ACUTE ABDOMEN IN ADULTS: A TWO YEAR EXPERIENCE IN MEKELLE, ETHIOPIA

The term acute abdomen denotes any sudden spontaneous non traumatic disorder whose main manifestation is in the abdominal area. It is one of the most commonly encountered emergencies in the practice of general surgery but there is no much study regarding the magnitude and pattern in Ethiopia and in the study area in particular.

The study was aimed at assessing the causes, pattern and outcomes of surgical regimen of acute abdomen in the study area.

This is a descriptive retrospective study conducted in all adult patients with acute abdomen admitted in Mekelle hospital from Sept, 2008 to August, 2010. Patient demographics, clinical features, white cell count levels, operative findings and outcomes were adequately recorded. Adequate recording has been maintained in the hospital. The source.and the study groups (N-299) were patients of adult age categories.

A total of 2628 surgical procedures were performed during the study period. Of these, 299 cases were surgical emergency conditions for acute abdomen accounting for (11.4%) of all surgeries. During the. study period, there were 989 adult surgical emergency procedures of which 299 (30.2%) cases were laparotomies for acute abdomen. The age ranged from 15 years to 95 years (mean = 31.5 years). The male to female ratio was (M: F; 4.1:1). In this series, the most common symptoms were abdominal pain, vomiting and abdominal distention accounting for 299 (100.0%), 149 (49.8%) and 38 (16.4%) respectively. The frequent. clinical signs were tenderness, localized guarding and rebound tenderness accounting for 287 (96.0%), 269 (90.0%) and 139 (46.4%) respectively. Acute abdomen was most common between 20-29 years of age at a rate of 96 (32.1%) with male 74 (24.7%) preponderance. Acute appendicitis was the leading cause of acute abdomen accounting for 159 (53.2%) followed by small bowel obstruction 48 (16.0%), sigmoid volvulus 38 (12.7%) and PPUD 13 (4.3%). Of the surgically treated patients for acute abdomen 92 (30.8%) had post-operative complications other than deaths. The three commonest immediate post-operative complications observed were wound infection (19.7%), pneumonia (9.0%) and sepsis (2.0%). In this series, there were 19 deaths giving an overall mortality rate of (6.4%). The low rate of mortality observed in study may be attributed to early presentation, early diagnosis and prompt surgical interventions.

The present study has depicted that acute abdomen commonly occurred in the 2nd to 3rd decades of life, majority caused by acute appendicitis and males were predominantly affected than females. Small bowel obstruction, sigmoid volvulus, PPUD and incarcerated hernias were other observed causes of acute abdomen.