The Diagnostic, Management Experience and Outcomes of Non-Traumatic Gastrointestinal Tract Perforations in Rural African Setting: A Descriptive Review

The Diagnostic, Management Experience and Outcomes of Non-Traumatic Gastrointestinal Tract Perforations in Rural African Setting: A Descriptive Review | 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 The Diagnostic, Management Experience and Outcomes of Non-Traumatic Gastrointestinal Tract Perforations in Rural African Setting: A Descriptive Review WUNDE Njineck UBRAINE, Wesley Harrisson Bouche Djatche, Dimitri Tchinda, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8591310/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 The gastrointestinal tract is vulnerable to perforations across multiple segments, with diverse etiologies. While existing research has largely focused on urban hospitals, data from rural settings remain scarce. Non-traumatic causes predominate, particularly typhic and peptic perforations. This study aims to determine the frequency of gastrointestinal perforations in a rural, hard-to-reach hospital in Cameroon, to describe the local management approaches and address gaps in rural emergency surgical care delivery. Methods and analysis We conducted a retrospective study at Tokombere District Hospital, with data collection via Google Forms. Analyses used Pearson correlation, Chi-square, and logistic regression in SPSS v26 to adjust for confounders. Significance was set at p < 0.05, with results presented in tables and figures. Results A total of 44 patients were included, with a median age of 21.5 years; most were male (68.2%). Abdominal pain was the predominant presenting symptom (46.9%), and abdominal x-ray served as the main diagnostic tool (36.4%). The average delay between symptom onset and definitive surgery was seven days. The ileum emerged as the most frequent site of perforation, and simple repair was the primary treatment modality (76.3%). Postoperatively, the mean time to return of intestinal transit was 2.8 ± 1.3 days, highlighting both the clinical burden and management outcomes in this cohort. Conclusion an important number of gastrointestinal perforations are being managed at the primary health care level, and efforts should be made to optimise and standardise this management. Gastrointestinal Perforation Emergency Laparotomy Maroua Peritonitis Figures Figure 1 INTRODUCTION Gastrointestinal tract (GIT) perforations can occur across various segments of this hollow viscous, caused by different etiologies. In many developing countries, the majority of these perforations are non-traumatic, representing one of the most frequent causes of peritonitis( 1 – 3 ). Peritonitis is a common presenting surgical emergency in the majority of health care settings in Cameroon ( 4 ). The extreme north region of Cameroon is even more particular with unique public health challenges; limited access to safe water sources, recurrent outbreaks, and the high prevalence of water-borne vectors significantly increase the risk of GIT complications ( 5 ). Despite the severity of this burden in rural areas, most studies on this pathology are focused on trends in the urban areas served by tertiary and quaternary healthcare facilities( 1 , 4 , 6 ). While the causes of peritonitis are wide and vary from primary through secondary to tertiary forms ( 4 ), this study focuses specifically on secondary and tertiary peritonitis resulting from non-traumatic causes. Typhoid fever endemic in sub-Saharan Africa remains a commonly reported etiology of GIT perforations in this region ( 3 , 7 ). Despite sparse data on its actual prevalence, data curated from recent studies around Africa reveal 120 GI Perforations out of 148 cases of peritonitis operated in Burkina Faso (Kambiré, 2017). Similarly Ngo Nonga et al. reported 30 cases of digestive perforation out of 69 cases of Peritonitis operated at the Yaounde Teaching Hospital ( 7 ) while Savom et al. in a multicentric study identified up to 52 patients with GIT perforations in their cohort ( 4 ). The diagnosis of GIT perforations rests on the clinical presentation corroborated by abdominal imaging. Moreso, the management is principally surgical with the need for urgent bespoke surgical intervention. This is sometimes not readily available at the primary healthcare level. The specific surgical approach and gestures depend on a myriad of factors; the site of the perforation and the patient's hemodynamic status at presentation. Due to systemic limitations within the regional healthcare infrastructure in Cameroon, patients frequently present with advanced disease, hence making management in hard-to-reach areas even more challenging ( 1 , 7 ). Consequently, while prompt diagnosis and timely surgical intervention are indispensable to curb the morbidity and mortality of this rapidly progressing pathology, there remains a critical lack of data regarding current management practices and outcomes in resource-limited, primary health care settings. By shifting the focus, this study aims to address this data gap and highlight the realities of managing GI perforations in a rural setting of Northern Cameroon. STUDY OBJECTIVES To; Describe the clinical presentation and diagnostic approaches of non-traumatic GIT perforations in Tokombere, Northern Cameroon Describe the treatment approaches, outcomes, and predictors of outcome following non-traumatic GIT perforations in Tokombere, Northern Cameroon METHODS Study design and period This was a retrospective descriptive study of patients managed for non-traumatic GIT perforations managed at the surgical department of the Private Catholic Hospital of Tokombere from January 2021 to January 2023. Study area and setting This study will be conducted in the surgical department of the aforementioned hospital, located in the rural areas of the extreme north region of Cameroon. It is noted for its hard-to-reach nature during the rainy season, with an average distance from the regional hospital being 48.2km equal to about 3 hours ride in fair weather. The main method of patient transportation in this area is by motorcycle. This hospital is recognised as the district hospital for Tokombere with a capacity of 152 beds. It serves as a referral hospital for 13 integrated health centres and provides care to over 100 neighbouring villages. The surgical department comprises a surgical ward with a capacity of 40 beds, a theatre and a modern sterilization unit. Study population We included all files of patients with the diagnosis of non-traumatic gastrointestinal tract perforations aged 1month and above, and had an initial surgical intervention performed in the surgical departments of the aforementioned hospital within the stated time frame. While excluding Patients with missing data on both their management and outcomes, Neonates, Patients who died prior to initiation of management, and Patients with a traumatic GIT perforation Study Procedures Administrative procedure Ethical clearance was obtained from the Regional Delegation of Public Health in the Far North Region and the Institutional Review Board (IRB) of the Tokombere District Hospital. Next, administrative approvals were obtained from Private Catholic Hospital of Tokombere. Individual patient consent was waived due to non-contact with the patient in accordance with the Declaration of Helsinki. Data collection Files of patients meeting our inclusion criteria were retained, and the following data were extracted: sex, age, presenting complaints, duration of symptoms, diagnostic methods, surgical intervention, and postoperative care and duration. The Calvien Dindo Score was used to access morbidity outcomes ( 6 , 8 ). A pre-formed online data collection form designed on Google Forms (Google, USA) (Appendix 1), was used to collect data. The form will be piloted amongst five files of patients with non-traumatic gastrointestinal perforation to maintain homogeneity. Data management and analysis All the data collected was coded and stored on Google Drive in a password-protected account, and access was granted only to the investigators. The collected data were transferred to SPSS v26 (IBM, USA) for analysis. Categorical variables are presented as frequencies and their respective proportions. Continuous variables were presented as means (and standard deviation) or median (and interquartile range) where appropriate, or as frequencies and percentages after categorising using predefined cutoffs or the median.The results were presented using tables and figures. RESULTS A total of 54 records on gastrointestinal perforations were identified and included during our study period. 