title: Etiology, treatment outcome and prognostic factors among patients with secondary peritonitis at Bugando Medical Centre, Mwanza, Tanzania.
abstract: BACKGROUND
  Secondary peritonitis due to perforation of the gastrointestinal tract is one of the most common surgical emergencies all over the world and is associated with significantly morbidity and mortality. Previous studies conducted at Bugando Medical Centre (BMC) were retrospective and each was focused on single etiology; therefore there was an obvious need to evaluate the etiologies, treatment outcome and their prognostic factors altogether.
  
  
  METHODS
  This was a descriptive cross-sectional study involving patients with secondary peritonitis admitted at BMC from May 2014 to April 2015. Sociodemographic and clinical characteristics among consented patients were collected using questionnaires. Peritoneal aspirate, biopsy and blood were collected perioperatively and processed using standard operating procedures. Analysis was done using STATA version 11 software.
  
  
  RESULTS
  The study enrolled 97 patients with the female to male ratio of 1:1.8 and approximately 41.2 % (40/97) were in their third and fourth decades of life. Only 3 (3.09 %) patients arrived to the hospital within 24 hours of onset of illness, 26 (26.80 %) patients presented with shock and HIV seropositivity among all patients was 13.40 % (13/97). The common etiologies of secondary peritonitis were perforated appendicitis 23 (23.71 %), peptic ulcer disease 18 (18.56 %), ischemia 18 (18.56 %) and typhoidal perforation 15 (15.46 %). Of the 97 patients, 35 (36.08 %) had complications and 15 (15.46 %) died. Presence of premorbid illness and post-operative complication were found to be associated with death (p values = 0.004 and <0.001 respectively).
  
  
  CONCLUSIONS
  The most common etiologies of secondary peritonitis at BMC are perforated appendicitis, peptic ulcer disease, ischemia and typhoidal perforation. Premorbid illness and postoperative complications in this setting are associated with death and as the matter of fact proper screening on admission should be done to identify patients with premorbid illness and confer prompt management.
authors.affiliation: Department of Surgery, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania ; Department of Surgery, Bugando Medical Centre, P.O. Box 1370, Mwanza, Tanzania.
authors.forename: Amri
authors.initials: A
authors.lastname: Mabewa
authors.affiliation: Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Seni
authors.affiliation: Department of Surgery, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania ; Department of Surgery, Bugando Medical Centre, P.O. Box 1370, Mwanza, Tanzania.
authors.forename: Phillipo L
authors.initials: PL
authors.lastname: Chalya
authors.affiliation: Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Mshana
authors.affiliation: Department of Surgery, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania ; Department of Surgery, Bugando Medical Centre, P.O. Box 1370, Mwanza, Tanzania.
authors.forename: Japhet M
authors.initials: JM
authors.lastname: Gilyoma
keywords: Etiology; Prognostic factors; Secondary peritonitis; Tanzania; Treatment outcome