Outcome of Emergency Abdominal Surgery at Kigali University Teaching Hospital: A review of 229 cases.

Background: Surgical abdominal emergencies constitute an entity of pathologies requiring immediate medical and surgical management in most of the cases. There is little information regarding the clinical spectrum of disease in these patients and the outcome after admission to hospital. This study was conducted at Kigali University Teaching Hospital (KUTH) and the main objective was to determine the outcome of emergency abdominal surgery at Kigali University Teaching Hospital.
Methods: This was a case series study of 229 patients who underwent emergency abdominal surgery at Kigali University Teaching Hospital over a period of 9 months. Variables analysed included the socio-demographic, clinical features, management and outcome of treatment. The multivariate analysis was applied to different factors to analyze their statistical correlation with mortality and morbidity.
Results: The patients’ ages ranged from 3 months to 87 years with an average of 28.8 years ± 18.2. The male to female sex ratio was 1.7:1.The majority of patients were referred (83.4%). The average time interval between onset of symptoms and admission was 3.6 days. Abdominal pain (100%) and constipation (51.1%) were the commonest complaints and abdominal distension (59%) and tenderness and guarding (45.4%) the most frequent physical findings. Abdominal trauma accounted for 11.8% of the cases. The most common operative findings were peritonitis (41.5%), intestinal obstruction (28.4%) and acute appendicitis (11.8%). Postoperative complications included wound infection (8.7%) and septicaemia (4.8%). The overall mortality was 18%. Variables influencing morbidity and mortality included the transfer (p=0.027), red cell count <4.106 (p = 0.002), haematocrit < 21% (p= 0.023), abnormal leukocytosis (p= 0.008), duration of surgery more than 1 hour (p= 0.034), presence of peritonitis (p = 0.005) and duration of hospitalization >7 days (p = 0.009).
Conclusion: Many patients requiring emergency abdominal surgery presented relatively late with an average of 3.6 days time interval between onset of symptoms and admission, serious attention is needed for these patients because the mortality is high.