Correlating clinical diagnosis with intra-operative findings in emergency exploratory laparotomies for acute abdomen in limited-resource settings: Our experience

Acute abdomen is a clinical condition that demands urgent attention and treatment to prevent morbidity and mortality. It may be caused by both intra-abdominal and extra-abdominal pathologies. It often produces diagnostic dilemma even for the experienced surgeon and more so in limited-resource settings. The purpose of this study is to review the indications for emergency laparotomy and correlate clinical provisional diagnosis with intra-operative findings in limited-resource settings. Medical records of 78 patients who had emergency exploratory laparotomy for acute abdomen between 2010 and 2014 were retrieved and analyzed. Acute abdomen was most common in males (64.1%). The predominant age group was 21-30 years (26.9%). Only one patient (1.3%) presented within 24 hours while majority (62%) presented within 4 days to two weeks. Plain abdominal X-rays were done for only 38 (48.7%) patients. Abdominal USS was done for just 18 (23.1%). The commonest pre-operative diagnosis was peritonitis secondary to bowel perforation (30.8%) and the commonest intra-operative finding was peritonitis secondary to ileal perforations (n=23, 29.5%). There was a statistically significant association between pre-operative diagnosis and intra-operative findings. Frequency of correct diagnosis is 59 (75.64%) and incorrect 19 (24.36%). P-value was 0.002, and the likelihood ratio’s p-value was 0.001. Strengthening the teaching of basic clinical skills of history taking and bedside examination should be a priority in our medical schools both at undergraduate and postgraduate levels.