Exploring the causative factors of secondary acute peritonitis and the reason for the delay in the referral of these patients

A case study of the surgical department of patients referred to the hospital of Herat province from the beginning of 2019 to the end of 2020.

Abstract

Secondary acute peritonitis is a severe inflammation of the peritoneum characterized by local and systemic symptoms, as well as profound organ and systemic dysfunction. It represents a critical complication of inflammatory diseases affecting the abdominal cavity or can arise from the perforation of hollow abdominal organs, traumatic injuries to abdominal organs, or postoperative complications. Surgeons frequently encounter this life-threatening condition in the field of surgery, particularly in regions like Afghanistan where healthcare services are not yet standardized. The incidence of secondary acute peritonitis in such regions is expected to be higher compared to developed countries, and several factors contribute to its occurrence. This research aims to investigate patients diagnosed with peritonitis between 2019 and 2020 at the hospital in Herat province, Afghanistan, who underwent surgical intervention. The study focuses on analyzing the reasons for delayed referral to the surgical department, as well as the factors contributing to delayed surgical intervention. By examining the patients' medical history from the onset of symptoms to the performance of laparotomy, the study aims to determine the specific pathologies associated with peritoneal inflammation. Additionally, the research explores the mortality rate and duration of hospitalization for these patients, along with treatment approaches categorized by age and gender. The primary objective of this study is to identify the causative factors underlying secondary acute peritonitis and ascertain the reasons for delays in patient referral to the surgical department. Furthermore, the impact of these delays on disease progression towards a diffuse state will be investigated. By elucidating these factors, the research intends to propose more effective measures to combat this lethal disease and ultimately reduce patient mortality rates. Although considerable efforts have been made to assess this critical issue in Herat, no cases of disseminated secondary acute peritonitis have been observed in the Surgical Ward of the Hospital in Herat province or private clinics. Such cases, which entail a high risk of morbidity and mortality, underscore the importance of research in this field and emphasize the necessity for surgeons to be aware of the study outcomes.