Pattern and Management Outcome of Patients with Generalized Peritonitis

Pattern and Management Outcome of Patients with Generalized Peritonitis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Pattern and Management Outcome of Patients with Generalized Peritonitis Eden Debele, Fasil Wale, Kidist Getachew This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6930551/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Generalized peritonitis is a microbial contamination of the peritoneal cavity that requires prompt diagnosis and treatment. Despite enhanced comprehension of its pathophysiology, advancements in diagnosis, surgery, antimicrobial therapy, and intensive care aid, peritonitis still has the potential to be lethal. .Especially in Hiwot Fana hospital, our patients arrive to hospital lately that make the management difficult. And there is no data regarding management outcome and clinical pattern of the problem in this hospital . Objective The aim of this study is to identify pattern and management outcome of generalized peritonitis among the adult admitted patients at Hiwot fana comprehensive specialized hospital from Dec 1,2018 – June 1,2023. The data gathered from October 16,2023 to November 1, 2023. Methods The study was conducted among 650 surgically treated generalized peritonitis patients using cross-Sectional study design by reviewing all patient charts who underwent surgical intervention for the surgically treated generalized peritonitis in the study period.Structured checklist was used to collect relevant data and analyzed using Statistical Package for the Social Sciences version 26 software package. Bi-variate and Multi-variate logistic regression was employed to assess association between dependent and independent variables with 95% Confidence interval and p-value less than 0.05. Results A total of 650 files were used. The mean age was 33.7 years (SD ± 13.6). And 539 ( 82.9%) of them were found to be in the age group of < 50 yrs and the male to female ratio was 5.99:1. Perforated PUD was the predominant intraoperative finding (34.6%) followed by Perforated appendix (31.1%), Gangrenous SBO (25.8%) and Lower GI perforation (8.5%). Omental patch was the common procedure done (34%). Favorable outcome was found in 72.5% of the cases. Pneumonia (8.6%) was the most common complication. Patients who were = 50 years old patients[(AOR- 4.675(1.219–17.933) P-.025)]. Conclusion and Recommendation: Most common pattern is perforated PUD. Older Age, failure to pass and dehydration, lower GI perforation and hospital stay between 8-15days are associated with unfavorable outcome. Community awareness about generalized peritonitis should increase to avoid late presentation. generalized peritonitis risk factor intraabdominal infection PUD perforated appendicitis Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction 1.1 Background of the study Microbial contamination of the peritoneal cavity is termed peritonitis or intra-abdominal infection., that is the inflammation of the peritoneum. It is most commonly due to localized or generalized infection caused by various probable factors and is classified according to etiology. Primary microbial peritonitis occurs when microbes invade the normally sterile confines of the peritoneal cavity via hematogenous dissemination from a distant source of infection or direct inoculation. Secondary microbial peritonitis occurs subsequent to contamination of the peritoneal cavity due to perforation or severe inflammation and infection of an intra-abdominal organ. Examples include appendicitis, perforation of any portion of the gastrointestinal tract, or diverticulitis ( Charles et al , 2019). Acute generalized peritonitis (AGP) affects about 9.3 patients per 1000 hospital admissions and requires adequate preoperative resuscitation to avert high perioperative morbidity and mortality. Although AGP is one of the most frequent surgical emergencies at the global level, it has been reported to disproportionately affect low-income and middle-income countries Strengths and limitations of this study To the best of our knowledge, this systematic review and meta-analysis will be the first reporting the global epidemiology of acute generalised peritonitis (AGP). This current review will include recent studies, hence, it will inform and guide policy makers in decision making on a global health perspective related to AGP. Open access especially the sub-Saharan African (SSA) region both in terms of prevalence and mortality rates. The most common types of AGP in a recent series of 305 cases in SSA were perforated gastroduodenal ulcers, perforated appendicitis and typhoid ileal perforation. The postoperative mortality rates of AGP vary between 8.4% and 34% from isolated studies(Tochie et al., 2020). The pathophysiology: Patients in whom standard therapy fails typically develop one or more of the following: an intra-abdominal abscess, leakage from a gastrointestinal anastomosis leading to postoperative peritonitis, or tertiary (persistent) peritonitis. The contamination of peritoneal cavity thus, can lead to a cascade of infection, sepsis and multisystem organ failure (MSOF) and death if not treated in a timely manner.( Charles et al,2019) Effective source control and antibiotic therapy is associated with low failure rates and a mortality rate of approximately 5% to 6%; inability to control the source of infection is associated with mortality greater than 40%. The response rate to effective source control and use of appropriate antibiotics has remained approximately 70% to 90% over the past several decades( Charles et al , 2019). Diagnosis of peritonitis was made based on clinical and radiological findings. Clinical findings included abdominal pain, vomiting, constipation, generalized abdominal tenderness, and absent bowel sounds. Peritonitis was indicated by X-ray showed air under the diaphragm. Exploratory laparotomy was done to identify the cause of peritonitis. Operative findings like duodenal perforation, ileal perforation, ileal stricture with perforation, and ruptured appendix (Kumar et al., 2021). Methodology 3.1. Study area and study period The study conducted at Hiwot fana comprehensive specialized university Hospital. The Hiwot Fana Specialized University Hospital located in Harar, the oldest and most illustrious city in eastern Ethiopia. Harar is located 525 kilometers from Addis Ababa, the nation's capital. The region's has two government hospitals are the Hiwot Fana Comprehensive Specialized Hospital and Jugol Regional Hospital with population size of around 5millon. With catchment areas in the Eastern part of Ethiopia, including the majority of both Hararghe Zones, Harari regions, as well as some areas of the Ethiopian Somalia regional state. HFCSH began as a referral hospital under Haramaya University administration in 2007. The hospital offers specialties in Emergency Medicine, Anesthesiology, Internal Medicine, Obstetrics and Gynecology, General Surgery and Orthopedics. Additionally, the hospital delivers treatments with different subspecialty level such as Radiology, Dermatology, Pathology, Oncology, Neurology, Neurosurgery, Plastic surgery, Pediatric surgery and ENT . Our General Surgery department service around 1220 patients per year. The data will be gathered from OCT 16, 2023 to Nov 1, 2023 among adult patients who admitted surgical ward at HFCSH eastern Ethiopia. 3.2. Study design An institutional -based retrospective cross-sectional study employed using quantitative method. 3.3. Population 3.3.1. Source population All adult patients who admitted at surgical ward with diagnosis of generalized peritonitis of HFCSH from December 1, 2018 to June 1, 2023. 3.3.2. Study population All adult patients who treated with the diagnosis of generalized peritonitis at surgical ward and sampled from it at HFCSH. 3.4. Inclusion and exclusion criteria 3.4.1. Inclusion criteria All adult patients who were admitted to the surgical ward of the HFCUH during the study period with the diagnosis of generalized peritonitis. 3.4.2. Exclusion criteria Incomplete medical records and missed medical records during data collection Pediatrics patients who are less than 18 years old 3.5. Sample size determination The study include all patients who admitted to HFCUH with the diagnosis of GP starting from December 1,2018 to June 1 ,2023 which are 650 participants 3 .6 Sampling procedure and Sampling technique The hospital was selected purposively and the study participants was selected by using simple random methods from registration log book in surgical ward by using lottery methods from, December 1,2018 to June 1, 2023.from card store collected based on MRN then review the chart so that six hundred fifty patient medical record retrieved from card room. 3.7 Data collection methods 3.7.1. Data collection instruments Data was collected using semi-structured data abstraction format. Preliminary data source was log books of surgical ward. Patients’ medical records documented on the respective log books was employed for the data capturing. The information obtained from the above-mentioned sources will include sociodemographic data such as age, sex, residence, etc. and clinical characteristics involving …. (Data collection form attached as annex).. In addition, the number of surgical ward admissions during the data capturing period was analyzed in order to determine the incidence rate and management outcome of generalized peritonitis. Medical charts with missing data and lacking the required information was excluded. 3.7.2 Data collectors and supervisor Ten nurses were taken to the data collection process. All data collection activities were supervised by a trained surgical resident and principal investigator. 3.7.3. Data collectors and procedures Four BSC nurses were take the data collection process. All the data collectors were given one-day training about cause and outcome of generalized peritonitis, objective of the study, variables on the questionnaire and its implication. Then, they were assigned to review medical record of patients and fill the data collection check list. All data collection activities were supervised by trained surgical residents and principal investigator. 3.8. Variables 3.8.1. Dependent Treatment outcome of generalized peritonitis (favorable, unfavorable) 3.8.2. Independent Socio-demographic characteristics (age, sex, residence) Preoperative clinical characteristics (presenting symptoms, duration of illness, preoperative diagnosis, comorbidity, and previous abdominal surgery), Intra and post-operative clinical characteristics (intraoperative diagnosis, type of intraoperative surgical procedure done, and length of hospital stay). 