Pattern of acute abdomen and variables associated with adverse outcome in a rural primary hospital setting

To analyze the clinical presentation, causes, outcomes of surgical intervention (as measured by postoperative morbidity and mortality), and variables associated with adverse outcomes of patients with surgically important acute abdominal pain.

A cross sectional hospital based longitudinal case series analysis.

Glen C Olsen Memorial Primary General Hospital. Butajira, Ethiopia.

All patients admitted and operated for acute abdominal pain over a period of two years. (Oct. 10, 2004 -Nov. 20, 2006)

Being referred from other centers, duration of symptoms, types of symptoms and physical findings, relevant investigations, diagnosis and procedure done, hospital stay, mortality, morbidity, and variables associated with adverse out comes.

A total of 143 patients were operated and of them 55.2% were referred from other health care facilities. Male to female ratio was 2.5:1 and mean age of presentation was 26.6 +/- 16.6 years. Patients presented after an average of 88.4 +/- 87.9 hours of symptom onset. Intestinal obstruction 50 (34.9%), acute appendicitis 35 (24.5%), Intussusceptions 23 (16.1%) and bowel perforation 16 (11.2%) were the leading causes of admission. Clinical variables found to have statistical significant association (P < 0.05) with adverse outcomes were referred patients, those with abdominal distension, absolute constipation, deranged vital signs, abdominal mass, guarding, positive vaginal/rectal examination and/or leukocytosis. The average hospital stay was 8.74 +/- 4.66 days and 28.7% of patients develop one or more of acute complications. Forty two (29.4%) patients presented with deranged vital signs from either septic or hypovolemic shock and of them 7 (4.9%) died with subsequent multiple organ failure.

Patients who presented early and immediate corrective measures were instituted had better outcome while those seen late developed unfavorable out-come with significantly higher complications. Therefore early detection and treatment of acute abdomen is essential.