Objective: To describe patterns, causes, management, and outcome of peritonitis at adult surgical wards in urban and rural areas.
Methods: A retrospective analysis of 106 patients with peritonitis was done from August 2011 to August 2014 at urban area, Kamenge University Teaching Hospital (CHUK), and rural area, Kibuye Hope Hospital (KHH), Burundi.
Results: A total of 106 patients were studied. Most of the patients were females (51%) and (50%) were at a young age (18-28 years). All the patients were presented with abdominal pain (100%) associated with bowel symptoms. Most common site of perforation was gastro-duodenal (32%), appendicular (17, 92%), small bowel (ileal-cecal/typhoid perforation 12, 26%). In this series, the most common risk factor of perforation was peptic ulcer disease (PUD). Laparotomy with vigorous abdominal irrigation was the most performed procedure. Overall morbidity was 37.2%, and mortality was 8.5%.
Conclusion: Considering the relatively higher rate of gastro-duodenal perforation quoted in this study, it is vital that peptic ulcer disease ought to be eliminated.

Pattern, Causes, Management, Outcome, Peritonitis.

Peritonitis is an inflammatory response to peritoneal injury. Injury results in an influx of protein-rich fluid, activation of the complement cascade, up-regulation of peritoneal mesothelial cell activity, and invasion of the peritoneum with polymorphonuclear neutrophils and macrophages.[1]

Peritonitis, if not treated promptly, can lead to multisystem organ failure and death.[2]. Untreated cases of acute peritonitis may be fatal. In 1926, the fundamental role of operative therapy in the treatment of peritonitis was documented. Kirschner reported that the mortality rate from intra-abdominal infections decreased from more than 90% to less than 40% during the period from 1890-1924 with the introduction of operative management as an effective therapeutic modality.[3]

Peritonitis is a common surgical emergency in developing countries.[4] Despite advances in surgical techniques, good antimicrobial therapy and intensive care support, it carries high morbidity and mortality while its management remains difficult and complex.[5] Despite improvements in antimicrobial therapy and great progress in intensive treatment, mortality due to diffuse infections ranges from 10% to 20% of cases in the literature. Necrotizing acute pancreatitis and surgery-related diffuse purulent, are the most important causes of death. Literature indicates, in this specific group, a mortality of 50-60% that nowadays continues to be unacceptably high.[6] Elsewhere in Africa, from the Democratic Republic of Congo, Ngandu T. has reported that perforation due to typhoid makes up 10 to 18% of cases with typhoid fever, and mortality was at around 40% of cases.[7]

There are poor formal statistics on the types and socio-demographic characteristics in urban area as well as rural area of Burundi, locally documented risk factors of peritonitis though Ndayizeye in his study carried out at CHUK and Hospital Prince Regent Charles (HPRC) in 2010, has revealed that 53 cases (23, 45%) were acute appendicular peritonitis, 51 cases about 22, 56% were peritonitis due to perforation resulting from typhoid fever.[8] The present study intends to address the concern of poor information and have a positive impact on the management of patients with peritonitis.

Study area: This study was carried out in the departments of surgery and the intensive care unit at CHUK, located in the capital of Burundi (Bujumbura), and KHH, located in Gitega central rural Province of Burundi.

Study design and methods: This study was a descriptive-based study with retrospective data collection from patients as they were received and hospitalized due to peritonitis over a period of 3 years (from August 2011 to August 2014).

Our study methodology followed different stages:

• Literature research from the library and websites
• Making data collection sheets
• Data analysis phase
• Editing phase

The data has been collected from the departmental emergencies, theater registry, and hospital patient records. The emergency and resuscitation unit, along with the adult surgical department, were involved in the study. All patients were studied in terms of demographic data, clinical presentation, causes of peritonitis, site of perforation, treatment undertaken, post-operative complications, and mortality. This design was sufficient to make a comparison between patterns, causes, and management, as well as to determine the outcome of peritonitis in both rural and urban hospitals.