3.9. Operational definitions Generalized peritonitis ( Acute diffuse peritonitis) contamination of the peritoneal cavity due to perforation or severe inflammation and infection of an intra-abdominal organ. Perforated appendicitis is perforation of appendix at any level Perforated PUD is perforation of stomach and duodenum. Lower GI perforation is perforation of jejunum and especially ileum. Favorable Treatment outcome the condition of the patient after the procedure has been done and a patient does not develop postoperative complications until the patient discharged from hospital. Unfavorable Treatment outcome the condition of the patient after the procedure has been done that develops any postoperative complications or died until the patient discharged from hospital. 3.10. Data quality control To ensure the quality of the data the questionnaires prepared in simple English was adapted from different published articles with some modification and check by a senior researcher and academician. Pretest on 5% medical record review was done two weeks before the actual data collection time. Training to data collectors and supervisors were given for one day. The training was focused mainly on the aim of the study and the data extraction tool, the need for data completeness, confidentiality, and how to approach data extraction during the data collection process. After the collected data was checked daily for its completeness, clarity, and consistency by the supervisor and the principal investigator. Overall activity was controlled by the principal investigator. 3.11. Methods of data analysis The collected data was checked for completeness and cleaned before entry into computer. Then the questionnaire was coded and entered into Epi data 7.2. Then the data was exported to statistical package for social science (SPSS) version 26 for data analysis. Data was analyzed with both descriptive analysis such as frequencies, percentage, mean median, standard deviations and for analysis done through Logistic regression modal. For measuring the strength of the association between the outcome and independent variables, Crude Odd Ratio (COR) and Adjusted Odd Ratio (AOR) along with 95% Confidence interval (CI) was calculated. All variables with the p value of < 0.25 will be further analyzed with multivariate logistic regression analysis to control for confounders. The Association will be considered Significant at 95% confidence interval and p-value set at less than 5%, using SPSS, version 26.0 3.12. Ethical considerations Ethical clearance was obtained from the Haramaya University, College of Health and Medical Sciences Institutional Health Research Ethics Review Committee (IHRERC) prior to data collection. Official permission was also obtained from Hiwot Fana Specialized University Hospital (HUHFSCH) administration, as well as inpatient and outpatient directors. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Information obtained from medical records was handled anonymously and kept strictly confidential. 3.13. Information dissemination The results of the study was presented and submitted to Haramaya University College of health and medical science, HFCSH. The study's results will also be made public through publications to reach a wider audience 3.14 Consent to Participate This study was retrospective in nature. Patient charts were reviewed and assessed for data analysis after ethical clearance was obtained from the Institutional Health Research Ethics Review Committee (IHRERC) of Haramaya University College of Health and Medical Sciences. Since the research involved no direct contact with patients and utilized anonymized data, the requirement for individual informed consent was waived by the IHRERC. RESULTS Four hundred twenty one files were considered to retrieve but I found beyond expectation of six hundred fifty files of generalized peritonitis patients with a complete file so I used all. ( Figure 1) 4.1 Socio demographic characteristics A total of 650 study participants aged between 18-80 years were involved and yielding A response rate of 100%. The mean (±SD) age of the study participants were 33.7 years (SD±13.6). And 539 (82.9 %) of them were found to be in the age group of <50 years The finding revealed Female participants, are only 93(17.22%) and those came from rural area were 381(58.6%). (table1) Table 1: Socio demographic characteristic of adults present with Generalized Peritonitis at HFCSUH, eastern Ethiopia 2023. Variable (n=650) Categories Frequency Percentage Age =50 111 17.1 Sex Male 539 82.9 Female 111 17.1 Residence Urban 269 41.4 Rural 381 4.2. Pre -operative clinical feature In this study, from patients presented to hospital with the diagnosis of Generalized peritonitis all 650 (100%) had abdominal pain and 293 (45.1%) had abdominal distension. Among those patients who have GP presented with Failure to pass 451(69.4%), fever 364 (56%), vomiting 619 (95.2%), Previous surgery 40(6.2 %%), comorbidities 26 (4%). From comorbidities the most common are HTN 16 (61.5%) , DM 8 (30.7%) has cardiac only 2 patients .Majority of the patient’s presentations and laboratory findings are tachycardia 557(85.7%), Dehydration 469(72.2%), Abdominal tenderness 644(99.1%), Guarding 576 (88.6%) and leukocytosis < 18000 are 514(79.1%). (Table2) Table 2: Pre-operative clinical characteristics among adult patients with diagnosis of generalized peritonitis at HFCSUH, eastern Ethiopia 2023. Variable (n=650) categories Frequency Percentage Duration of illness 25 486 74.8 Abdominal pain yes 650 100 No 0 Abdominal distension Yes 293 45.1 No 357 54.9 Failure to pass Yes 451 69.4 No 199 30.6 fever Yes 364 56 No 286 44 vomiting Yes 619 95.2 no 31 4.8 Previous surgery yes 40 6.2 No 610 93.8 comorbidities Yes 26 4 No 624 96 If yes to comorbidity Hypertension 16 61.5 DM 8 30.7 Cardiac 2 7.6 tachycardia Yes 557 85.7 No 93 14.3 Dehydration Yes 469 72.2 No 181 27.8 leukocytosis 18000 136 20.9 Abdominal tenderness Yes 644 99.1 No 6 0.9 Guarding Yes 576 88.6 No 74 11.4 4.3 Operative assessment and care of adult patients with generalized peritonitis Among the study participant (650) who had laparotomy, and the most common intra operative finding was Perforated PUD 225 (34.6%) , Perforated appendix 202 ,(31.1%) , Gangrenous SBO 168 (25.8 %), Lower GI perforation 55 (8.5%) respectively. (Figure 2) The procedure done Appendectomy 202 (31.1%), Omental patch 225 (34.6%), ileostomy 183 (28.2%), Resection and anastomosis 40 (6.2%) respectively. ( figure 3) 4.4 Post-operative condition Among 650 study participant 456(70.2%) had Smooth outcome and 194 (29.8%) are Complicated. From those complication Pneumonia 56 (8.6%) is the most common complication, Intra-abdominal collection 27 (4.2%), SSI 26(4%), Sepsis/septic shock 19(2.9 %), Dehiscence 14 (2.2%), Ileus 4 (0.6 %), Anastomosis leak 3 (0.5%) are the rest common complications . (Figure 4). The post-operative course was smooth in 70.2% of patients, while complications occurred in 29.8%. A total of 55.2% of patients had a hospital stay of less than 7 days. Upon discharge, 72.5% of patients had a favorable outcome. (Table 3) Table 3: Frequency distribution of postop condition of patients who were operated at HFCSUH Categories Frequency Percentage Post-operative course Smooth 456 70.2 Complicated 194 29.8 Post-operative complication SSI 26 4 Pneumonia 56 8.6 Dehiscence 14 2.2 Ileus 4 0.6 Intra-abdominal collection 27 4.2 Anastomosis leak 3 0.5 Sepsis/septic shock 19 2.9 Death 50 7.7 No complication 451 69.4 Hospital stays 1-7 359 55.2 8-15 176 27.1 16-23 59 9.1 24-31 39 6 >32 17 2.6 Outcome at discharge Favorable 471 72.5 unfavorable 179 27.5 4.5 Factors Associated with outcome According to this study, bivariate logistic regression analysis of patients who developed favorable outcome had significant association with patients having age [(COR-2.486),CI=95%:(1.62--3.797)P-0.000)],sex [( COR -.752,CL=95%:(.484-1.169 )P- .206], residence [(COR-2.504),CI=95%:(1.714-3.658)P-0.000)], duration of illness [(COR-5.0592),CI=95%:(2.881-8.886)P-0.000)], failure to pass[(COR-6.001),CI=95%:(3.522 -10.226) (P-0.000)],tachycardia [(C0R- .346 ) CL=95%:(.184-.651)P-0.01)] ,dehydration [(COR-3.637)CI=95%:(2.238-5.909) (P-0.000)] ,guarding [(COR-1.900 CI=95%:(1.017-3.550) (P-0.044)] and intra operative finding of perforated appendix [(COR--.330),CI=95%:(.196-.557),(P-0.000)] lower GI perforation[(COR=-.124,CI=95%:(.063-.246),(P-0.000)] Gangrenous SBO [(COR--.204),CI=95%:(.119-.347),(P-0.000)] ,post op condition [(COR=351.806 CI=95%(160.276 -772.212)P-0.000)] ,hospital stay From 8-15days [(COR=43.3 CI=95% (9.624 -194.83) P-0.000)], from 16-23days [(COR=20.00 CI=95% (4.408 -90.738) P-0.000)] from 31daysand above [(COR=5.795 CI=95%(1.164 -28.861) P-0.032)]. From this study those variables significantly associated and included in multivariate are age, failure to pass, dehydration, from intra operative finding lower GI perforation and hospital stay between 8-15days. (Table4). Patients who were =50 years old patients [(AOR- 4.675(1.219-17.933) P-.000)]. The patients who does not presented with failure to pass had 12 times more likely to get favorable outcome when compare to those have history of failure to pass. Patients who had no signs of dehydration had 10 times more likely to get favorable outcome when compare to those show this signs [(AOR-10.390(3.057-35.319) P- .000)]. (Table 4). Patients with intra operative finding of Lower GI perforation 94%, less likely to get favorable outcome as compare to perforated PUD [AOR-.061(.009-.404) P-.004]. The patients who had hospital stay in days of 8-15dys, 97% less likely to get favorable outcome than the patient who stay between 1-7 days [(AOR-.030(.001-.611) P-.002)]. Considered statistically significant at p ≤ 0.05 in multivariable logistic regression model, AOR=Adjusted odd ratio, CI=Confidence interval. (Table 4). Table 4: Multivariate Analysis of Factors associated with surgical treatment outcome of Generalized peritonitis at HFCSUH ,eastern Ethiopia ,2023. Variables (n=650) Category Treatment Outcome COR AOR P-value favorable unfavorable age categories >=50 62 49 1 1 <50 409 130 2.486(1.628-3.797) 4.675(1.219-17.933) .025 Failure to pass flatus Yes 289 162 1 1 No 182 17 6.001(3.522-10.226) 12.024(2.530-57.140) .002 Dehydration Yes 312 157 1 1 No 159 22 3.637(2.238-5.909) 10.390(3.057-35.319) .000 Intraoperative finding Perforate PUD 179 23 1 1 Perforate appendix 162 63 .330(.196-.557) .227(.051-1.009) .051 Lower GI perforation 27 28 .124(.063-.246) .061(.009-.404) .004 Gangrenous SBO 103 65 .204(.119-.347) .400(.099-1.618) .199 hospital stay in days 1-7 306 53 1 1 8-15 128 48 43.302 (9.624-194.833) .030(.001-.611) .023 16-23 18 41 20.000 (4.408-90.738) .217(.011-4.378) .319 24-31 17 22 3.293(.681-15.923) 2.091(.193-22.599) .544 >=31 2 15 5.795(1.164-28.861) 3.046(.270-34.343) .368 Discussion In this study we tried to reveal pattern and treatment outcome of generalized peritonitis among patients admitted to surgical ward of Hiwot Fana Comprehensive Specialized Hospital, so Perforated PUD (34.6%) is the most common cause of generalized peritonitis. And the unfavorable outcome is 29.8% with the most common complication