix serology was positive in 19 cases. Perioperative bacteriological sampling was systematic. The etiologies were dominated by digestive perforations in 81 cases (87%) of which 33 were located at the ileal level, postoperative peritonitis (6 cases) and ruptured pyocholecyst (2 cases). There were also 3 cases of primary peritonitis and 1 case of gynecological peritonitis. Excision-suturing was the most used surgical technique with 35.5% (n = 33). Postoperatively, we identified 10 cases of parietal suppuration (10.8%), 6 cases of postoperative peritonitis (6.5%), 2 cases of external digestive fistula (2.2%) and 7 cases of death (7.5%). Conclusion: Acute peritonitis occupies second place in abdominal surgical emergencies in the Koutiala circle. The etiologies are multiple and varied and are dominated by the ileal perforation which is secondary to typhoid fever more often. In most cases the surgical treatment is done by excision-suturing of the perforation. Mortality and morbidity remain high.