1 was excluded for traumatic abdominal wall laceration, 4 were excluded for patients who died before the procedure and 5 were excluded for inexploitable data. Sociodemographic characteristics of study population The median age was 21.5 (IQR 9–43) years, males (n = 30, 68.2%) and adults (≥ 18 years, n = 24, 54.5%) were mostly affected (Table 1 ). The majority presented directly to the hospital following the onset of symptoms (n = 14, 35.0%), however delays were significant with a median time interval between onset of symptoms and presentation being 5 days (IQR 2.2-7). Abdominal pain (n = 31, 46.9%) being the most frequent presenting complaint, followed by fever (n = 16, 24.2%), while the most common signs were tachycardia (n = 28, 71.8%) and signs of generalized peritoneal irritation (n = 20, 45.5%) (Table 2 ). Table 1 Sociodemographic characteristics of study participants with non-traumatic gastrointestinal perforations (N = 44) Variable Category Frequency (n) Percentage (%) Age group, Median[IQR] 21.5[9,43] Paediatric* 20 45.5 Adult** 24 54.5 Sex Female 14 31.8 Male 30 68.2 *Age 18years Table 2 Clinical presentation and diagnostic imagery technique of study participants with gastrointestinal perforations Variable Category Frequency Percentage (%) Timing of presentation Delayed* 14 35.0 Direct 21 52.5 Referred 5 12.5 Symptoms Abdominal pain 31 46.9 Fever 16 24.2 Vomiting 10 15.1 Constipation 9 13.6 Signs Signs of Generalized peritoneal irritation 20 45.5 Local signs of peritoneal irritation 15 34.1 Aged (biased presentation) 3 6.8 Hypertension 3 6.8 Hypotension 2 5.9 Tachycardia 28 63.6 Hyperthermia 25 56.8 Imaging used Ultrasound and X-ray 16 36.4 X-ray only 16 36.4 Ultrasound only 11 25 CT Scan only 1 2.3 *Patient went home or non-medical facility before coming to the hospital Clinical presentation and imaging technique used Plain abdominal x-ray only (n = 16, 36.4%), or an abdominal x-ray and abdominal ultrasound together (n = 16, 36.4%) were the main diagnostic imaging modalities (Table 2 ). 63.6% (n = 28) of patients had leukocytosis on presentation and 65.9% (n = 29) had a neutrophilic predominance. Management and Outcome The most common site of perforation in the pediatric population was the small bowel (n = 15, 75%), and the most common site of perforation in the adult population was the stomach (n = 5, 27.3%) (Fig. 1 ). Apart from the rectum, all other parts of the gastrointestinal tract were involved. Consequently, the most practised surgical intervention was simple repair (n = 29, 76.3%) see Table 3 . The majority of participants had a Clavien and Dindo grade 1 classification (n = 11, 40.7%) ( Table 4 ) .. The median duration of hospitalization was 8.5 (IQR 5.2–10) days. The median time interval between onset of symptoms and surgical intervention was 7 days (IQR 4–11). The median duration of intervention was 1 hour (IQR 1–3). The site of perforation varied with the patient’s age group. Pediatric patients most often had small-bowel perforations (75%), whereas adults more commonly had gastric perforations (27.3%). Table 3 Peroperative findings and interventions in patients managed for nontraumatic gastrointestinal perforations Variable Category Frequency (n) Percentage (%) Per op Findings Number of perforations 3 29 76.32 Per operative gestures Bowel resection 8 21.1 Repair 29 76.3 Stoma 1 2.6 Total 38 100.0 Table 4 Outcome of study participants Variable Category Frequency (N) Percentage (%) Clavien and Dindo classification Grade 1 11 40.7 Grade 2 6 13.6 Grade 3 3 6.8 Grade 4 5 11.4 Grade 5 2 4.5 Table 5 Comparing outcome score in age group of the study participant Characteristic Pediatric N = 20 Adult N = 24 p-value 2 Clavien and Dindo classification 0.257 Grade 1 4 (20.0%) 12 (50.0%) Grade 2 6 (30.0%) 4 (16.7%) Grade 3 5 (25.0%) 5 (20.8%) Grade 4 4 (20.0%) 2 (8.3%) Grade 5 1 (5.0%) 1 (4.2%) There was no significant association between the Clavien and Dindo classification of patients and their age (value = 13.64, p = 0.6) (Table 5 ). Using the Kruska walis test to look for the association between duration of surgical intervention and the Clavien and Dindo classification, there was no significant difference across different groups(p = 0.053). DISCUSSION Since the first clinically reported case of perforated peptic ulcer in 1799, there has been a steady evolution in diagnostic and therapeutic techniques for the management of GI perforation ( 9 , 10 ). While most publications on this subject are tilted to the experience of an urban setting, research priorities in the rural settings remain underserved, despite the important number of cases managed there. The modal age range of presentation was 1–18 years (45.5%) hence a skewed distribution of mostly teenagers. This observation is contrasting with a similar study carried out in Mali (34.5 years) ( 7 ) and at the Yaounde Central hospital - Cameroon, where the mean age was 37.6 ± 13.5 ( 11 ). The male sex was seen to be predominating, accounting for 68.2% of patients similar to the study conducted in Uganda, Mali and Cameroon ( 4 , 7 , 9 , 11 ). Clinical Picture Most of the patients (52.50%) presented directly to the hospital, an important percentage however were delayed presentations (35.00%) and 12.5% were referred from nearby health centers with a median time interval between onset of symptoms and presentation being 5 days (IQR 2.2-7). This delay was equally an objective finding in the series of Coualibaly et al. in Mali ( 7 ) and Chichom et al. in Cameroon ( 6 ). Upon presentation, 50% of patients had signs of generalised peritoneal irritation (generalised abdominal pain, vomiting and constipation boardlike rigidity and signs of pneumoperitoneum). Abdominal pain was the most common of all presentations (46.9%). However, these signs were not typically elicitable in 6.8% of patients, biased by the age of these ones, which on its own was a poor prognostic factor. The result of a gastrointestinal perforation is a peritonitis which ultimately leads to sepsis and death. A great percentage of these patients (39.53%) on arrival needed an emergency surgery to survive hence an ASA status of V. Most of this category of patients either presented late or were referred from health centres. However, a greater percentage were normal, healthy and fit for surgery (44.19%). Findings and Intervention The median time interval between onset of symptoms and surgical intervention was 7 days (IQR 4–11) much longer than a mean of 3.62 days obtained by Chichom et al. in the South West region, Cameroon ( 6 ). Patients in Tokombéré could delay for up to 11 days after the onset of their symptoms before benefiting from a definitive surgical intervention. This could be accounted for by; delayed presentation which averaged at 5 days, missed diagnosed on entry due to atypical presentations, and at other times, the unavailability of qualified medical personnel for diagnosis and intervention. Accessing the per-operative findings and gestures in these patients, the most common site of perforation was the small bowel (47.6%), followed by the Appendix, colon and gastric (16.7%). This reflects a pattern