Epidemioclinical Profile, Therapeutics and Outcome of Patients with Post-Perforation Typhic Peritonitis in DRC in Lomami Province, Luputa Rural Health Zone: 5-Year Retrospective Study at Lusuku Rural Hospital Center

Introduction: Perforations of the small intestine are a common cause of generalized peritonitis, a common condition in surgical practice. It has high morbidity and mortality, and postoperative complications are common. Various techniques have been described for their treatment, without any real consensus on performance. The magnitude of the problem is not fully appreciated, especially in rural areas. The objective of this study is to determine the epidemioclinical character and management of peritonitis secondary to typhoid perforation in a rural setting. Materials and Methods: The Observational Study Retrospective Cross-Section Description from April 2018 to April 2023 included 72 records of patients operated for peritonitis on typhoid perforation at the Lusuku Rural Hospital Center in the province of LOMAMI in the DRC. Clinical and paraclinical data (age, sex, Widal), surgical data (surgical technique: excision, suture for perforation repair, resection, anastomosis, postoperative complications, wound evolution, release of digestive sutures) and vital outcome (survivor, death) were considered. Results: The frequency of peritonitis due to typhoid perforation has been estimated at 85% of cases of all generalized peritonitis, and 28% of all surgical pathologies. Males were more affected with 57% and the mean age was 22 years. The surgical techniques used for the perforations essentially included: - Excision and simple suturing was used in 49 patients, whose course was marked by parietal suppuration at 61.2%, and postoperative peritonitis at 10.2%. For this technique, the cure rate is high in patients who have had 1 to 2 perforations with 88%; - Immediate resection and anastomosis was used in 11 patients who had more than 3 distant perforations, among which more than 30% manifested as complications parietal suppuration, more than 20% postoperative peritonitis, about 20% evisceration and 18% digestive fistulas, the mortality rate is 80% in this technique. - Deferred resection and anastomosis preceded by an enterostomy was used in 12 patients with more than 3 perforations, 25% had parietal suppurations as a complication, 8% eviscerations as complications, 17% mortality rate in this technique. Conclusion: First-line excision-suture and delayed resection and anastomosis seem to give a better result compared to immediate resection-anastomosis as a surgical technique for peritonitis on typhoic perforation.