is pneumonia (8.6%). Age, failure to pass, dehydration intraoperative finding and hospital stay were factors found to be significantly associated with generalized peritonitis. From this study Perforated PUD is the most common cause of Generalized peritonitis as compare to other African country unlike Malawi perforated appendix is most common(Samuel et al. , 2011). Since our community has a behavior of chewing chat, smoking and history of dyspepsia as the study done in Addis Ababa teaching hospital Chewing chat, smoking and alcohol use were seen in 22 (23.6%), 35(37.6%), and 34(36.5%), cases respectively and 23.6% gave previous history of dyspepsia (Birhanu Nega et al., 2020) are the most common risk factors for PPUD. As compare to another studies as etiology of generalized peritonitis, perforated PUD (34.6%) is the most common etiology and lower than the study done in Himalayan region 118(77.13%) ,and in other study of India (52.40%)(Naveen .k et al.,2016 but higher than in Tanzania 18(18.56 %) (Mabewa et al. , 2015). Perforated appendix (31.1%) in this study making the second most common like Rwanda (16 %) (Ndayizeye et al., 2000) , but 3 rd common (10%) at India (Bylapudi et al. , 2021).but it is the most common in Malawi (22%)(Samuel et al. , 2011), still lower. Gangrenous SBO (25.8%) is the 3 rd common in my study but the 2 nd most common at India (Bylapudi et al., 2021) the last common intra operative finding from this study is lower GI perforation (8.5%). Morbidity rate in surgery for peritonitis vary worldwide with report ranging from(18%-67%) regionally in Kenya (47.1) ,in Rwanda (51%) and in Uganda (32%) (Cent and Afr, 2014) which is nearer to our study( 30.6% ) and the most common complications are pneumonia (8.6%) alike India morbidity is ( 70% ) and most common complications are SSI and sepsis 18% (Bylapudi et al., 2021). Mortality rate of this study is (7.7%) in Rwanda 17% (Ndayizeye et al. , 2000),in Malawi 15%(Samuel et al. , 2011). Older patients who present with a diagnosis of generalized peritonitis have 4.6 times less likely to get favorable outcome as compare to younger patients. This is in line with the study done at Ottawa that 3.1 times to be complicated for older patients(Watters et al. , 1996). The reason for this is due to increased prevalence of chronic illnesses in the elderly and a predictable decline in the ability to maintain physiologic homeostasis. Additionally, age-related changes in the host responses to surgical illness. Looking from the current study failure to pass has association with outcome of generalized peritonitis.it reveal those who fail to pass feaces and flatus had 12 times less likely to get favorable outcome as compare to those who had no history of failure to pass and with the incidence of 69..4% higher than the study done at Serbia(28,43%) (Doklestić et al. , 2014) When we see the association of dehydration, it had 10.3 times less likely to get favorable outcome and its incidence is 72.2% which is higher than the study done in Nigeria 37%(Agboola, Olatoke and Rahman, 2014). Regarding of hospital stay , patients who stayed more days between 8-15 days has 97% less favorable outcome than the patient who stayed fewer days .when we see the frequency its lower(44.8%) than the study done at Serbia(75.8%) who stay more than a weeks.(Doklestić et al., 2014) On this study, even though failure to pass, dehydration and hospital stay are associated, there is no studies I could find to compare with the management outcome. .However, sex , duration of illness, abdominal pain and tenderness ,fever and tachycardia are not associated as the study done in Malawi that age, gender, symptoms (obstipation, vomiting) and symptom duration, tachypnea, abnormal temperature, hemoconcentration, thrombocytopenia and thrombocytosis were not associated with increased mortality (Samuel et al., 2011). Strength and Limitation 6.1. Strength This research may be an entry point for further research if published because there is no research done related with this topic at eastern Ethiopia even thought Generalized peritonitis is a daily facing emergency cases. 6.2. Limitation Since this research was a retrospective study, including other characteristics that could only be assessed by observation or history-taking was not possible. There were also incompletely recorded charts otherwise we could get more charts . As there is no literature found on the same topic in our country. Conclusion and Recommendation 7.1. Conclusion The study indicate Most of intraoperative finding of the patients who had presented with the diagnosis of Generalized peritonitis is Perforated PUD (34.6%) being the most common one which is different from western set up in which Perforated appendix is the leading etiology. Omental patch was the most common performed procedure. About (27% )of the patients have unfavorable outcome and pneumonia(8.6%) is the most common post-operative complication followed by intra abdominal collection and SSI 7.2-Recommendation Post operation care should be changed to practice standard care like post op chest physiotherapy and appropriate wound care to decrease post-operative complication in the hospital. HFCSH with Regional health bureau should give Community awareness about generalized peritonitis to avoid late presentation as well as cessation of smoking and use of NSAID by primary health care system of catchment population. Card office and documentation should be digitalized. For Future Researcher prospective study should be done in the area. Declarations 7.3 Funding declarations This study received no funding from any public, commercial, or non-profit organizations. 7.4 Clinical trial number Not applicable. 7.5 Human Ethics and Consent to Participate Declarations Ethical clearance for this retrospective study was obtained from the Institutional Health Research Ethics Review Committee (IHRERC) of Haramaya University College of Health and Medical Sciences. As the study involved anonymized patient chart reviews with no direct contact with participants, the requirement for individual informed consent was waived by the IHRERC. 7.6 Consent for Publication : Not Applicable. Author Contribution E.D. conceived and designed the study, collected the data, performed the data analysis, and drafted the manuscript. F.W.W. and K.G. contributed to data interpretation, critical revision of the manuscript, and final approval. All authors read and approved the final manuscript. 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Available at: https://doi.org/10.1001/jamasurg.2016.4638. Hameed, T. et al. (2020) ‘Emerging Spectrum of Perforation Peritonitis in Developing World’, 7(September), pp. 1–7. Available at: https://doi.org/10.3389/fsurg.2020.00050. Kumar, D. et al. (2021) ‘Causes of Acute Peritonitis and Its Complication’, 13(5), pp. 1–5. Available at: https://doi.org/10.7759/cureus.15301. Kumar, R., Gupta, R., et al. (2020a) ‘Clinical Presentation and Findings in Secondary Generalised Peritonitis among the Patients Admitted in a Tertiary Care Hospital in Northern Part of’, International Journal of Health Sciences and Research , 10(July), pp. 316–320. Kumar, R., Gupta, R., et al. (2020b) ‘Descriptive Study Regarding the Etiological Factors Responsible for Secondary Bacterial Peritonitis in Patients Admitted in a Tertiary Care Hospital in Trans Himalayan Region’, 10(July), pp. 283–286. Kumar, R., Sharma, A., et al. (2020) ‘Pattern of Pneumoperitoneum in Generalised Secondary Peritonitis : A Descriptive Observational Study in a Tertiary Care Hospital in Trans Himalayan Region’, 10(August), pp. 15–18. Laméris, W. et al. (2009) ‘Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: Diagnostic accuracy study’, BMJ (Online) , 339(7711), pp. 29–33. Available at: https://doi.org/10.1136/bmj.b2431. Mabewa, A. et al. (2015) ‘Etiology , treatment outcome and prognostic factors among patients with secondary peritonitis at Bugando Medical Centre , Mwanza , Tanzania’, World Journal of Emergency Surgery , pp. 1–7. Available at: https://doi.org/10.1186/s13017-015-0042-5. Maghsoudi, H. and Ghaffari, A. (2011) ‘Generalized peritonitis requiring re-operation after leakage of omental patch repair of perforated peptic ulcer’, Saudi Journal of Gastroenterology , 17(2), pp. 124–128. Available at: https://doi.org/10.4103/1319-3767.77243. Malangoni, M.A. and Inui, T. (2006) ‘World Journal of Emergency Peritonitis – the Western experience’, 5, pp. 1–5. Available at: https://doi.org/10.1186/1749-7922-1-25. Malik, M. et al. (2019) ‘Causes of Acute Peritonitis and its Outcome in Tertiary Medical Centre’, 18(03), pp. 193–196. Available at: https://doi.org/10.22442/jlumhs.191830626. Mehboob, A. et al. (2022) ‘Outcome of Acute Peritonitis Related to Cause and Duration of Presentation In trodu ction Meth odo log y’, 18(1), pp. 9–14. Ndayizeye, L. et al. (2000) ‘Peritonitis in Rwanda : Epidemiology and risk factors for morbidity and mortality’. Of, S. et al. (2016) ‘Jebmh.com Original Article’, 3(65), pp. 3536–3541. Available at: https://doi.org/10.18410/jebmh/2016/759. Ohene-yeboah, M. (2015) ‘Causes of acute peritonitis in 1188 consecutive adult patients in Ghana Causes of acute peritonitis in 1188 consecutive adult patients in Ghana’, (April 2005), pp. 1–3. Prasad, N. and Reddy, K. (2016) ‘A study of acute peritonitis: evaluation of its mortality and morbidity’, International Surgery Journal , pp. 663–668. Available at: https://doi.org/10.18203/2349-2902.isj20161140. Riché, F.C. et al. (2009) ‘Factors associated with septic shock and mortality in generalized peritonitis: Comparison between community-acquired and postoperative peritonitis’, Critical Care , 13(3), pp. 1–9. Available at: https://doi.org/10.1186/cc7931. Samuel, J.C. et al. (2011) ‘An Observational Study of the Etiology , clinical presentation and outcomes associated with peritonitis in Lilongwe , Malawi’, pp. 1–5. Tochie, J.N. et al. (2020) ‘Global epidemiology of acute generalised peritonitis: A protocol for a systematic review and meta-analysis’, BMJ Open , 10(1), pp. 1–4. Available at: https://doi.org/10.1136/bmjopen-2019-034326. Watters, J.M. et al. (1996) ‘The influence of age on the severity of peritonitis’, Canadian Journal of Surgery , 39(2), pp. 142–146. