Case series of acute abdominal surgery in rural Sierra Leone

In many poor countries of the world the need for surgical treatment:of acute abdominal emergencies is largely unmet. In some cases this service is provided by physicians with little postgraduate surgical training, and there is a paucity of published data on the outcomes of this service. This series of sequential cases of acute abdominal surgical emergencies from a hospital in rural Sierra Leone illustrates the causes, outcomes, and challenges in this setting. All patients with an acute abdomen from September 1992 until September 1994 who required surgery were identified by review of theater records, ward books, and patients' notes. Altogether, 173 cases were identified. Operative diagnoses included ectopic pregnancy (n = 43), strangulated hernia (n = 45) 15 of which required bowel resection, appendicitis (n = 15), normal appendix (n = 4), uterine rupture (n 9), perforated ulcer (n = 8), tubal or pelvic abscess (n = 7), volvulus (n 6), and others. Ninety percent survived to discharge after a median postoperative stay of 9.2 days (range 7-127 days). Of the 18 deaths, 83% occurred during the first 3 days. Factors associated with poor outcome were ileal perforation due to typhoid fever and resection of bowel after a strangulated hernia. These results show that acute abdominal surgery can be done at the district level in poor countries using limited facilities by staff without extensive surgical training. The outcomes are comparable to those from larger centers.