frequently described in rural African settings where infectious and inflammatory etiologies remain common. In many Cameroonian and sub-Saharan studies, small bowel perforations—particularly those linked to typhoid ileitis—are consistently the leading cause of non-traumatic GI perforation. This is consistent with the findings of a retrospective study on non-traumatic acute peritonitis patients conducted at the Zinger national hospital in Niger where the pediatric population (0–15 years) admitted for non-traumatic acute peritonitis had Ileal perforations, presumably due to typhoid fever ( 2 ). Typhoid intestinal perforations are feared and well-documented complication of Typhoid fever observed in an estimated 0.8% to 39% of untreated or improperly treated cases worldwide ( 3 ). In Tokombere, a rural setting, the hygiene and sanitary conditions of the general population are mostly precarious. The majority of the population lives from farming (31.82% of adult patients). This lifestyle is dictated at least in part by the area's geographical location, with extreme climatic conditions, dry/sandy soils, and seasonal streams, resulting in limited access to portable water. With children being particularly vulnerable to this disease, they constitute the modal age range of presentation in our cohort. Similar findings were made by Megan et al in their scoping review ( 3 ). However they contrast the findings of Savom et al and Engbang et al. conducted at the Yaounde, where adults were most implicated and peptic ulcer perforation was the main cause of acute abdomen ( 4 , 11 ). Similarly, a sharp contrast is shown with findings obtained in Douala intestinal obstruction (32.0%), appendicitis (24.6%) ( 1 ). Hence, painting a picture in the discrepancy that age and setting could engender in the diagnosis of nontraumatic gastrointestinal perforations. With the hospital from which this other study was conducted being located in major cities, these populations are more likely to have access to clean water and proper hygienic conditions. This could explain the difference in etiologies and the predominant site of perforation, where the epidemiologic shift from non-communicable to communicable diseases in the developing world can be highlighted and from a global perspective, the double burden of disease facing the Cameroonian public health space. most of the patients had multiple perforations (> 3, n = 29, 76.32) along the small bowel. typhoid commonly causes terminal ileum perforations from Peyer’s patch necrosis, producing pathognomonic characteristic oval lesions along the antimesenteric border, though other etiologies may mimic hence the need for histopathologic confirmation even with clinical evidence ( 3 , 9 ). Appendicitis and gastric perforations were equally present, and gastric perforation was more common at age > 30 years. The median duration of this surgical intervention was 1 hour IQR 1–3 hours. A surgical intervention duration of over 2 hours has been associated with a poor prognosis in other similar studies. Outcome Delay in presentation and in management are some of the most important determinants of unfavourable outcome in peritonitis patients ( 12 , 13 ). Symptoms duration for over 48h, significantly increases mortality from peritonitis ( 13 ). These findings are similar to those of Chichom et al. and are probably a direct consequence of some of the local conditions of surgical practice such as the scarcity of surgeons, the lack of appropriate diagnosis and management tools and the socio-economic conditions characterized by the total absence of social security even for such critical and potentially deadly conditions ( 6 ). Ideally, better outcomes are expected in patients who present early in the course of their disease and a prompt intervention initiated. Preoperative shock, usually septic shock, is a well-established risk factor for mortality following intestinal perforation ( 13 ). However, the site of perforation may aswell alter the presentation, as signs of small bowel perforations occur sooner than those of large bowel perforations. The median duration of hospitalisation was 8.5(IQR 5.2–10). This timing included the time before and after the surgery. The preoperative period in this context was characterised by running the necessary paraclinicals for the surgery. The postoperative period on the other hand, was characterised by antibiotherapy and continuous fluid resuscitation and follow-up. Majority of participants had a Clavien and Dindo grade 1 classification, 22.2% were at grade 2 and 7.4% grade 3A 7.4% had a grade 5 classification. This implies that a significant number of patients needed a repeat laparotomy. Amongst these complications included surgical site infections and acute kidney injuries just to list but these. The morbidity rate was at 7.4% as opposed to Chichom et al. who had a complication rate of 31.5% ( 6 ). This discrepancy could be accounted for by the difference in age, while Chim in his cohort had older patients, we had younger patients who could resist the extreme conditions imposed by surgical treatment. It is noteworthy that the death toll following small bowel perforation repair surgery has been on the fall over the last decade ( 3 , 12 ). it is a progress worth noting and should be commended and encouraged with the investments in technical plateau and staffing of health structures even in the peripheries. It however remains unacceptably high, with the toll being worse amongst patients with typhic intestinal perforations ( 3 , 6 ). CONCLUSION The Etiologies of non-traumatic gastrointestinal perforations vary according to settings and contexts. Typhic perforations are more common amongst young persons and in rural areas. It is noteworthy that presentation is frequently delayed in rural areas, hence a predictor for poor outcome. The need for emergency surgical care in the rural setting is non-negligible and the findings from developed settings are not always readily applicable in these settings. Hence the need for ample investments in resources and research in such underserved areas. Declarations Conflict of interest : The Authors declare no conflict of interest. Ethical clearance Obtained from the Tokombere District Hospital Local Ethics Committee Informed Consent: Not obtained, as this study did not deal directly with human subjects ETHICS APPROVAL AND CONSENT TO PARTICIPATE Human Ethics and Consent to Participate declarations: not applicable CONSENT FOR PUBLICATION All authors declare consent to the publication of this work COMPETING INTEREST Authors of this work declare no competing interests. ETHICS APPROVAL AND CONSENT TO PARTICIPATE This work received ethical clearance from the Institutional Review Board of the Tokombere District Hospital. AUTHOR’S INFORMATION Dr WUNDE NJINECK UBRAINE is a young, enthusiastic, passionate clinician, with great admiration for literary works of science. He is passionate about surgery, public health and youth leadership. The current work is the first fruit of his scientific curiosity while serving as a house officer in his final medical school training station. It was commonplace in this locality to have children present with acute abdomens, most needing emergency surgical intervention. This prompted the development of this research protocol, which he and the team learned to develop over the years to this stage for public consumption. FUNDING No funding received for the processing of this work. Author Contribution WNU: Concept of work, data collection and drafting of blueprintsWHBD: review of blueprints, results and discussionDT: Data Analysis, results and discussionGKK: Data analysis and resultsTLM: Literature review and BackgroundMFR: Literature reviewAB: Selection of files and data entryDM: Selection of files and data entryVMK: General overview and referencing review Acknowledgement special thanks to the administration of the Tokombéré district Hospital, the personnel directly and indirectly involved in this study and especially the patients for their consent.Appreciation to the administration of the clinical sciences department of the faculty of Health Sciences. Data Availability Authors declare the availability of data and materials upon request. References Engbang JP, Essola B, Koundo RM, Ntama A, Motah M, Ngowe MN. Diagnosis and Treatment of Acute Peritonitis in Douala (Cameroon). J Surg Res. 2021;4(2):287–95. O H, I HA. AM, M D, M A, M H. Non-traumatic acute peritonitis in children: causes and prognosis in 226 patients at the National Hospital of Zinder, Niger. Med Sante Trop [Internet]. 