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6930551","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":478149355,"identity":"1e838210-a934-420c-803e-093928d8ac9b","order_by":0,"name":"Eden Debele","email":"","orcid":"","institution":"Haramaya Unversity","correspondingAuthor":false,"prefix":"","firstName":"Eden","middleName":"","lastName":"Debele","suffix":""},{"id":478149356,"identity":"10b981e2-e3f3-49a4-967a-957aa36fdc6b","order_by":1,"name":"Fasil Wale","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYBAC9gYGhgMPQKwDDMwPPlQwMBgQ0sJzAKg4AaKFzXDGGSK1MEC1MEjzthGjhf34wwOJbTZ5fNfOGBjzzjssb87efIDhR8U23Fp4cgyAWtKKJW/nGDycu+2w4c6eYwmMPWdu49Riz5DDcCBx2+HEDUAtBm+3HWbccCPHgJmxDbcWHv7nD+BaJHjnHLYnrEUiwQCuRZK3AcggrOUNUMu/tMSZt9PKDGccS0/ecOZYwkF8fuHhT3/84cMZm8S+28mbH3yosbbdcLz54IMfFbi1oINmMHmAaPVAUEeK4lEwCkbBKBghAAAfaWflbJiHRAAAAABJRU5ErkJggg==","orcid":"","institution":"Haramaya Unversity","correspondingAuthor":true,"prefix":"","firstName":"Fasil","middleName":"","lastName":"Wale","suffix":""},{"id":478149357,"identity":"5689906d-f3b2-4adc-bdfe-9287dd450d3c","order_by":2,"name":"Kidist Getachew","email":"","orcid":"","institution":"Haramaya Unversity","correspondingAuthor":false,"prefix":"","firstName":"Kidist","middleName":"","lastName":"Getachew","suffix":""}],"badges":[],"createdAt":"2025-06-19 11:08:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6930551/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6930551/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85917817,"identity":"841eaeed-b496-4676-bcbf-0c3a3f0414ad","added_by":"auto","created_at":"2025-07-03 07:12:29","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":8091,"visible":true,"origin":"","legend":"\u003cp\u003eFlow of Data Collection: Charts Retrieved, Enrolled, and Collection Efficiency\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6930551/v1/3fbfd8a633657a78b0615f5e.png"},{"id":85917820,"identity":"479a08c7-fd8c-4c14-bf41-5394065b1d74","added_by":"auto","created_at":"2025-07-03 07:12:29","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":33536,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFrequency distribution by operative assessment of adult patients with generalized peritonitis at HFCSUH ,eastern Ethiopia 2023.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6930551/v1/aeff3fe9c4176edf62c17db6.png"},{"id":85918107,"identity":"bbe948ec-1382-4ca7-949c-9a4d7ff1c579","added_by":"auto","created_at":"2025-07-03 07:20:29","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":32030,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFrequency distribution operation done for the patient with diagnosis of Generalized peritonitis at HFCSUH ,eastern Ethiopia, 2023.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6930551/v1/50f533afbb4be6b17feca234.png"},{"id":85917819,"identity":"4dabc489-d2db-4a56-ba9e-5b6767251153","added_by":"auto","created_at":"2025-07-03 07:12:29","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":20111,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFrequency distribution of post-operative complications for generalized peritonitis at HFCSUH, eastern Ethiopia2023.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6930551/v1/ba5ef411fa49b40003313b37.png"},{"id":88880550,"identity":"a8561da3-6eb7-4975-82b7-f72021f0cf70","added_by":"auto","created_at":"2025-08-12 11:02:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1270423,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6930551/v1/8c584a4d-ccc1-447e-a538-24b9c5f91c3c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePattern and Management Outcome of Patients with Generalized Peritonitis\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003cstrong\u003e1.1 Background of the study\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMicrobial contamination of the\u0026nbsp;peritoneal cavity is termed peritonitis or intra-abdominal infection., that is the inflammation of the peritoneum. It is most commonly due to localized or generalized infection caused by various probable factors and is classified according\u0026nbsp;to etiology.\u0026nbsp;Primary microbial peritonitis\u0026nbsp;occurs when microbes\u0026nbsp;invade the normally sterile confines of the peritoneal cavity via\u0026nbsp;hematogenous dissemination from a distant source of infection\u0026nbsp;or direct inoculation.\u0026nbsp;Secondary microbial peritonitis\u0026nbsp;occurs subsequent to contamination of the peritoneal cavity due to perforation or severe inflammation and infection of an intra-abdominal organ. Examples include appendicitis, perforation of any portion of the gastrointestinal tract, or diverticulitis (\u003cem\u003e\u0026nbsp;Charles et al\u0026nbsp;\u003c/em\u003e, 2019).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Acute generalized peritonitis (AGP) affects about 9.3 patients per 1000 hospital admissions and requires adequate preoperative resuscitation to avert high perioperative morbidity and mortality. Although AGP is one of the most frequent surgical emergencies at the global level, it has been reported to disproportionately affect low-income and middle-income countries Strengths and limitations of this study \u0026nbsp;To the best of our knowledge, this systematic review and meta-analysis will be the first reporting the global epidemiology of acute generalised peritonitis (AGP). \u0026nbsp; This current review will include recent studies, hence, it will inform and guide policy makers in decision making on a global health perspective related to AGP. \u0026nbsp;Open access especially the sub-Saharan African (SSA) region both in terms of prevalence and mortality rates. The most common types of AGP in a recent series of 305 cases in SSA were perforated gastroduodenal ulcers, perforated appendicitis and typhoid ileal perforation. The postoperative mortality rates of AGP vary between 8.4% and 34% from isolated studies(Tochie et al., 2020).\u003c/p\u003e\n\u003cp\u003eThe pathophysiology: Patients in whom standard therapy fails typically develop one or more of the following: an intra-abdominal abscess, leakage from a gastrointestinal anastomosis leading to postoperative peritonitis, or tertiary (persistent) peritonitis. The contamination of peritoneal cavity thus, can lead to a cascade of infection, sepsis and multisystem organ failure (MSOF) and death if not treated in a timely manner.( Charles et al,2019)\u003c/p\u003e\n\u003cp\u003eEffective source control and antibiotic therapy is associated with low failure rates and a mortality rate of approximately 5% to 6%; inability to control the source of infection is associated with mortality greater than 40%. The response rate to effective source control and use of appropriate antibiotics has remained approximately 70% to 90% over the past several decades(\u003cem\u003e\u0026nbsp;Charles et al\u0026nbsp;\u003c/em\u003e, 2019).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Diagnosis of peritonitis was made based on clinical and radiological findings. Clinical findings included abdominal pain, vomiting, constipation, generalized abdominal tenderness, and absent bowel sounds. Peritonitis was indicated by X-ray showed air under the diaphragm. Exploratory laparotomy was done to identify the cause of peritonitis. Operative findings like duodenal perforation, ileal perforation, ileal stricture with perforation, and ruptured appendix (Kumar et al., 2021).\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cstrong\u003e3.1. Study area and study period\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study conducted at Hiwot fana comprehensive specialized university Hospital. The Hiwot Fana Specialized University Hospital located in Harar, the oldest and most illustrious city in eastern Ethiopia. Harar is located 525 kilometers from Addis Ababa, the nation's capital. The region's has two government hospitals are the Hiwot Fana Comprehensive Specialized Hospital and Jugol Regional Hospital with population size of around 5millon. With catchment areas in the Eastern part of Ethiopia, including the majority of both Hararghe Zones, Harari regions, as well as some areas of the Ethiopian Somalia regional state. HFCSH began as a referral hospital under Haramaya University administration in 2007.\u003c/p\u003e\n\u003cp\u003eThe hospital offers specialties in Emergency Medicine, Anesthesiology, Internal Medicine, Obstetrics and Gynecology, General Surgery and Orthopedics. Additionally, the hospital delivers treatments with different subspecialty level such as Radiology, Dermatology, Pathology, Oncology, Neurology, Neurosurgery, Plastic surgery, Pediatric surgery and ENT . Our General Surgery department service around 1220 patients per year.\u003c/p\u003e\n\u003cp\u003eThe data will be gathered from OCT 16, 2023 to Nov 1, 2023 among adult patients who admitted surgical ward at HFCSH eastern Ethiopia.\u003c/p\u003e\n\u003cp id=\"_Toc152748161\"\u003e\u003cstrong\u003e3.2. Study design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn institutional -based retrospective cross-sectional study employed using quantitative method.\u003c/p\u003e\n\u003cp id=\"_Toc152748162\"\u003e\u003cstrong\u003e3.3. Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc152748163\"\u003e3.3.1. Source population\u003c/p\u003e\n\u003cp\u003eAll adult patients who admitted at surgical ward with diagnosis of generalized peritonitis of HFCSH from December 1, 2018 to June 1, 2023.\u003c/p\u003e\n\u003cp id=\"_Toc152748164\"\u003e3.3.2. Study population\u003c/p\u003e\n\u003cp\u003eAll adult patients who treated with the diagnosis of generalized peritonitis at surgical ward and sampled from it at HFCSH.\u003c/p\u003e\n\u003cp id=\"_Toc152748165\"\u003e\u003cstrong\u003e3.4. Inclusion and exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc152748166\"\u003e3.4.1. Inclusion criteria\u003c/p\u003e\n\u003cp\u003eAll adult patients who were admitted to the surgical ward of the HFCUH during the study period with the diagnosis of generalized peritonitis.\u003c/p\u003e\n\u003cp id=\"_Toc152748167\"\u003e3.4.2. Exclusion criteria\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u0026nbsp;Incomplete medical records and missed medical records during data collection\u003c/li\u003e\n \u003cli\u003ePediatrics patients who are less than 18 years old\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp id=\"_Toc152748168\"\u003e\u003cstrong\u003e3.5. Sample size determination\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe study include \u0026nbsp;all patients who admitted to HFCUH with the diagnosis of \u0026nbsp;GP starting from December 1,2018 to June 1 ,2023 which are 650 participants\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e3 .6 Sampling procedure and Sampling technique\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; The hospital was selected purposively and the study participants was selected by using simple random methods from registration log book in surgical ward by using lottery methods from, December 1,2018 to June 1, 2023.from card store collected based on MRN then review the chart so that six hundred fifty patient medical record \u0026nbsp;retrieved from card room.\u003c/p\u003e\n\u003cp id=\"_Toc152748169\"\u003e\u003cstrong\u003e3.7 Data collection methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc152748170\"\u003e3.7.1. Data collection instruments\u003c/p\u003e\n\u003cp\u003eData was collected using semi-structured data abstraction format. Preliminary data source was log books of surgical ward. Patients’ medical records documented on the respective log books was employed for the data capturing. The information obtained from the above-mentioned sources will include sociodemographic data such as age, sex, residence, etc. and clinical characteristics involving …. (Data collection form attached as annex).. In addition, the number of surgical ward admissions during the data capturing period was analyzed in order to determine the incidence rate and management outcome of generalized peritonitis. Medical charts with missing data and lacking the required information was excluded.