Morbidity and mortality of Hartmann's procedure for sigmoid volvulus at the University Hospital of Cocody, Abidjan.

BACKGROUND: The restoration of intestinal continuity following Hartmann's procedure is associated with high morbidity and mortality rates and low restoration rate. OBJECTIVE: To determine the causes of complications and deaths associated with Hartmann's procedure and the secondary restoration of digestive continuity for sigmoid volvulus. METHODS: This was a retrospective study involving 25 patients treated for sigmoid volvulus according to Hartmann's procedure, from January 1998 to January 2008; at the Cocody university hospital, Abidjan (Cote d'Ivoire). The mortality and morbidity rates were assessed on the basis of the age, the duration of illness, the ASA (American Society of Anesthesiologists) score, the state of the sigmoid colon and peritoneal cavity. RESULTS: The mean age of the patients was 42.52 years (range: 22-77 years). The mean duration of illness was 02.80± 0.71 days (range: 06 hours to 07 days). Sixteen (64%) of the patients had an ASA score lower than III. The mean length of intervention was 209.75 min.±102.530 min. (range: 120 min. to 327 min). The mortality rate was 12% (n=3) in the Hartmann's procedure. The necrosis state of the sigmoid colon was not significantly associated with a higher death risk (p=0.071) but the contamination of the peritoneal cavity by stools (p=0.001) or an ASA score ≥3 (p=0.036) was significantly associated with a higher death risk. Infections of the operative site (42.86%) were the most common complications. The mean length of hospital stay was 12.05 ± 25.45 days. Eleven patients (50%) out of 22 had the intestinal continuity restored. The median time of restoration was 3.43 months (range: 3-12 months).The mortality rate among the restoration group was nil and the morbidity rate was 27.27% represented by parietal suppurations only. The mean length of hospital stay was 14 ± 2.83 days. CONCLUSION: Hartmann's procedure remains associated with an significant mortality. Morbidity, essentially arises from infections of the operative site. However the restoration of the intestinal continuity remains a sure intervention with an acceptable morbidity.

[Nontraumatic digestive surgical emergencies in elderly patients at the Cocody University Hospital Center in Abidjan, Côte d'Ivoire: etiology and outcome]. / Urgences abdominates digestives non traumatiques chez les sujets âgés au CHU de Cocody à abidjan, Côte d'Ivoire: étiologies et résultats thérapeutiques.

OBJECTIVES: The purpose of this retrospective report is to describe etiologies and therapeutic outcomes of nontraumatic abdominal surgical emergencies in elderly patients. MATERIAL AND METHODS: The charts of patients aged 60 years or more who underwent emergency surgery for nontraumatic abdominal disorders at a Teaching Hospital in Abidjan, Cote d'Ivoire from August 1998 to July 2008 were reviewed. Demographic data, clinical findings, operative protocols, and postoperative outcomes were noted. RESULTS: A total of 137 patients with a mean age of 68.3 years (range, 60-93 years) underwent emergency surgery for nontraumatic abdominal disorders during the study period. The underlying etiologies were strangulated hernia (n = 40), abdominal parietal abscess (n = 6), bowel obstruction (n = 32), acute diffuse peritonitis (n = 29), acute appendicitis (n = 23), acute cholecystitis (n = 6) and massive rectorragy from colonic diverticulitis (n = 1). Coexisting medical problems (n = 84) were noted in 69 patients. Surgical procedures were tailored to operative findings. Twenty-seven patients were admitted to the intensive care unit in the immediate postoperative period. Mean hospital stay was 7.7 days (range, 2-23 days). Surgical complications included wound infection (n = 14), stoma-related complications (n = 7), digestive fistula (n = 4), scrotal hematoma (n = 5) and postoperative evisceration (n = 2). The mortality rate was 10.21% (n = 14) mainly due to postoperative peritonitis. CONCLUSION: The findings of this study indicated that most nontraumatic abdominal surgical emergencies in elderly patients were related to complications of neglected or undiagnosed preexisting disease. Prognosis was related to the stage of the disorder, initial surgical management, and deterioration of the coexisting medical problems.

[Early oral feeding versus classic oral feeding after appendicectomy for acute appendicitis]. / Réalimentation orale précoce versus réalimentation orale classique après appendicectomie pour appendicite aiguë.