2017 Aug 1 [cited 2025 Nov 20];27(3). Available from: https://pubmed.ncbi.nlm.nih.gov/28947401/ Morbidity and Mortality of Typhoid Intestinal Perforation Among Children in Sub-Saharan. Africa 1995–2019: A Scoping Review - PMC [Internet]. [cited 2025 Nov 28]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7236653/ Savom EP, Mbele RI, Boukar MYE, Deudeu A, Atangana CP, Dikongue FD, et al. Clinical Epidemiology and Surgical Treatment of Spontaneous Perforations of the Terminal Ileum: A Multicentre Study in Cameroon. Surg Sci. 2024;15(5):311–20. Gorham TJ, Yoo J, Garabed R, Mouhaman A, Lee J, Gorham TJ et al. Water Access, Sanitation, and Hygiene Conditions and Health Outcomes among Two Settlement Types in Rural Far North Cameroon. Int J Environ Res Public Health [Internet]. 2017 Apr 19 [cited 2025 Dec 12];14(4). Available from: https://www.mdpi.com/1660-4601/14/4/441 Chichom-Mefire A, Fon TA, Ngowe-Ngowe M. Which cause of diffuse peritonitis is the deadliest in the tropics? A retrospective analysis of 305 cases from the South-West Region of Cameroon. World J Emerg Surg. 2016;11(1):14. Perforation-digestive-non. -traumatique-a-Koutiala-aspects-epidemio-cliniques-et-therapeutiques.pdf [Internet]. [cited 2025 Nov 17]. Available from: https://www.malimedical.org/wp-content/uploads/2019/10/Perforation-digestive-non-traumatique-a-Koutiala-aspects-epidemio-cliniques-et-therapeutiques.pdf Dindo D, Demartines N, Clavien PA. Classification of Surgical Complications. Ann Surg. 2004;240(2):205–13. Chanler-Berat J, Birungi A, Dreifuss B, Mbiine R. Typhoid intestinal perforation: Point-of-care ultrasound as a diagnostic tool in a rural Ugandan Hospital. Afr J Emerg Med. 2016;6(1):44–6. Morbidity and Mortality of Typhoid Intestinal Perforation Among Children in Sub-Saharan. Africa 1995–2019: A Scoping Review - PubMed [Internet]. [cited 2025 Nov 27]. Available from: https://pubmed.ncbi.nlm.nih.gov/32430740/ Bang GA, Motto GRB, Ngoumfe JCC, Boukar YME, Tim FT, Savom EP et al. Complications des prises en charge chirurgicales des abdomens aigus non traumatiques d’origine digestive à l’hôpital central de Yaoundé, Cameroun (novembre 2019 - juillet 2020). MTSI [Internet]. 2021 Nov 26 [cited 2025 Dec 2];1(4). Available from: https://revuemtsi.societe-mtsi.fr/index.php/bspe-articles/article/view/99 Khan PS, Dar LA, Hayat H, Khan PS, Dar LA, Hayat H. Predictors of mortality and morbidity in peritonitis in a developing country. Turk J Surg [Internet]. [cited 2025 Dec 2]; Available from: https://turkjsurg.com/articles/predictors-of-mortality-and-morbidity-in-peritonitis-in-a-developing-country/UCD.2013.1955 Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS). Study: a WSES observational study | World Journal of Emergency Surgery [Internet]. [cited 2025 Dec 2]. Available from: https://link.springer.com/article/ 10.1186/s13017-019-0253-2 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-8591310","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":590473386,"identity":"db5ae85c-9917-4348-9eca-33507a0f5422","order_by":0,"name":"WUNDE Njineck 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Cameroon","correspondingAuthor":false,"prefix":"","firstName":"Dourwe","middleName":"","lastName":"Maaga","suffix":""},{"id":590473400,"identity":"654f77e9-d783-4994-a241-0421bfe525ed","order_by":8,"name":"Victor Meza Kyaruzi","email":"","orcid":"","institution":"School of Medicine, Muhimbili University of Health and Allied Sciences, Upanda West, Dar es Salaam, Tanzania.","correspondingAuthor":false,"prefix":"","firstName":"Victor","middleName":"Meza","lastName":"Kyaruzi","suffix":""}],"badges":[],"createdAt":"2026-01-13 11:23:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8591310/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8591310/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102598207,"identity":"c44ab337-2b84-40f0-927c-bf1419858f8e","added_by":"auto","created_at":"2026-02-13 12:27:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":13409,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSite of nontraumatic gastrointestinal perforations with respect to participant’s age group\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8591310/v1/e7e4bd4307ec66a94483e438.png"},{"id":102749417,"identity":"b5188c1e-b138-41ad-ba5b-c8935357175f","added_by":"auto","created_at":"2026-02-16 09:12:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":908271,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8591310/v1/770db0c9-ed12-492c-8a7b-ac50c642489f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Diagnostic, Management Experience and Outcomes of Non-Traumatic Gastrointestinal Tract Perforations in Rural African Setting: A Descriptive Review\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eGastrointestinal tract (GIT) perforations can occur across various segments of this hollow viscous, caused by different etiologies. In many developing countries, the majority of these perforations are non-traumatic, representing one of the most frequent causes of peritonitis(\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Peritonitis is a common presenting surgical emergency in the majority of health care settings in Cameroon (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The extreme north region of Cameroon is even more particular with unique public health challenges; limited access to safe water sources, recurrent outbreaks, and the high prevalence of water-borne vectors significantly increase the risk of GIT complications (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the severity of this burden in rural areas, most studies on this pathology are focused on trends in the urban areas served by tertiary and quaternary healthcare facilities(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). While the causes of peritonitis are wide and vary from primary through secondary to tertiary forms (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), this study focuses specifically on secondary and tertiary peritonitis resulting from non-traumatic causes. Typhoid fever endemic in sub-Saharan Africa remains a commonly reported etiology of GIT perforations in this region (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Despite sparse data on its actual prevalence, data curated from recent studies around Africa reveal 120 GI Perforations out of 148 cases of peritonitis operated in Burkina Faso (Kambir\u0026eacute;, 2017). Similarly Ngo Nonga et al. reported 30 cases of digestive perforation out of 69 cases of Peritonitis operated at the Yaounde Teaching Hospital (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) while Savom et al. in a multicentric study identified up to 52 patients with GIT perforations in their cohort (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe diagnosis of GIT perforations rests on the clinical presentation corroborated by abdominal imaging. Moreso, the management is principally surgical with the need for urgent bespoke surgical intervention. This is sometimes not readily available at the primary healthcare level. The specific surgical approach and gestures depend on a myriad of factors; the site of the perforation and the patient's hemodynamic status at presentation. Due to systemic limitations within the regional healthcare infrastructure in Cameroon, patients frequently present with advanced disease, hence making management in hard-to-reach areas even more challenging (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConsequently, while prompt diagnosis and timely surgical intervention are indispensable to curb the morbidity and mortality of this rapidly progressing pathology, there remains a critical lack of data regarding current management practices and outcomes in resource-limited, primary health care settings. By shifting the focus, this study aims to address this data gap and highlight the realities of managing GI perforations in a rural setting of Northern Cameroon.