Comparative analysis of primary repair vs resection and anastomosis, with laparostomy, in management of typhoid intestinal perforation: results of a rural hospital in northwestern Benin

BACKGROUND: The objective is to compare primary repair vs intestinal resection in cases of intestinal typhoid perforations. In addition, we hypothesised the usefulness of laparostomy for the early diagnosis and treatment of complications. METHODS: 111 patients with acute peritonitis underwent emergency laparotomy: number of perforations, distance of perforations from the ileocaecal valve, and type of surgery performed were recorded. A laparostomy was then created and explored every 48 to 72 hours. The patients were then divided into two groups according to the surgical technique adopted at the initial laparotomy: primary repair (Group A) or intestinal resection with anastomosis (Group B). Clinical data, intraoperative findings, complications and mortality were evaluated and compared for each group. RESULTS: In 104/111 patients we found intestinal perforations, multiple in 47.1% of patients. 75 had primary repair (Group A) and 26 had intestinal resection with anastomosis (Group B). Group B patients had more perforations than patients in Group A (p = 0.0001). At laparostomy revision, the incidence of anastomotic dehiscence was greater than that of primary repair dehiscence (p = 0.032). The incidence of new perforations was greater in Group B than in Group A (p = 0.01). Group B correlates with a higher morbility and with a higher number of laparostomy revisions than Group A (p = 0.005). There was no statistical difference in terms of mortality between Group A and Group B. Presence of pus in the abdominal cavity at initial laparotomy correlates with significantly higher mortality (p = 0.0001). CONCLUSIONS: Resection and anastomosis shows greater morbidity than primary repair. Laparostomy revision makes it possible to rapidly identify new perforations and anastomotic or primary repair dehiscences; although this approach may seem aggressive, the number of operations was greater in patients who had a favourable outcome, and does not correlate with mortality

Mannheim Peritonitis Index: usefulness in a context with limited resources: Prognosis of acute peritonitis.

Background: The objective of this study is to evaluate the Mannheim Peritonitis Index (MPI) usefulness for acute generalized peritonitis management in a clinical limited resources context. Methods: This is a prospective study from 1 January to 31 October 2019 including patients admitted to a sub-saharan hospital for acute generalized peritonitis. Perioperative variables and outcomes were considered. Results:  70 patients were included. Mean age was 32.6 ± 14.6 years with a sex ratio of 1.33. The mean time to patients’ hospital admission was 3.9 ± 2.1 days. Most patients had ileal and gastric perforations (27.1% and 18.6%). Twenty six patients (37.1%) developed complications and thirty-day mortality rate was 14.3%. Positive predictive value of MPI was 63.6% and negative predictive value was 83, 8%. Sensitivity of MPI ≥ 26 was 77.8%; Specificity of MPI < 25 was 72.1%. Conclusion This experience shows that MPI is a good predictor of morbidity and mortality for patients with acute peritonitis even in a difficult context with few resources and many patients. Identifying the most critical patients, a more careful surgical staff involvement may improve patients outcome

Epidemiological, Clinical and Therapeutic Features of Bacterial Dermohypodermatitis and Necrotizing Fasciitis in a Municipality of Northern Benin

Background: Dermohypodermatitis is an infectious skin disease affecting dermis and hypodermis, often caused by bacteria. In Benin, these infections are frequent in the northern region, especially in Atacora municipality. Objective: The current study aims to investigate through a multicenter data collection, the epidemiological, clinical and therapeutic features of bacterial dermohypodermatitis and necrotizing fasciitis in Atacora prefecturemunicipality in Benin. Method: This was a prospective cross-sectional study with descriptive and analytical purposes carried out from February to July 2021 (six months) in the general surgery services of three hospitals in Atacora municipality. Patients were at least 15 years old and diagnosed for non-necrotizing dermohypodermatitis, necrotizing dermohypodermatitis or necrotizing fasciitis. Results: A total of 48 cases of dermohypodermatitis were recorded throughout the study period. The mean age of the patients was 36 ± 13 years. The sex-ratio (male-out of-female) was 1.4. Farmers accounted for 43.75% of the cases. The median time from the symptoms onset to patient admission into a health care center was 14 days. A disease entry was found in 81.25% of cases, dominated by neglected traumatic wounds (72.92%). The pelvic limb was the most affected (89.58%). Necrotizing forms predominated in two-thirds of the cases (66.67%). The mean LRINEC score was 6 ± 1.08. The common bacteria isolated after swabbing were: Staphylococcus aureus, Pseudomonas aeruginosa, Peptostreptococcus anaerobius, Streptococcus pyogenes, Proteus mirabilis and Escherichia coli. Surgical excision of necrotic tissue was performed in 68.75% of patients with a necrotizing form and 40.62% of them have undergone a thin skin grafting afterwards. The hospital stay averaged 36 days [minimum and maximum, 4 and 139 days, respectively]. Mortality rate was 4.17% and sequelae, 9.76%. NSAIDs use (p=0.000), traditional treatment prior to admission into a health care center .....</jats:p

Surveillance of surgical site infections. An emergency in Saint John of God Regional Hospital of Northem in Republic of Benin

Surveillance of surgical site infections: an emergency in Saint John of God regional hospital of Northern in Republic of BeninIntroduction: The patient’s endogenous source is mostly involved in the occurrence of surgical site infections1 (SSI). Exogenous contamination is less frequent. Objectives: - Determine the incidence of SSI in Caesarean parturient - Identify the causative germs. Methods: This is a prospective cohort study with real-time data collection, including Caesarean parturients from 01 February to 30 May 2014 and 2015. The follow-up with phone calls was provided up to +30 days. In case of suspicion of an SSI, samples for cytobacteriological examination of the liquid coming from the superficial or deep part of the incision have been realized. The data was entered and evaluated using Epi info6 software. Results: The incidence rate in 2014 is 16.72% (52/311) and 4.7% (14/ 300) in 2015. Third generation cephalosporins were used in 87.2% (472/541) for antibiotic prophylaxis. The SSI occurred after the exit of the parturients in 72.7% of the cases, 42 (63.6%) cases benefited cytobacteriological analysis from purulent secretions. The examination returned positive in 43% (18/42) of the cases, 57% (24/42) were decapitated (sampling after an average delay of antibiotic therapy of 6.9 ± 2.8 days). 20 germs were isolated, predominantly monomicrobial (88.9%), 65% were Gram-positive cocci: staphylococcus aureus accounted for 45% of the isolated germs including MRSA followed by Streptococcus agalactiae in 20%, no strain of staphylococcal coagulase has been found. Gram-negative bacilli represent 35%: 71.4% are enterobacteriaceae, 40% of which are extended-spectrum beta-lactamase (ESBL), Escherichia coli was isolated in 10%, the same for pseudomonas aeruginosa (without any resistance). Conclusion: The endogenous flora is responsible for the majority of documented SSI, whether through poor skin preparation or aseptic error, but the emergence of ESBL is linked to the use of broadspectrum antibiotics. This requires clinical, microbiological and therapeutic vigilance in view of their specific resistance profile to antibiotics