The appendectomies for acute appendicitis are the most frequent surgical interventions (43.6%) in our service. The recent studies demonstrated the feasibility and the economical gain of the early oral feeding vs. classic oral feeding, after elective digestive surgery. We wanted to spread these results therefore to the appendectomy for acute appendicitis. It is about a prospective survey carrying on 110 patients also left in two groups, and comparing the classic postoperative oral feeding vs. the early postoperative oral feeding on one year. The two groups were comparable and the studied parameters were : the length of the postoperative ileus, the hospitable morbidity, the length of the hospitalization and the cost of the hold in charge. The length of the postoperative ileus was not different in the two groups as well as the morbidity. The difference of the median length of hospitalization in the two groups was not meaningful. The cost of the hold in charge was meaningfully more elevated in the group with classic postoperative feeding. In conclusion, the early postoperative oral feeding in our survey doesn't reduce the length of the postoperative ileus and don't drag a morbidity anymore that the classic oral feeding. However if it doesn't shorten the length of the hospitalization, it drags a reduction of the cost of the hold in charge. There is a gain therefore precociously to nourish the patients after appendectomy for acute appendicitis.

[Post-operative morbidity and mortality in non traumatic colon emergencies]. / Morbidite et mortalite post-operatoire des urgences coliques non traumatiques a propos de 85 interventions.

UNLABELLED: This study aimed to evaluate emergency non traumatic colonic surgery mortality and morbidity in our practice MATERIAL AND METHODS: Data of all 85 patients who underwent an emergency non traumatic colonic surgery during the period from August the 1st 1998 to June the 30th 2006, were retrospectively reviewed. Surgical procedures included either colonic resections with (n = 33) or without (n = 47) immediate anastomosis or, ileostomies (n = 3) or colostomies (n = 2) without colonic resection. RESULTS: A 16.5% (n = 14) mortality rate was recorded due to septic shock (n = 6), postoperative peritonitis (n = 2), stroke (n = 2) and cachexia, malnutrition, acute anemia, acute heart failure (n = 1 each). Morbidity rate was 38.8% (n = 33). Surgical complications (n = 29 34.1%) were related to wound infection (21.1% n = 18), stoma related (n = 6), post-operative peritonitis due to an anastomotic dehiscence and prolonged ileus (n = 2 each), rectorragy (n = 1). Medical complication reached a 4.7% rate and included malaria (n = 2), acute pulmonary edema, diabete acido cetosis (n = 1 each). Seven patients (8.2%) needed a reoperation for post operative complication. Hospital stay was 19.4 days. CONCLUSION: Post-operative morbidity and mortality in non traumatic colon emergencies still remain high owing to anastomotic leak, patients comorbidities and infectious complications.

Morbidite et mortalite post-operatoire des urgences coliques non traumatiques a propos de 85 interventions

Evaluer la mortalite et la morbidite de la chirurgie des urgences coliques non traumatiques dans notre pratique. Methodologie : Dans une etude retrospective couvrant la periode du 1er aout 1998 au 30 juin 2006; nous avons revu les dossiers de 85 patients operes pour une urgence colique non traumatique. Les methodes chirurgi- cales etaient soit des resections coliques avec (n=33) ou sans (n=47) anastomoses; soit des ileostomies (n=3) ou colostomies (n=2) sans resection. Resultats : La mortalite post-operatoire a ete de 14 deces (16;5) par choc toxi-infectieux (n=6); peritonite post-operatoire (n=6); accident vasculaire cerebral (n=2) et; par anemie aigue; insuffisance cardiaque; denutrition et cachexie (un cas chacun). Des complications non mortelles ont ete notees chez 33 patients (38;8). Celles liees a la chirurgie (n= 29 ; 34;1) regroupaient 18 suppurations parietales (21;1; n=18) ; trois necroses stomiales; deux abces peristomiaux; une dermite peristomiale; deux ileus prolonges; deux peritonites post-operatoires par lachage d'une anastomose colorectale et un cas de rectorragie . Les complications medicales (4;7n=4) etaient deux acces palustres; une acidocetose diabetique et un oedeme aigue du poumon. Des reinterventions ont ete necessaires chez sept patients (8;2). La duree moyenne d'hospitalisation a ete de 19;4 jours. Conclusion : La mortalite et la morbidite de la chirurgie des urgences coliques non traumatiques sont elevees; en rapport avec les complications infectieuses; les decompensations de tares et les fistules coliques