\u003c/p\u003e\n\u003cp id=\"_Toc152748171\"\u003e3.7.2 Data collectors and supervisor\u003c/p\u003e\n\u003cp\u003eTen nurses were taken to the data collection process. All data collection activities were supervised by a trained surgical resident and principal investigator.\u003c/p\u003e\n\u003cp id=\"_Toc152748172\"\u003e3.7.3. Data collectors and procedures\u003c/p\u003e\n\u003cp\u003eFour BSC nurses were take the data collection process. All the data collectors were given one-day training about cause and outcome of generalized peritonitis, objective of the study, variables on the questionnaire and its implication. Then, they were assigned to review medical record of patients and fill the data collection check list. All data collection activities were supervised by trained surgical residents and principal investigator.\u003c/p\u003e\n\u003cp id=\"_Toc152748173\"\u003e\u003cstrong\u003e3.8. Variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc152748174\"\u003e3.8.1. Dependent\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Treatment outcome of generalized peritonitis (favorable, unfavorable)\u003c/p\u003e\n\u003cp id=\"_Toc152748175\"\u003e3.8.2. Independent\u003c/p\u003e\n\u003cp id=\"_Toc122633026\"\u003e\u003cstrong\u003eSocio-demographic characteristics\u003c/strong\u003e (age, sex, residence)\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc122633027\"\u003e\u003cstrong\u003ePreoperative clinical characteristics\u003c/strong\u003e (presenting symptoms, duration of illness, preoperative diagnosis, comorbidity, and previous abdominal surgery),\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc122633028\"\u003e\u003cstrong\u003eIntra and post-operative clinical characteristics\u003c/strong\u003e (intraoperative diagnosis, type of intraoperative surgical procedure done, and length of hospital stay).\u003c/p\u003e\n\u003cp id=\"_Toc152748176\"\u003e\u003cstrong\u003e3.9. Operational definitions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneralized peritonitis (\u003c/strong\u003eAcute diffuse peritonitis) contamination of the peritoneal cavity due to perforation or severe inflammation and infection of an intra-abdominal organ.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerforated appendicitis\u0026nbsp;\u003c/strong\u003eis perforation of appendix at any level\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerforated PUD is\u003c/strong\u003e perforation of stomach and duodenum.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLower GI perforation\u0026nbsp;\u003c/strong\u003eis perforation of jejunum and especially ileum.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFavorable Treatment outcome\u003c/strong\u003e the condition of the patient after the procedure has been done and a patient does not develop postoperative complications until the patient discharged from hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUnfavorable Treatment outcome\u003c/strong\u003e the condition of the patient after the procedure has been done that develops any postoperative complications or died until the patient discharged from hospital.\u003c/p\u003e\n\u003cp id=\"_Toc152748177\"\u003e\u003cstrong\u003e3.10. Data quality control\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo ensure the quality of the data the questionnaires prepared in simple English was adapted from different published articles with some modification and check by a senior researcher and academician. Pretest on 5% medical record review was done two weeks before the actual data collection time. Training to data collectors and supervisors were given for one day. The training was focused mainly on the aim of the study and the data extraction tool, the need for data completeness, confidentiality, and how to approach data extraction during the data collection process. After the collected data was checked daily for its completeness, clarity, and consistency by the supervisor and the principal investigator. Overall activity was controlled by the principal investigator.\u003c/p\u003e\n\u003cp id=\"_Toc152748178\"\u003e\u003cstrong\u003e3.11. Methods of data analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc53829908\"\u003eThe collected data was checked for completeness and cleaned before entry into computer. Then the questionnaire was coded and entered into Epi data 7.2. Then the data was exported to statistical package for social science (SPSS) version 26 for data analysis.\u0026nbsp;Data was analyzed with both descriptive analysis such as frequencies, percentage, mean median, standard deviations and for analysis done through Logistic regression modal. For measuring the strength of the association between the outcome and independent variables, Crude Odd Ratio (COR) and Adjusted Odd Ratio (AOR) along with 95% Confidence interval (CI) was calculated. All variables with the p value of \u0026lt; 0.25 will be further analyzed with multivariate logistic regression analysis to control for confounders. The Association will be considered Significant at 95% confidence interval and p-value set at less than 5%, using SPSS, version 26.0\u003c/p\u003e\n\u003cp id=\"_Toc152748179\"\u003e\u003cstrong\u003e3.12. Ethical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from the Haramaya University, College of Health and Medical Sciences Institutional Health Research Ethics Review Committee (IHRERC) prior to data collection. Official permission was also obtained from Hiwot Fana Specialized University Hospital (HUHFSCH) administration, as well as inpatient and outpatient directors. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Information obtained from medical records was handled anonymously and kept strictly confidential.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc152748180\"\u003e\u003cstrong\u003e3.13. Information dissemination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of the study was presented and submitted to Haramaya University College of health and medical science, HFCSH. The study's results will also be made public through publications to reach a wider audience\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.14 Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was retrospective in nature. Patient charts were reviewed and assessed for data analysis after ethical clearance was obtained from the Institutional Health Research Ethics Review Committee (IHRERC) of Haramaya University College of Health and Medical Sciences. Since the research involved no direct contact with patients and utilized anonymized data, the requirement for individual informed consent was waived by the IHRERC.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eFour hundred twenty one files were considered to retrieve \u0026nbsp; but I found beyond expectation of six hundred fifty files of generalized peritonitis patients with a complete file so I used all. (\u003cstrong\u003eFigure 1)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;4.1 Socio demographic characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 650 study participants aged between 18-80 years were involved and yielding A response rate of 100%. The mean (\u0026plusmn;SD) age of the study participants were 33.7 years (SD\u0026plusmn;13.6). And 539 (82.9 %) of them were found to be in the age group of \u0026lt;50 years The finding revealed Female participants, are only 93(17.22%) and those came from rural area were 381(58.6%). (table1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1: Socio demographic characteristic of adults present with Generalized Peritonitis at HFCSUH, eastern Ethiopia 2023.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eVariable (n=650)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eCategories\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eFrequency\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003ePercentage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026lt;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e539\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e82.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026gt;=50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e17.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e539\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e82.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e17.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eResidence\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eUrban\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e41.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003col start=\"58\"\u003e\n \u003cli\u003e\u0026nbsp;\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e4.2. Pre\u003c/strong\u003e\u003cstrong\u003e-operative clinical feature\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, from patients presented to hospital with the diagnosis of Generalized peritonitis all \u0026nbsp; 650 (100%) had abdominal pain and 293 (45.1%) had abdominal distension. \u0026nbsp;Among those patients who have GP presented with Failure to pass 451(69.4%), fever 364 (56%), vomiting 619 (95.2%), Previous surgery 40(6.2 %%), comorbidities 26 (4%). From comorbidities the most common are \u0026nbsp; HTN 16 (61.5%) , \u0026nbsp;DM 8 (30.7%) has cardiac only \u0026nbsp;2 patients .Majority of the patient\u0026rsquo;s \u0026nbsp; presentations and laboratory findings are tachycardia 557(85.7%), Dehydration 469(72.2%), Abdominal tenderness \u0026nbsp; 644(99.1%), Guarding 576 (88.6%) and leukocytosis \u0026lt; 18000 are 514(79.1%). (Table2)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Pre-operative clinical characteristics among adult patients with diagnosis of generalized peritonitis at HFCSUH, eastern Ethiopia 2023.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eVariable (n=650)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003ecategories\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eDuration of illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026lt;=24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e25.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026gt;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e486\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e74.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAbdominal pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAbdominal distension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e45.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e54.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eFailure to pass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e69.