Non-traumatic acute peritonitis in children: causes and prognosis in 226 patients at the National Hospital of Zinder, Niger

To report etiological and prognostic characteristics of acute peritonitis in children. This retrospective study reviewed the records for a 30-month period (January 2013-June 2015) at Zinder National Hospital (Niger) of all children between the ages of 0-15 years who underwent surgery for non-traumatic acute peritonitis. Statistical tests were performed, with significance defined by a P-value < 5 %. Acute peritonitis accounted for 62.12 % (226/358) of all emergency gastrointestinal surgery in children. Their median age was 10 years (range: 0-15 years), with almost two-thirds of them male (n=148). Ileal perforation, presumably due to typhoid fever, was the main cause (n=153), with acute appendicular peritonitis in second place, accounting for 25.22 % (n=57) of cases. Gastrointestinal ostomy was performed in 101 patients (44.7 %) and an appendectomy in 56 (24.8 %). The average length of stay was 10.9±3.6 days. Postoperative complications, defined by the Clavien-Dindo classification, occurred in 46.5 % of these procedures (n=105). Surgical site infections were recorded in 66 cases. Overall mortality was 13.7 % (n=31) and was statistically associated with an American Society of Anesthesiologists (ASA) score of IV (OR = 3,32 : 1,07-10,27 ; P = 0,037) and Mannheim Peritonitis Index (MPI) ≥ 26 (OR = 44,68 : 10,17 - 196,32 ; P = 0,000), time to admission (OR = 4,626 : 1,39 - 15,34, P = 0,012), and time to surgery in hours (OR = 4,59 : 1,60 - 13,18 ; P = 0,0046). In Niger, perforation apparently due to typhoid is the main cause of peritonitis in children. Mortality is associated with an ASA score of IV, Mannheim Peritonitis Index ≥ 26, time to admission, and time to surgery.