\u003c/p\u003e\u003ch2\u003eSTUDY OBJECTIVES\u003c/h2\u003e\u003cp\u003e \u003cb\u003eTo;\u003c/b\u003e \u003c/p\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDescribe the clinical presentation and diagnostic approaches of non-traumatic GIT perforations in Tokombere, Northern Cameroon\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDescribe the treatment approaches, outcomes, and predictors of outcome following non-traumatic GIT perforations in Tokombere, Northern Cameroon\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"METHODS","content":" \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eStudy design and period\u003c/h2\u003e \u003cp\u003eThis was a retrospective descriptive study of patients managed for non-traumatic GIT perforations managed at the surgical department of the Private Catholic Hospital of Tokombere from January 2021 to January 2023.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eStudy area and setting\u003c/h3\u003e\n\u003cp\u003eThis study will be conducted in the surgical department of the aforementioned hospital, located in the rural areas of the extreme north region of Cameroon. It is noted for its hard-to-reach nature during the rainy season, with an average distance from the regional hospital being 48.2km equal to about 3 hours ride in fair weather. The main method of patient transportation in this area is by motorcycle. This hospital is recognised as the district hospital for Tokombere with a capacity of 152 beds. It serves as a referral hospital for 13 integrated health centres and provides care to over 100 neighbouring villages. The surgical department comprises a surgical ward with a capacity of 40 beds, a theatre and a modern sterilization unit.\u003c/p\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eWe included all files of patients with the diagnosis of non-traumatic gastrointestinal tract perforations aged 1month and above, and had an initial surgical intervention performed in the surgical departments of the aforementioned hospital within the stated time frame.\u003c/p\u003e \u003cp\u003eWhile excluding Patients with missing data on both their management and outcomes, Neonates, Patients who died prior to initiation of management, and Patients with a traumatic GIT perforation\u003c/p\u003e\n\u003ch3\u003eStudy Procedures\u003c/h3\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAdministrative procedure\u003c/h2\u003e \u003cp\u003eEthical clearance was obtained from the Regional Delegation of Public Health in the Far North Region and the Institutional Review Board (IRB) of the Tokombere District Hospital. Next, administrative approvals were obtained from Private Catholic Hospital of Tokombere. Individual patient consent was waived due to non-contact with the patient in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eFiles of patients meeting our inclusion criteria were retained, and the following data were extracted: sex, age, presenting complaints, duration of symptoms, diagnostic methods, surgical intervention, and postoperative care and duration. The Calvien Dindo Score was used to access morbidity outcomes (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). A pre-formed online data collection form designed on Google Forms (Google, USA) (Appendix 1), was used to collect data. The form will be piloted amongst five files of patients with non-traumatic gastrointestinal perforation to maintain homogeneity.\u003c/p\u003e\n\u003ch3\u003eData management and analysis\u003c/h3\u003e\n\u003cp\u003eAll the data collected was coded and stored on Google Drive in a password-protected account, and access was granted only to the investigators. The collected data were transferred to SPSS v26 (IBM, USA) for analysis. Categorical variables are presented as frequencies and their respective proportions. Continuous variables were presented as means (and standard deviation) or median (and interquartile range) where appropriate, or as frequencies and percentages after categorising using predefined cutoffs or the median.The results were presented using tables and figures.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 54 records on gastrointestinal perforations were identified and included during our study period. 1 was excluded for traumatic abdominal wall laceration, 4 were excluded for patients who died before the procedure and 5 were excluded for inexploitable data.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic characteristics of study population\u003c/h2\u003e \u003cp\u003eThe median age was 21.5 (IQR 9\u0026ndash;43) years, males (n\u0026thinsp;=\u0026thinsp;30, 68.2%) and adults (\u0026ge;\u0026thinsp;18 years, n\u0026thinsp;=\u0026thinsp;24, 54.5%) were mostly affected (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The majority presented directly to the hospital following the onset of symptoms (n\u0026thinsp;=\u0026thinsp;14, 35.0%), however delays were significant with a median time interval between onset of symptoms and presentation being 5 days (IQR 2.2-7). Abdominal pain (n\u0026thinsp;=\u0026thinsp;31, 46.9%) being the most frequent presenting complaint, followed by fever (n\u0026thinsp;=\u0026thinsp;16, 24.2%), while the most common signs were tachycardia (n\u0026thinsp;=\u0026thinsp;28, 71.8%) and signs of generalized peritoneal irritation (n\u0026thinsp;=\u0026thinsp;20, 45.5%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of study participants with non-traumatic gastrointestinal perforations (N\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group, \u003cem\u003eMedian[IQR]\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.5[9,43]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePaediatric*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdult**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*Age\u0026thinsp;\u0026lt;\u0026thinsp;18 years\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e**Age\u0026thinsp;\u0026gt;\u0026thinsp;18years\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical presentation and diagnostic imagery technique of study participants with gastrointestinal perforations\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTiming of presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDelayed*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDirect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReferred\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSymptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbdominal pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConstipation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSigns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSigns of Generalized peritoneal irritation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLocal signs of peritoneal irritation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAged (biased presentation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypotension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTachycardia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHyperthermia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImaging used\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUltrasound and X-ray\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eX-ray only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUltrasound only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCT Scan only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*Patient went home or non-medical facility before coming to the hospital\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eClinical presentation and imaging technique used\u003c/h2\u003e \u003cp\u003ePlain abdominal x-ray only (n\u0026thinsp;=\u0026thinsp;16, 36.4%), or an abdominal x-ray and abdominal ultrasound together (n\u0026thinsp;=\u0026thinsp;16, 36.4%) were the main diagnostic imaging modalities (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e 63.6% (n\u0026thinsp;=\u0026thinsp;28) of patients had leukocytosis on presentation and 65.9% (n\u0026thinsp;=\u0026thinsp;29) had a neutrophilic predominance.