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e30.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003efever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003evomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e95.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePrevious surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e610\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e93.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ecomorbidities\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e624\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eIf yes to comorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e61.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e30.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eCardiac\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003etachycardia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e85.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eDehydration\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e469\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e72.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e27.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eleukocytosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026lt;18000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e514\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e79.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026gt;18000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e20.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAbdominal tenderness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e99.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eGuarding\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e88.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e4.3 Operative assessment and care of adult patients with generalized peritonitis\u003c/p\u003e\n\u003cp\u003eAmong the study participant (650) who had laparotomy, and the most common intra operative finding was\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e Perforated PUD 225 (34.6%) , Perforated appendix \u0026nbsp; 202 ,(31.1%) , Gangrenous SBO 168 (25.8 %), Lower GI perforation 55 (8.5%) respectively. (Figure 2) The procedure done \u0026nbsp; Appendectomy 202 (31.1%), Omental patch 225 (34.6%), ileostomy 183 (28.2%), Resection and anastomosis 40 (6.2%) respectively. ( figure 3)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.4 Post-operative condition \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong 650 study participant 456(70.2%) had Smooth outcome and 194 (29.8%) are Complicated. From those complication Pneumonia 56 (8.6%) is the most common complication, Intra-abdominal collection 27 (4.2%), SSI 26(4%), Sepsis/septic shock 19(2.9 %), Dehiscence 14 (2.2%), Ileus 4 (0.6 %), Anastomosis leak 3 (0.5%) are the rest common complications\u003cstrong\u003e. (Figure 4).\u0026nbsp;\u003c/strong\u003eThe post-operative course was smooth in 70.2% of patients, while complications occurred in 29.8%. A total of 55.2% of patients had a hospital stay of less than 7 days. Upon discharge, 72.5% of patients had a favorable outcome. (Table 3)\u003c/p\u003e\n\u003cp\u003eTable 3: Frequency distribution of postop condition of patients who were operated at HFCSUH\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"631\" style=\"margin-right: calc(9%); width: 91%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.6659%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003eCategories\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003ePercentage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 25.6659%;\"\u003e\n \u003cp\u003ePost-operative course \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003eSmooth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003e456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003e70.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003eComplicated\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003e194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003e29.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"9\" valign=\"top\" style=\"width: 25.6659%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-operative complication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003eSSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003ePneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003e8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003eDehiscence \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003eIleus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003eIntra-abdominal collection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003eAnastomosis leak\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003eSepsis/septic shock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003eDeath\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003eNo complication\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003e451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003e69.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 25.6659%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Hospital stays\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003e1-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003e359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003e55.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003e8-15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003e27.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003e16-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003e24-31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003e\u0026gt;32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 67.4476%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 25.6659%;\"\u003e\n \u003cp\u003eOutcome at discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003eFavorable\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003e471\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003e72.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.726%;\"\u003e\n \u003cp\u003eunfavorable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.1002%;\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7706%;\"\u003e\n \u003cp\u003e27.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e4.5 Factors Associated with outcome\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to this study, bivariate logistic regression analysis of patients who developed favorable outcome had significant association with patients having age \u0026nbsp;[(COR-2.486),CI=95%:(1.62--3.797)P-0.000)],sex \u0026nbsp;[( \u0026nbsp; \u0026nbsp;COR -.752,CL=95%:(.484-1.169 \u0026nbsp;)P- .206], residence \u0026nbsp; \u0026nbsp;[(COR-2.504),CI=95%:(1.714-3.658)P-0.000)], \u0026nbsp;duration of illness \u0026nbsp;[(COR-5.0592),CI=95%:(2.881-8.886)P-0.000)], failure to pass[(COR-6.001),CI=95%:(3.522 -10.226) (P-0.000)],tachycardia [(C0R- .346 ) CL=95%:(.184-.651)P-0.01)] ,dehydration [(COR-3.637)CI=95%:(2.238-5.909) (P-0.000)] ,guarding [(COR-1.900 CI=95%:(1.017-3.550) (P-0.044)] and intra operative finding of perforated appendix [(COR--.330),CI=95%:(.196-.557),(P-0.000)] lower GI perforation[(COR=-.124,CI=95%:(.063-.246),(P-0.000)] Gangrenous SBO [(COR--.204),CI=95%:(.119-.347),(P-0.000)] \u0026nbsp; ,post op condition \u0026nbsp; [(COR=351.806 CI=95%(160.276 -772.212)P-0.000)] ,hospital stay \u0026nbsp; From 8-15days [(COR=43.3 CI=95% (9.624 -194.83) P-0.000)], from 16-23days [(COR=20.00 CI=95% \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(4.408 -90.738) P-0.000)] from 31daysand above [(COR=5.795 CI=95%(1.164 -28.861) P-0.032)].\u003c/p\u003e\n\u003cp\u003eFrom this study those variables significantly associated and included in multivariate are age, failure to pass, dehydration, from intra operative finding lower GI perforation and hospital stay between 8-15days. (Table4). Patients who were \u0026lt; 50 years had 4.6 times more likely to get favorable outcome when compare to those with \u0026gt;=50 years old patients [(AOR- 4.675(1.219-17.933) P-.000)]. The patients who does not presented with failure to pass had 12 times more likely to get favorable outcome when compare to those \u0026nbsp; have history of failure to pass. Patients who had no signs of dehydration \u0026nbsp; \u0026nbsp;had 10 times more likely to get favorable outcome when compare to those show this signs [(AOR-10.390(3.057-35.319) P- .000)]. (Table 4).\u003c/p\u003e\n\u003cp\u003ePatients with intra operative finding of \u0026nbsp; Lower GI perforation 94%, less likely to get favorable outcome as compare to perforated PUD [AOR-.061(.009-.404) P-.004]. The patients who had hospital stay in days of \u0026nbsp; 8-15dys, 97% less likely to get favorable outcome than the patient who stay between 1-7 days [(AOR-.030(.001-.611) P-.002)]. Considered statistically significant at p \u0026le; 0.05 in multivariable logistic regression model, AOR=Adjusted odd ratio, CI=Confidence interval. (Table 4).\u003c/p\u003e\n\u003cp\u003eTable 4: \u0026nbsp;Multivariate Analysis of Factors associated with surgical treatment outcome of Generalized peritonitis \u0026nbsp;at HFCSUH ,eastern Ethiopia ,2023.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"715\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;Variables\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n=650)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eTreatment Outcome\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003eCOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eAOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003efavorable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eunfavorable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eage categories\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026gt;=50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026lt;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e2.486(1.628-3.797)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e4.675(1.219-17.933)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eFailure to pass flatus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e6.001(3.522-10.226)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e12.024(2.530-57.140)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eDehydration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e3.637(2.238-5.909)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e10.390(3.057-35.319)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eIntraoperative finding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003ePerforate PUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003ePerforate appendix\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e.330(.196-.557)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e.227(.051-1.009)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.051\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003eLower