Raheel AHMAD, Muhammad Salman SHAFİQUE, Syed Waqas HASSAN, Jahangir Sarwar KHAN, Sheikh Haseeb AHMAD, Muhammad Umer FAYYAZ, Saqib MEHMOOD

Burden of Emergency Exploratory Laparotomies: Sleepless Nights in Operation Rooms

Background: Recently the burden of emergency exploratory laparotomies has increased very rapidly. Both traumatic and non-traumatic abdominal emergencies are dealt with in surgical emergency departments which not only increase financial burden to health care setup but also a physical and psychological burden to healthcare providers. The purpose of this study was to share the burden and spectrum of these laparotomies in the emergency surgical department of a tertiary care hospital in a third world country. Materials and Methods: A retrospective observational study conducted at Surgical Unit-I, Holy Family Hospital, Rawalpindi, Pakistan from June 2014 to December 2016. All patients above 12 years presenting to our emergency department directly or referred from any other facility who underwent midline exploratory laparotomy in our hospital were included in our study. Results: A total of 433 patients were included in our study. Out of which, 254 58.66% were males and 179 41.33% were females and male to female ratio was 1.41:1.342 78.9% patients presented with non-traumatic cause whereas 91 21% patients have the history of abdominal trauma. Peritonitis 57.6% followed by intestinal obstruction 28.65% were the two most common indications of laparotomy in non-trauma patients whereas road traffic accidents and falls 65% were the most common cause of laparotomy in trauma patients. Intraoperative findings and operative management was compared between trauma and non-trauma patients. Conclusion: In resource-limited countries, they are posing a great burden to emergency departments of tertiary care hospitals. More specialized trauma centers should be established to cope with this burden.

Keywords:

Emergency exploratory laparotomies, peritonitis, intestinal obstruction, road traffic accidents,

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Cook GC. Gastroenterological emergencies in the tropics. Baillieres Clin Gastroenterol. 1999 Dec;5(4):861-86
Bhangu A, Fitzgerald JE, Fergusson S, Khatri C, Holmer H, Sİreide K, et al. Determining universal processes related to best outcome in emergency abdominal surgery: a multicentre, international, prospective cohort study. BMJ Open. 2014;4(10):e006239
Abdullah MT, Hanif A, Waqar SH, Shah SF, Malik ZI, Zahid MA. Presentation and Outcome of Acute Abdomen in a Tertiary Care Unit. Ann. Pak. Inst. Med. Sci. 2011; 7(3):137-41
Ramakrishnan K, Salinas RC. Peptic ulcer disease. Am Fam Physician. 2007 Oct 1;76(7):1005-12
Prachalias AA, Kontis E. Isolated abdominal trauma: diagnosis and clinical management considerations. Curr Opin Crit Care. 2014 Apr;20(2):218-25
Elmore LC, Jeffe DB, Jin L, Awad MM, Turnbull IR. National survey of burnout among US general surgery residents. J Am Coll Surg. 2016 Sep;223(3):440-51
Barrow E, Anderson ID, Varley S, Pichel AC, Peden CJ, Saunders DI, et al. Current UK practice in emergency laparotomy. Ann R Coll Surg Engl. 2013 Nov;95(8):599-603
Jhobta RS, Attri AK, Kaushik R, Sharma R, Jhobta A. Spectrum of perforation peritonitis in India-review of 504 consecutive cases. World J Emerg Surg. 2006 Sep 5;1:26
Wani RA, Parray FQ, Bhat NA, Wani MA, Bhat TH, Farzana F. Nontraumatic terminal ileal perforation. World J Emerg Surg. ;1:7 Wani MM, Khan MA, Wani MM, Durrani AM, Singh B, Shafi M. Analysis of acute abdomen admissions in the surgical emergency room of a developing third world country. Int J Surg. 2006;11(2):2
Kumar GK, Chakravarthi DS, Kamal VR, Arjuna G, Vijayalaxmi M. Mortality in emergency laparotomy on acute abdomen: A retrospective study in King George Hospital, Visakhapatnam. PIJR. 2015 Feb;4(2):219-21
Berhane Y, Girmay K, Gebresilassie A. Outcome of emergency surgical operations performed for non-traumatic acute abdomen among adults in Mekelle hospital, Tigray, Ethiopia, 2013. Eur J Pharm Med Res. 2016;3(4):106-11
Jain R, Gupta V. A prospective study of epidemiology and clinical presentation of non-traumatic acute abdomen cases in a tertiary care hospital of central India. Int Surg J. 2017 Jan; (1):242-45
Khan TA, Awan SH, Khan SA, Amin S. An audit of laparotomies; carried out in combined military hospital Panno Aqil over three years period. Professional Med J. ;20(2):279-83
Ali N, Hussain M, Israr M. Tuberculosis as a cause of small bowel obstruction in adults. GJMS. 2011;9(2):233-35
Sulis G, Roggi A, Matteelli A, Raviglione MC. Tuberculosis: Epidemiology and Control. Mediterr J Hematol Infect Dis. ;6(1):e2014070
Omari A, Bani-Yaseen M, Khammash M, Qasaimeh G, Eqab F, Jaddou H. Patterns of anterior abdominal stab wounds and their management at Princess Basma teaching hospital, North of Jordan. World J Surg. 2013 May;37(5):1162-8
Pande R, Saratzis A, Beatty JW, Doran C, Kirby R, Harmston C. Contemporary characteristics of blunt abdominal trauma in a regional series from the UK. Ann R Coll Surg Engl. 2017 Jan;99(1):82-7
Hamidian Jahromi A, Johnson L, Youssef AM. Delayed small bowel perforation following blunt abdominal trauma: A case report and review of the literature. Asian J Surg. 2016 Apr;39(2):109-12
D’Souza N, Clarke D, Laing G. Prevalence, management and outcome of traumatic diaphragm injuries managed by the Pietermaritzburg Metropolitan Trauma Service. Ann R Coll Surg Engl. 2017 May;99(5):394-401
Tinkoff G, Esposito TJ, Reed J, Kilgo P, Fildes J, Pasquale M, et al. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg. 2008 Nov;207(5):646-55
Schnüriger B, Lam L, Inaba K, Kobayashi L, Barbarino R, Demetriades D. Negative laparotomy in trauma: are we getting better? Am Surg. 2012 Nov;78(11):1219-23