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eManagement and Outcome\u003c/h2\u003e \u003cp\u003eThe most common site of perforation in the pediatric population was the small bowel (n\u0026thinsp;=\u0026thinsp;15, 75%), and the most common site of perforation in the adult population was the stomach (n\u0026thinsp;=\u0026thinsp;5, 27.3%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Apart from the rectum, all other parts of the gastrointestinal tract were involved. Consequently, the most practised surgical intervention was simple repair (n\u0026thinsp;=\u0026thinsp;29, 76.3%) see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThe majority of participants had a Clavien and Dindo grade 1 classification (n\u0026thinsp;=\u0026thinsp;11, 40.7%) \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.. The median duration of hospitalization was 8.5 (IQR 5.2\u0026ndash;10) days. The median time interval between onset of symptoms and surgical intervention was 7 days (IQR 4\u0026ndash;11). The median duration of intervention was 1 hour (IQR 1\u0026ndash;3).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe site of perforation varied with the patient\u0026rsquo;s age group. Pediatric patients most often had small-bowel perforations (75%), whereas adults more commonly had gastric perforations (27.3%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePeroperative findings and interventions in patients managed for nontraumatic gastrointestinal perforations\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePer op Findings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of perforations\u0026thinsp;\u0026lt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Perforations\u0026thinsp;\u0026gt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePer operative gestures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBowel resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRepair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOutcome of study participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavien and Dindo classification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparing outcome score in age group of the study participant\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePediatric\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdult\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;24\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClavien and Dindo classification\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.257\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (5.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere was no significant association between the Clavien and Dindo classification of patients and their age (value\u0026thinsp;=\u0026thinsp;13.64, p\u0026thinsp;=\u0026thinsp;0.6) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Using the Kruska walis test to look for the association between duration of surgical intervention and the Clavien and Dindo classification, there was no significant difference across different groups(p\u0026thinsp;=\u0026thinsp;0.053).\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eSince the first clinically reported case of perforated peptic ulcer in 1799, there has been a steady evolution in diagnostic and therapeutic techniques for the management of GI perforation (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). While most publications on this subject are tilted to the experience of an urban setting, research priorities in the rural settings remain underserved, despite the important number of cases managed there. The modal age range of presentation was 1\u0026ndash;18 years (45.5%) hence a skewed distribution of mostly teenagers. This observation is contrasting with a similar study carried out in Mali (34.5 years) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) and at the Yaounde Central hospital - Cameroon, where the mean age was 37.6\u0026thinsp;\u0026plusmn;\u0026thinsp;13.5 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The male sex was seen to be predominating, accounting for 68.2% of patients similar to the study conducted in Uganda, Mali and Cameroon (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eClinical Picture\u003c/h2\u003e \u003cp\u003eMost of the patients (52.50%) presented directly to the hospital, an important percentage however were delayed presentations (35.00%) and 12.5% were referred from nearby health centers with a median time interval between onset of symptoms and presentation being 5 days (IQR 2.2-7). This delay was equally an objective finding in the series of Coualibaly et al. in Mali (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) and Chichom et al. in Cameroon (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Upon presentation, 50% of patients had signs of generalised peritoneal irritation (generalised abdominal pain, vomiting and constipation boardlike rigidity and signs of pneumoperitoneum). Abdominal pain was the most common of all presentations (46.9%). However, these signs were not typically elicitable in 6.8% of patients, biased by the age of these ones, which on its own was a poor prognostic factor. The result of a gastrointestinal perforation is a peritonitis which ultimately leads to sepsis and death.\u003c/p\u003e \u003cp\u003eA great percentage of these patients (39.53%) on arrival needed an emergency surgery to survive hence an ASA status of V. Most of this category of patients either presented late or were referred from health centres. However, a greater percentage were normal, healthy and fit for surgery (44.19%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eFindings and Intervention\u003c/h2\u003e \u003cp\u003eThe median time interval between onset of symptoms and surgical intervention was 7 days (IQR 4\u0026ndash;11) much longer than a mean of 3.62 days obtained by Chichom et al. in the South West region, Cameroon (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Patients in Tokomb\u0026eacute;r\u0026eacute; could delay for up to 11 days after the onset of their symptoms before benefiting from a definitive surgical intervention. This could be accounted for by; delayed presentation which averaged at 5 days, missed diagnosed on entry due to atypical presentations, and at other times, the unavailability of qualified medical personnel for diagnosis and intervention.