GI perforation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e.124(.063-.246)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e.061(.009-.404)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;Gangrenous \u0026nbsp;SBO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e.204(.119-.347)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e.400(.099-1.618)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.199\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003ehospital stay in days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;8-15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e43.302\u0026nbsp;(9.624-194.833)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e.030(.001-.611)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.023\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e16-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e20.000\u0026nbsp;(4.408-90.738)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e.217(.011-4.378)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.319\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e24-31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e3.293(.681-15.923)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e2.091(.193-22.599)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.544\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026gt;=31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e5.795(1.164-28.861)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e3.046(.270-34.343)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.368\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study we tried to reveal pattern and treatment outcome of generalized peritonitis among patients admitted \u0026nbsp; to surgical ward of Hiwot Fana Comprehensive Specialized Hospital, so\u0026nbsp;Perforated PUD (34.6%) is the most common cause of generalized peritonitis. And\u0026nbsp;the unfavorable outcome is 29.8% with \u0026nbsp; \u0026nbsp;the most common complication is \u0026nbsp; pneumonia (8.6%). Age, failure to pass, dehydration intraoperative finding and hospital stay were factors found to be significantly associated with generalized peritonitis.\u003c/p\u003e\n\u003cp\u003eFrom this study Perforated PUD is the most common cause of Generalized peritonitis as compare to other African country unlike Malawi perforated appendix is most common(Samuel \u003cem\u003eet al.\u003c/em\u003e, 2011). \u0026nbsp; Since our community has a behavior of chewing chat, smoking and history of dyspepsia as the study done in Addis Ababa teaching hospital Chewing chat, smoking and alcohol use were seen in 22 (23.6%), 35(37.6%), and 34(36.5%), cases respectively and 23.6% gave previous history of dyspepsia (Birhanu Nega et al., 2020) are the most common risk factors for PPUD.\u003c/p\u003e\n\u003cp\u003eAs compare to another studies \u0026nbsp;as etiology of generalized peritonitis, perforated PUD (34.6%) is the most common etiology and lower than the study done\u0026nbsp;in Himalayan region 118(77.13%) ,and in other study of India (52.40%)(Naveen .k et al.,2016 but higher than \u0026nbsp;in Tanzania\u0026nbsp;\u0026nbsp;18(18.56 %) (Mabewa \u003cem\u003eet al.\u003c/em\u003e, 2015). Perforated appendix (31.1%) in this study making the second most common like Rwanda (16 %) (Ndayizeye et al., 2000) , but 3\u003csup\u003erd\u003c/sup\u003e common (10%) at India (Bylapudi \u003cem\u003eet al.\u003c/em\u003e, 2021).but it is the most common in Malawi \u0026nbsp; (22%)(Samuel \u003cem\u003eet al.\u003c/em\u003e, 2011), still lower.\u0026nbsp;Gangrenous SBO (25.8%) is the 3\u003csup\u003erd\u003c/sup\u003e common in my study but the 2\u003csup\u003end\u003c/sup\u003e most common at India (Bylapudi et al., 2021) the last common intra operative finding from this study is lower GI perforation (8.5%).\u003c/p\u003e\n\u003cp\u003eMorbidity rate in surgery for peritonitis vary worldwide with report ranging from(18%-67%) regionally in Kenya (47.1) ,in Rwanda (51%) and in Uganda (32%) (Cent and Afr, 2014) which is nearer to our study( 30.6% ) and the most common complications are pneumonia (8.6%) alike India \u0026nbsp;morbidity is ( 70% ) and most common complications are SSI and sepsis 18% (Bylapudi et al., 2021). Mortality rate of this study is (7.7%) in Rwanda 17% (Ndayizeye \u003cem\u003eet al.\u003c/em\u003e, 2000),in Malawi 15%(Samuel \u003cem\u003eet al.\u003c/em\u003e, 2011).\u003c/p\u003e\n\u003cp\u003eOlder patients who present with a diagnosis of generalized peritonitis have 4.6 times less likely to get favorable outcome as compare to younger patients. This is in line with the study done at Ottawa that 3.1 times to be complicated for older patients(Watters \u003cem\u003eet al.\u003c/em\u003e, 1996). \u0026nbsp; The reason for this is \u0026nbsp; due to \u0026nbsp; increased prevalence of chronic illnesses in the elderly and a predictable decline in the ability to maintain physiologic homeostasis. Additionally, age-related changes in the host responses to surgical illness.\u003c/p\u003e\n\u003cp\u003eLooking from the current study failure to pass has association with outcome of generalized peritonitis.it reveal those who fail to pass feaces and flatus had \u0026nbsp;12 times less likely to get favorable outcome as compare to those who had no \u0026nbsp;history of failure to pass and with the incidence of 69..4% higher than the study done at Serbia(28,43%)\u0026nbsp; (Doklestić \u003cem\u003eet al.\u003c/em\u003e, 2014)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhen we see the association of dehydration, it had 10.3 times less likely to get favorable outcome and its incidence is 72.2% which is higher than the study done in Nigeria 37%(Agboola, Olatoke and Rahman, 2014).\u003c/p\u003e\n\u003cp\u003eRegarding of hospital stay , patients who stayed more days between 8-15 days has 97% \u0026nbsp;less favorable outcome than the patient who stayed fewer days .when we see the frequency its \u0026nbsp;lower(44.8%) than \u0026nbsp;the study done at Serbia(75.8%) who stay more than a weeks.(Doklestić et al., 2014)\u003c/p\u003e\n\u003cp\u003eOn this study, even though failure to pass, dehydration and hospital stay are associated, there is no studies I could find to compare with the management outcome. .However, sex , duration of illness, abdominal pain and tenderness ,fever and tachycardia are not associated as the study done in Malawi \u0026nbsp; that age, gender, symptoms (obstipation, vomiting) and symptom duration, tachypnea, abnormal temperature, hemoconcentration, thrombocytopenia and thrombocytosis were not associated with increased mortality (Samuel et al., 2011).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrength and Limitation\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc152748185\"\u003e6.1. Strength\u003c/p\u003e\n\u003cp id=\"_Toc82627715\"\u003eThis research may be an entry point for further research if published\u0026nbsp;because there is no research done related with this topic at eastern Ethiopia even thought Generalized peritonitis is a daily facing emergency cases.\u003c/p\u003e\n\u003cp id=\"_Toc152748186\"\u003e6.2. Limitation\u003c/p\u003e\n\u003cp id=\"_Toc152748187\"\u003eSince this research was a retrospective study, including other characteristics that could only be assessed by observation or history-taking was not possible. There were also incompletely recorded charts otherwise we could get more charts . As there is no literature found on the same topic in our country.\u003c/p\u003e"},{"header":"Conclusion and Recommendation","content":"\u003cp\u003e7.1. Conclusion\u003c/p\u003e\n\u003cp\u003eThe study indicate Most of intraoperative finding of the patients who had presented with the diagnosis of \u0026nbsp; Generalized peritonitis is Perforated PUD (34.6%) being the most common one which is different from western set up in which Perforated appendix is the leading etiology. Omental patch was the most common performed procedure. About (27% )of the patients have unfavorable outcome and pneumonia(8.6%) \u0026nbsp;is the most common post-operative complication followed by intra abdominal collection and SSI\u003c/p\u003e\n\u003cp id=\"_Toc152748190\"\u003e7.2-Recommendation\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003ePost operation care should be changed to \u0026nbsp; practice standard care like post op chest physiotherapy and appropriate wound care to decrease post-operative complication in the hospital.\u003c/li\u003e\n \u003cli\u003eHFCSH with Regional health bureau should give Community awareness about generalized peritonitis to avoid late presentation as well as cessation of smoking and use of NSAID \u0026nbsp;by primary health care system of catchment population.\u003c/li\u003e\n \u003cli\u003eCard office and documentation should be digitalized.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFor Future Researcher prospective study should be done in the area.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e7.3\u0026nbsp;Funding declarations\u003c/p\u003e\n\u003cp\u003eThis study received no funding from any public, commercial, or non-profit organizations.\u003c/p\u003e\n\u003cp\u003e7.4 Clinical trial number\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e7.5\u0026nbsp;Human Ethics and Consent to Participate Declarations\u003c/p\u003e\n\u003cp\u003eEthical clearance for this retrospective study was obtained from the Institutional Health Research Ethics Review Committee (IHRERC) of Haramaya University College of Health and Medical Sciences. As the study involved anonymized patient chart reviews with no direct contact with participants, the requirement for individual informed consent was waived by the IHRERC.\u003c/p\u003e\n\u003cp\u003e7.6\u0026nbsp;\u003cstrong\u003eConsent for Publication\u003c/strong\u003e: Not Applicable.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eE.D. conceived and designed the study, collected the data, performed the data analysis, and drafted the manuscript. F.W.W. and K.G. contributed to data interpretation, critical revision of the manuscript, and final approval. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbdulrahman, A., Elgazwi, K. and Khudora, M. (2015) \u0026lsquo;The characteristics and outcomes of secondary peritonitis in a Tertiary Hospital, Benghazi, Libya\u0026rsquo;, \u003cem\u003eIbnosina Journal of Medicine and Biomedical Sciences\u003c/em\u003e, 07(04), pp. 136\u0026ndash;140. Available at: https://doi.org/10.4103/1947-489x.210275.\u003c/li\u003e\n\u003cli\u003eAgboola, J., Olatoke, S. and Rahman, G. (2014) \u0026lsquo;Pattern and presentation of acute abdomen in a Nigerian teaching hospital\u0026rsquo;, \u003cem\u003eNigerian Medical Journal\u003c/em\u003e, 55(3), p. 266. Available at: https://doi.org/10.4103/0300-1652.132068.\u003c/li\u003e\n\u003cli\u003eBylapudi, S.K. \u003cem\u003eet al.