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[Acute abdomens of parasitic origin: retrospective analysis of 135 cases].

OBJECTIVE: To assess acute abdomens incidence of parasitic origin at Yaounde (Cameroon) and evaluate their different management modalities. MATERIALS AND METHODS: Retrospective study from January 1973 to December 2002 of patients managed at Department of Surgery, Central Hospital, Yaounde (Cameroon). RESULTS: Among 3464 acute abdomens managed by laparotomy during this period, 135 patients (3.9%) had a parasitic origin. Ninety-seven patients (79%) were operated on before 1990. Among these 135 patients, 63 (47%) had peritonitis secondary to liver amoebic abscess intraperitoneal rupture, 24 (18%) had acute intestinal obstruction due to an ascaridioma, 21 (15%) had appendicitis of parasitic origin, 15 (11%) had amoebic typhlitis, 4 (3%) had pancreatitis and/or angiocholitis caused by the obstruction of ampulla of Vater by an adult ascaris worm, 4 (3%) had intestinal perforation by ascaris, and 4 (3%) had intussusception (tricocephalus). CONCLUSIONS: Incidence of abdominal emergencies of parasitic origin is unfrequent but not rare at Central Hospital, Yaounde, Cameroon. This incidence is decreasing over time. However, liver amoebic abscess intraperitoneal rupture is the most common cause of peritonitis and is still associated with postoperative high mortality rate. Preoperative diagnosis could lead to non-operative management that may be associated with better prognosis.

Abdomen, Acute↗

Placenta percreta causing acute abdomen in the second trimester of pregnancy.

Two cases of acute abdomen due to haemoperitoneum caused by placenta percreta in the second trimester are presented. Both had a history of previous lower segment caesarean section, a factor well-known to predispose the condition. However, the rarity of the condition, presenting in mid pregnancy makes diagnosis and management difficult. Optimum ways of management are discussed.

Abdomen, Acute↗

Ultrasonography in the acute abdomen.

In a prospective study 152 consecutive patients presenting with acute abdominal pain were assessed clinically and an ultrasonographic examination was performed immediately. Of these, 16 (11 per cent) patients would normally have had an immediate ultrasonographic scan requested; routine (within 24 h of admission) ultrasonographic examination would have been requested in a further 66 (43 per cent) patients. In 70 (46 per cent) patients an ultrasonographic examination would not have been requested. Ultrasonography altered the diagnosis in one patient from probable appendicitis to cholecystitis. Ultrasonography missed one abdominal aortic aneurysm and one empyema of the gallbladder. Ultrasonography had a sensitivity of 96 per cent, a specificity of 94 per cent, a positive predictive value of 96 per cent, a negative predictive value of 94 per cent and an accuracy of 95 per cent in diagnosing appendicitis. Exactly the same values were found for the clinical diagnosis of appendicitis. The study shows that routine immediate ultrasonographic examination of the acute abdomen is rarely helpful, with the possible exception of appendicitis. Where an urgent ultrasonographic scan is necessary on clinical grounds the expertise of a radiologist is probably required, whereas in specific areas, for example in the diagnosis of right iliac fossa pain, there may be a place for training the surgical trainee.

Abdomen, Acute↗