\u003c/p\u003e \u003cp\u003eAccessing the per-operative findings and gestures in these patients, the most common site of perforation was the small bowel (47.6%), followed by the Appendix, colon and gastric (16.7%). This reflects a pattern frequently described in rural African settings where infectious and inflammatory etiologies remain common. In many Cameroonian and sub-Saharan studies, small bowel perforations\u0026mdash;particularly those linked to typhoid ileitis\u0026mdash;are consistently the leading cause of non-traumatic GI perforation. This is consistent with the findings of a retrospective study on non-traumatic acute peritonitis patients conducted at the Zinger national hospital in Niger where the pediatric population (0\u0026ndash;15 years) admitted for non-traumatic acute peritonitis had Ileal perforations, presumably due to typhoid fever (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Typhoid intestinal perforations are feared and well-documented complication of Typhoid fever observed in an estimated 0.8% to 39% of untreated or improperly treated cases worldwide (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In Tokombere, a rural setting, the hygiene and sanitary conditions of the general population are mostly precarious. The majority of the population lives from farming (31.82% of adult patients). This lifestyle is dictated at least in part by the area's geographical location, with extreme climatic conditions, dry/sandy soils, and seasonal streams, resulting in limited access to portable water. With children being particularly vulnerable to this disease, they constitute the modal age range of presentation in our cohort. Similar findings were made by Megan et al in their scoping review (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). However they contrast the findings of Savom et al and Engbang et al. conducted at the Yaounde, where adults were most implicated and peptic ulcer perforation was the main cause of acute abdomen (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Similarly, a sharp contrast is shown with findings obtained in Douala intestinal obstruction (32.0%), appendicitis (24.6%) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Hence, painting a picture in the discrepancy that age and setting could engender in the diagnosis of nontraumatic gastrointestinal perforations. With the hospital from which this other study was conducted being located in major cities, these populations are more likely to have access to clean water and proper hygienic conditions. This could explain the difference in etiologies and the predominant site of perforation, where the epidemiologic shift from non-communicable to communicable diseases in the developing world can be highlighted and from a global perspective, the double burden of disease facing the Cameroonian public health space. most of the patients had multiple perforations (\u0026gt;\u0026thinsp;3, n\u0026thinsp;=\u0026thinsp;29, 76.32) along the small bowel. typhoid commonly causes terminal ileum perforations from Peyer\u0026rsquo;s patch necrosis, producing pathognomonic characteristic oval lesions along the antimesenteric border, though other etiologies may mimic hence the need for histopathologic confirmation even with clinical evidence (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Appendicitis and gastric perforations were equally present, and gastric perforation was more common at age\u0026thinsp;\u0026gt;\u0026thinsp;30 years. The median duration of this surgical intervention was 1 hour IQR 1\u0026ndash;3 hours. A surgical intervention duration of over 2 hours has been associated with a poor prognosis in other similar studies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eOutcome\u003c/h2\u003e \u003cp\u003eDelay in presentation and in management are some of the most important determinants of unfavourable outcome in peritonitis patients (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Symptoms duration for over 48h, significantly increases mortality from peritonitis (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). These findings are similar to those of Chichom et al. and are probably a direct consequence of some of the local conditions of surgical practice such as the scarcity of surgeons, the lack of appropriate diagnosis and management tools and the socio-economic conditions characterized by the total absence of social security even for such critical and potentially deadly conditions (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Ideally, better outcomes are expected in patients who present early in the course of their disease and a prompt intervention initiated. Preoperative shock, usually septic shock, is a well-established risk factor for mortality following intestinal perforation (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). However, the site of perforation may aswell alter the presentation, as signs of small bowel perforations occur sooner than those of large bowel perforations. The median duration of hospitalisation was 8.5(IQR 5.2\u0026ndash;10). This timing included the time before and after the surgery. The preoperative period in this context was characterised by running the necessary paraclinicals for the surgery. The postoperative period on the other hand, was characterised by antibiotherapy and continuous fluid resuscitation and follow-up.\u003c/p\u003e \u003cp\u003eMajority of participants had a Clavien and Dindo grade 1 classification, 22.2% were at grade 2 and 7.4% grade 3A 7.4% had a grade 5 classification. This implies that a significant number of patients needed a repeat laparotomy.\u003c/p\u003e \u003cp\u003eAmongst these complications included surgical site infections and acute kidney injuries just to list but these. The morbidity rate was at 7.4% as opposed to Chichom et al. who had a complication rate of 31.5% (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). This discrepancy could be accounted for by the difference in age, while Chim in his cohort had older patients, we had younger patients who could resist the extreme conditions imposed by surgical treatment. It is noteworthy that the death toll following small bowel perforation repair surgery has been on the fall over the last decade (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). it is a progress worth noting and should be commended and encouraged with the investments in technical plateau and staffing of health structures even in the peripheries. It however remains unacceptably high, with the toll being worse amongst patients with typhic intestinal perforations (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe Etiologies of non-traumatic gastrointestinal perforations vary according to settings and contexts. Typhic perforations are more common amongst young persons and in rural areas. It is noteworthy that presentation is frequently delayed in rural areas, hence a predictor for poor outcome. The need for emergency surgical care in the rural setting is non-negligible and the findings from developed settings are not always readily applicable in these settings. Hence the need for ample investments in resources and research in such underserved areas.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003e \u003cb\u003eConflict of interest\u003c/b\u003e:\u003c/strong\u003e \u003cp\u003eThe Authors declare no conflict of interest.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical clearance\u003c/strong\u003e \u003cp\u003eObtained from the Tokombere District Hospital Local Ethics Committee\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInformed Consent:\u003c/strong\u003e \u003cp\u003eNot obtained, as this study did not deal directly with human subjects\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eETHICS APPROVAL AND CONSENT TO PARTICIPATE\u003c/strong\u003e \u003cp\u003eHuman Ethics and Consent to Participate declarations: not applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCONSENT FOR PUBLICATION\u003c/strong\u003e \u003cp\u003eAll authors declare consent to the publication of this work\u003c/p\u003e \u003ch2\u003eCOMPETING INTEREST\u003c/h2\u003e \u003cp\u003eAuthors of this work declare no competing interests.\u003c/p\u003e \u003ch2\u003eETHICS APPROVAL AND CONSENT TO PARTICIPATE\u003c/h2\u003e \u003cp\u003eThis work received ethical clearance from the Institutional Review Board of the Tokombere District Hospital.