\u003c/em\u003e (2021) \u0026lsquo;Role of Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II Score in Predicting Outcomes of Peritonitis Due to Hollow Viscous Perforation: A Prospective Observational Study\u0026rsquo;, \u003cem\u003eCureus\u003c/em\u003e [Preprint]. Available at: https://doi.org/10.7759/cureus.20155.\u003c/li\u003e\n\u003cli\u003eCent, E. and Afr, J. (2014) \u0026lsquo;ISSN 2073- ISSN 2073- 2073 - 9990 East Cent . Afr . J . s urg\u0026rsquo;, 19(3), pp. 99\u0026ndash;106.\u003c/li\u003e\n\u003cli\u003eChichom-mefire, A., Fon, T.A. and Ngowe-ngowe, M. (2016) \u0026lsquo;Which cause of diffuse peritonitis is the deadliest in the tropics ? A retrospective analysis of 305 cases from the South-West Region of Cameroon\u0026rsquo;, \u003cem\u003eWorld Journal of Emergency Surgery\u003c/em\u003e, pp. 1\u0026ndash;11. Available at: https://doi.org/10.1186/s13017-016-0070-9.\u003c/li\u003e\n\u003cli\u003eDoklestić, S.K. \u003cem\u003eet al.\u003c/em\u003e (2014) \u0026lsquo;Secondary peritonitis - evaluation of 204 cases and literature review\u0026rsquo;, \u003cem\u003eJournal of medicine and life\u003c/em\u003e, 7(2), pp. 132\u0026ndash;138.\u003c/li\u003e\n\u003cli\u003eGallaher, J.R. \u003cem\u003eet al.\u003c/em\u003e (2015) \u0026lsquo;Outcomes of Peritonitis in Sub-Saharan Africa : An Issue of Access to Surgical\u0026rsquo;, \u003cem\u003eJournal of the American College of Surgeons\u003c/em\u003e, 221(4), pp. S87\u0026ndash;S88. Available at: https://doi.org/10.1016/j.jamcollsurg.2015.07.199.\u003c/li\u003e\n\u003cli\u003eGallaher, J.R. \u003cem\u003eet al.\u003c/em\u003e (2017) \u0026lsquo;Mortality after peritonitis in sub-saharan Africa: An issue of access to care\u0026rsquo;, \u003cem\u003eJAMA Surgery\u003c/em\u003e, 152(4), pp. 408\u0026ndash;410. Available at: https://doi.org/10.1001/jamasurg.2016.4638.\u003c/li\u003e\n\u003cli\u003eHameed, T. \u003cem\u003eet al.\u003c/em\u003e (2020) \u0026lsquo;Emerging Spectrum of Perforation Peritonitis in Developing World\u0026rsquo;, 7(September), pp. 1\u0026ndash;7. Available at: https://doi.org/10.3389/fsurg.2020.00050.\u003c/li\u003e\n\u003cli\u003eKumar, D. \u003cem\u003eet al.\u003c/em\u003e (2021) \u0026lsquo;Causes of Acute Peritonitis and Its Complication\u0026rsquo;, 13(5), pp. 1\u0026ndash;5. Available at: https://doi.org/10.7759/cureus.15301.\u003c/li\u003e\n\u003cli\u003eKumar, R., Gupta, R., \u003cem\u003eet al.\u003c/em\u003e (2020a) \u0026lsquo;Clinical Presentation and Findings in Secondary Generalised Peritonitis among the Patients Admitted in a Tertiary Care Hospital in Northern Part of\u0026rsquo;, \u003cem\u003eInternational Journal of Health Sciences and Research\u003c/em\u003e, 10(July), pp. 316\u0026ndash;320.\u003c/li\u003e\n\u003cli\u003eKumar, R., Gupta, R., \u003cem\u003eet al.\u003c/em\u003e (2020b) \u0026lsquo;Descriptive Study Regarding the Etiological Factors Responsible for Secondary Bacterial Peritonitis in Patients Admitted in a Tertiary Care Hospital in Trans Himalayan Region\u0026rsquo;, 10(July), pp. 283\u0026ndash;286.\u003c/li\u003e\n\u003cli\u003eKumar, R., Sharma, A., \u003cem\u003eet al.\u003c/em\u003e (2020) \u0026lsquo;Pattern of Pneumoperitoneum in Generalised Secondary Peritonitis : A Descriptive Observational Study in a Tertiary Care Hospital in Trans Himalayan Region\u0026rsquo;, 10(August), pp. 15\u0026ndash;18.\u003c/li\u003e\n\u003cli\u003eLam\u0026eacute;ris, W. \u003cem\u003eet al.\u003c/em\u003e (2009) \u0026lsquo;Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: Diagnostic accuracy study\u0026rsquo;, \u003cem\u003eBMJ (Online)\u003c/em\u003e, 339(7711), pp. 29\u0026ndash;33. Available at: https://doi.org/10.1136/bmj.b2431.\u003c/li\u003e\n\u003cli\u003eMabewa, A. \u003cem\u003eet al.\u003c/em\u003e (2015) \u0026lsquo;Etiology , treatment outcome and prognostic factors among patients with secondary peritonitis at Bugando Medical Centre , Mwanza , Tanzania\u0026rsquo;, \u003cem\u003eWorld Journal of Emergency Surgery\u003c/em\u003e, pp. 1\u0026ndash;7. Available at: https://doi.org/10.1186/s13017-015-0042-5.\u003c/li\u003e\n\u003cli\u003eMaghsoudi, H. and Ghaffari, A. (2011) \u0026lsquo;Generalized peritonitis requiring re-operation after leakage of omental patch repair of perforated peptic ulcer\u0026rsquo;, \u003cem\u003eSaudi Journal of Gastroenterology\u003c/em\u003e, 17(2), pp. 124\u0026ndash;128. Available at: https://doi.org/10.4103/1319-3767.77243.\u003c/li\u003e\n\u003cli\u003eMalangoni, M.A. and Inui, T. (2006) \u0026lsquo;World Journal of Emergency Peritonitis \u0026ndash; the Western experience\u0026rsquo;, 5, pp. 1\u0026ndash;5. Available at: https://doi.org/10.1186/1749-7922-1-25.\u003c/li\u003e\n\u003cli\u003eMalik, M. \u003cem\u003eet al.\u003c/em\u003e (2019) \u0026lsquo;Causes of Acute Peritonitis and its Outcome in Tertiary Medical Centre\u0026rsquo;, 18(03), pp. 193\u0026ndash;196. Available at: https://doi.org/10.22442/jlumhs.191830626.\u003c/li\u003e\n\u003cli\u003eMehboob, A. \u003cem\u003eet al.\u003c/em\u003e (2022) \u0026lsquo;Outcome of Acute Peritonitis Related to Cause and Duration of Presentation In trodu ction Meth odo log y\u0026rsquo;, 18(1), pp. 9\u0026ndash;14.\u003c/li\u003e\n\u003cli\u003eNdayizeye, L. \u003cem\u003eet al.\u003c/em\u003e (2000) \u0026lsquo;Peritonitis in Rwanda : Epidemiology and risk factors for morbidity and mortality\u0026rsquo;.\u003c/li\u003e\n\u003cli\u003eOf, S. \u003cem\u003eet al.\u003c/em\u003e (2016) \u0026lsquo;Jebmh.com Original Article\u0026rsquo;, 3(65), pp. 3536\u0026ndash;3541. Available at: https://doi.org/10.18410/jebmh/2016/759.\u003c/li\u003e\n\u003cli\u003eOhene-yeboah, M. (2015) \u0026lsquo;Causes of acute peritonitis in 1188 consecutive adult patients in Ghana Causes of acute peritonitis in 1188 consecutive adult patients in Ghana\u0026rsquo;, (April 2005), pp. 1\u0026ndash;3.\u003c/li\u003e\n\u003cli\u003ePrasad, N. and Reddy, K. (2016) \u0026lsquo;A study of acute peritonitis: evaluation of its mortality and morbidity\u0026rsquo;, \u003cem\u003eInternational Surgery Journal\u003c/em\u003e, pp. 663\u0026ndash;668. Available at: https://doi.org/10.18203/2349-2902.isj20161140.\u003c/li\u003e\n\u003cli\u003eRich\u0026eacute;, F.C. \u003cem\u003eet al.\u003c/em\u003e (2009) \u0026lsquo;Factors associated with septic shock and mortality in generalized peritonitis: Comparison between community-acquired and postoperative peritonitis\u0026rsquo;, \u003cem\u003eCritical Care\u003c/em\u003e, 13(3), pp. 1\u0026ndash;9. Available at: https://doi.org/10.1186/cc7931.\u003c/li\u003e\n\u003cli\u003eSamuel, J.C. \u003cem\u003eet al.\u003c/em\u003e (2011) \u0026lsquo;An Observational Study of the Etiology , clinical presentation and outcomes associated with peritonitis in Lilongwe , Malawi\u0026rsquo;, pp. 1\u0026ndash;5.\u003c/li\u003e\n\u003cli\u003eTochie, J.N. \u003cem\u003eet al.\u003c/em\u003e (2020) \u0026lsquo;Global epidemiology of acute generalised peritonitis: A protocol for a systematic review and meta-analysis\u0026rsquo;, \u003cem\u003eBMJ Open\u003c/em\u003e, 10(1), pp. 1\u0026ndash;4. Available at: https://doi.org/10.1136/bmjopen-2019-034326.\u003c/li\u003e\n\u003cli\u003eWatters, J.M. \u003cem\u003eet al.\u003c/em\u003e (1996) \u0026lsquo;The influence of age on the severity of peritonitis\u0026rsquo;, \u003cem\u003eCanadian Journal of Surgery\u003c/em\u003e, 39(2), pp. 142\u0026ndash;146.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"generalized peritonitis, risk factor, intraabdominal infection, PUD, perforated appendicitis","lastPublishedDoi":"10.21203/rs.3.rs-6930551/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6930551/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eGeneralized peritonitis is a microbial contamination of the peritoneal cavity that requires prompt diagnosis and treatment. Despite enhanced comprehension of its pathophysiology, advancements in diagnosis, surgery, antimicrobial therapy, and intensive care aid, peritonitis still has the potential to be lethal. .Especially in Hiwot Fana hospital, our patients arrive to hospital lately that make the management difficult. And there is no data regarding management outcome and clinical pattern of the problem in this hospital .\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThe aim of this study is to identify pattern and management outcome of generalized peritonitis among the adult admitted patients at Hiwot fana comprehensive specialized hospital from Dec 1,2018 \u0026ndash; June 1,2023. The data gathered from October 16,2023 to November 1, 2023.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e The study was conducted among 650 surgically treated generalized peritonitis patients using cross-Sectional study design by reviewing all patient charts who underwent surgical intervention for the surgically treated generalized peritonitis in the study period.Structured checklist was used to collect relevant data and analyzed using Statistical Package for the Social Sciences version 26 software package. Bi-variate and Multi-variate logistic regression was employed to assess association between dependent and independent variables with 95% Confidence interval and p-value less than 0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 650 files were used. The mean age was 33.7 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;13.6). And 539 ( 82.9%) of them were found to be in the age group of \u0026lt;\u0026thinsp;50 yrs and the male to female ratio was 5.99:1. Perforated PUD was the predominant intraoperative finding (34.6%) followed by Perforated appendix (31.1%), Gangrenous SBO (25.8%) and Lower GI perforation (8.5%). Omental patch was the common procedure done (34%). Favorable outcome was found in 72.5% of the cases. Pneumonia (8.6%) was the most common complication. Patients who were \u0026lt;\u0026thinsp;50 years had 4.6 times more likely to get favorable outcome when compare to those with \u0026gt;\u0026thinsp;=\u0026thinsp;50 years old patients[(AOR- 4.675(1.219\u0026ndash;17.933) P-.025)].\u003c/p\u003e\u003ch2\u003eConclusion and Recommendation:\u003c/h2\u003e \u003cp\u003eMost common pattern is perforated PUD. Older Age, failure to pass and dehydration, lower GI perforation and hospital stay between 8-15days are associated with unfavorable outcome. Community awareness about generalized peritonitis should increase to avoid late presentation.\u003c/p\u003e","manuscriptTitle":"Pattern and Management Outcome of Patients with Generalized Peritonitis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-03 07:12:24","doi":"10.21203/rs.3.rs-6930551/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"78786f90-226e-45d9-a0b5-e75b1c4b72bc","owner":[],"postedDate":"July 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-12T10:53:52+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-03 07:12:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6930551","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6930551","identity":"rs-6930551","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}