\u003c/p\u003e \u003ch2\u003eAUTHOR\u0026rsquo;S INFORMATION\u003c/h2\u003e \u003cp\u003eDr WUNDE NJINECK UBRAINE is a young, enthusiastic, passionate clinician, with great admiration for literary works of science. He is passionate about surgery, public health and youth leadership. The current work is the first fruit of his scientific curiosity while serving as a house officer in his final medical school training station. It was commonplace in this locality to have children present with acute abdomens, most needing emergency surgical intervention. This prompted the development of this research protocol, which he and the team learned to develop over the years to this stage for public consumption.\u003c/p\u003e \u003ch2\u003eFUNDING\u003c/h2\u003e \u003cp\u003eNo funding received for the processing of this work.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eWNU: Concept of work, data collection and drafting of blueprintsWHBD: review of blueprints, results and discussionDT: Data Analysis, results and discussionGKK: Data analysis and resultsTLM: Literature review and BackgroundMFR: Literature reviewAB: Selection of files and data entryDM: Selection of files and data entryVMK: General overview and referencing review\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003especial thanks to the administration of the Tokomb\u0026eacute;r\u0026eacute; district Hospital, the personnel directly and indirectly involved in this study and especially the patients for their consent.Appreciation to the administration of the clinical sciences department of the faculty of Health Sciences.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAuthors declare the availability of data and materials upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEngbang JP, Essola B, Koundo RM, Ntama A, Motah M, Ngowe MN. Diagnosis and Treatment of Acute Peritonitis in Douala (Cameroon). J Surg Res. 2021;4(2):287\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO H, I HA. AM, M D, M A, M H. Non-traumatic acute peritonitis in children: causes and prognosis in 226 patients at the National Hospital of Zinder, Niger. Med Sante Trop [Internet]. 2017 Aug 1 [cited 2025 Nov 20];27(3). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/28947401/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/28947401/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorbidity and Mortality of Typhoid Intestinal Perforation Among Children in Sub-Saharan. Africa 1995\u0026ndash;2019: A Scoping Review - PMC [Internet]. [cited 2025 Nov 28]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC7236653/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC7236653/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSavom EP, Mbele RI, Boukar MYE, Deudeu A, Atangana CP, Dikongue FD, et al. Clinical Epidemiology and Surgical Treatment of Spontaneous Perforations of the Terminal Ileum: A Multicentre Study in Cameroon. Surg Sci. 2024;15(5):311\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGorham TJ, Yoo J, Garabed R, Mouhaman A, Lee J, Gorham TJ et al. Water Access, Sanitation, and Hygiene Conditions and Health Outcomes among Two Settlement Types in Rural Far North Cameroon. Int J Environ Res Public Health [Internet]. 2017 Apr 19 [cited 2025 Dec 12];14(4). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mdpi.com/1660-4601/14/4/441\u003c/span\u003e\u003cspan address=\"https://www.mdpi.com/1660-4601/14/4/441\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChichom-Mefire A, Fon TA, Ngowe-Ngowe M. Which cause of diffuse peritonitis is the deadliest in the tropics? A retrospective analysis of 305 cases from the South-West Region of Cameroon. World J Emerg Surg. 2016;11(1):14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerforation-digestive-non. -traumatique-a-Koutiala-aspects-epidemio-cliniques-et-therapeutiques.pdf [Internet]. [cited 2025 Nov 17]. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://revuemtsi.societe-mtsi.fr/index.php/bspe-articles/article/view/99\u003c/span\u003e\u003cspan address=\"https://revuemtsi.societe-mtsi.fr/index.php/bspe-articles/article/view/99\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan PS, Dar LA, Hayat H, Khan PS, Dar LA, Hayat H. Predictors of mortality and morbidity in peritonitis in a developing country. Turk J Surg [Internet]. [cited 2025 Dec 2]; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://turkjsurg.com/articles/predictors-of-mortality-and-morbidity-in-peritonitis-in-a-developing-country/UCD.2013.1955\u003c/span\u003e\u003cspan address=\"https://turkjsurg.com/articles/predictors-of-mortality-and-morbidity-in-peritonitis-in-a-developing-country/UCD.2013.1955\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhysiological parameters for Prognosis in Abdominal Sepsis (PIPAS). Study: a WSES observational study | World Journal of Emergency Surgery [Internet]. [cited 2025 Dec 2]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://link.springer.com/article/\u003c/span\u003e\u003cspan address=\"https://link.springer.com/article/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13017-019-0253-2\u003c/span\u003e\u003cspan address=\"10.1186/s13017-019-0253-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\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":"Gastrointestinal Perforation, Emergency Laparotomy, Maroua, Peritonitis","lastPublishedDoi":"10.21203/rs.3.rs-8591310/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8591310/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe gastrointestinal tract is vulnerable to perforations across multiple segments, with diverse etiologies. While existing research has largely focused on urban hospitals, data from rural settings remain scarce. Non-traumatic causes predominate, particularly typhic and peptic perforations. This study aims to determine the frequency of gastrointestinal perforations in a rural, hard-to-reach hospital in Cameroon, to describe the local management approaches and address gaps in rural emergency surgical care delivery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods and analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a retrospective study at Tokombere District Hospital, with data collection via Google Forms. Analyses used Pearson correlation, Chi-square, and logistic regression in SPSS v26 to adjust for confounders. Significance was set at p \u0026lt; 0.05, with results presented in tables and figures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 44 patients were included, with a median age of 21.5 years; most were male (68.2%). Abdominal pain was the predominant presenting symptom (46.9%), and abdominal x-ray served as the main diagnostic tool (36.4%). The average delay between symptom onset and definitive surgery was seven days. The ileum emerged as the most frequent site of perforation, and simple repair was the primary treatment modality (76.3%). Postoperatively, the mean time to return of intestinal transit was 2.8 ± 1.3 days, highlighting both the clinical burden and management outcomes in this cohort.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ean important number of gastrointestinal perforations are being managed at the primary health care level, and efforts should be made to optimise and standardise this management.\u003c/p\u003e","manuscriptTitle":"The Diagnostic, Management Experience and Outcomes of Non-Traumatic Gastrointestinal Tract Perforations in Rural African Setting: A Descriptive Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-13 12:27:25","doi":"10.21203/rs.3.rs-8591310/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":"5644e911-0537-40ed-84d6-bed48e880497","owner":[],"postedDate":"February 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-15T19:23:55+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-13 12:27:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8591310","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8591310","identity":"rs-8591310","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}