Research instruments: A structured data collection sheet was used to collect information on socio-demographic characteristics, patient history, clinical and physical exam, causes, diagnosis, treatment, complications, and outcome of peritonitis.

Study population: All patients with the diagnosis of peritonitis following various causes; infectious, gastrointestinal tract (GIT) perforation, traumatic, or due to any other cause were taken as elements of the study population.

Sample size: Patients who presented during the period of the study with signs and symptoms of peritonitis to both hospitals (CHUK and KHH), were recruited and considered as sample size.

Inclusion criteria: The following were considered as inclusion criteria in our study

• All patients who were operated on during the study period for peritonitis and whose operation theatre (OT) and medical records were complete.
• All patients who were operated on for peritonitis and died during the surgical operation or in the post-operative period.

Exclusion criteria: The following were considered as exclusion criteria in our study

• All patients who had peritonitis and whose OT records were incomplete.
• Patients who were referred from any study hospital under the motive of peritonitis
• All patients who were diagnosed with peritonitis were under 18 years old.

Data analysis and interpretation:  Statistical data analysis was done using EPI Info software. For analysis, the patients were divided into 2 groups according to the hospital they consulted. Group I included patients who had presented to CHUK, and group 2 included patients who had presented to KHH. Data was summarized in the form of proportions, frequency tables, and charts for categorical variables. Continuous variables were summarized using means and ratios, and categorical variables were computed for categorical variables.

Socio-demographic characteristics of patients with peritonitis: A total of 106 patients presented with peritonitis during the study period of 3 years, from August 2011- August 2014. All patients whose medical records were complete were recruited and were operated on in one of the study settings, either at CHUK or KHH.

Table 1: Pattern of peritonitis according to age

Table 1 illustrates that the age group between 18 and 38 years was the most affected, constituting 50.0%, and the mean age, as the table above reveals, was 39.5, with a range of 18-72 years.

Table 2: Pattern of peritonitis according to sex

Table 2 shows that in the group of 106 patients, females constituted the majority (50.95%), mostly related to post-caesarean section (CS) pelvi-peritonitis, and the male to female ratio was 0.96%.

Table 3: Distribution of patients according to their origins

Table 3 illustrates origins of patients who consulted during the whole period of the study, and the majority were from Bujumbura City (38%) for CHUK and Gitega (23%) for KHH.

Table 4: Distribution of patients according to causes of perforation by age (years)

Table 4 shows that among organ perforations gastro duodenal perforation was much more common in the age group 18-28 years (15.6%) for CHUK and 51-61 years (10.35%) for KHH, whereas appendicular perforation was much more common in age group 29-39 years (15.6%) for CHUK and 18-28 years (6.89%) for KHH. Ileal perforation due to typhoid was common in the age group 18-28 years (13%) for CHUK and in the same group (10.34%) for KHH.

Therapeutic data:

Table 5: Distribution of patients according to post-operative antibiotics and analgesics

Source: Field research, 2014

Table 5 illustrates that the combination of Claforan, gentamycin, and Flagyl was highly prescribed in 39 cases (37.00 %), and diclofenac was the most analgesic used, but other antibiotics (Ciprofloxacin, anti-TB drugs) were used in 5 cases (4.50%).

Table 6: Distribution of patients according to surgical techniques

Table 6 summarizes the rates of patients who benefited from different surgical techniques. All 106 patients recorded (100%) benefited from explorative laparotomy and peritoneal irrigation on an emergency basis, and a high rate of 21.69% or 23 cases benefited from appendectomy more than laparotomy and peritoneal irrigation.

Table 7: Distribution of patients according to post-operative outcome

Table 7 illustrates that 54 patients developed post-operative complications and a long stay in the hospital, which led to morbidity (51%). The mean hospital stay was 16.5 days. The overall mortality rate was (8.5%) with septic shock associated with multiple organ systemic dysfunctions as the most common cause.

Table 8: Illustrative table of mortality and causes

Table 8 reported the rate of mortality which was 8.5% (see Table 3-13 = 9 patients) to both study settings (CHUK and KHH) and septicemic infections were at a high rate among the causes of mortality associated with other organ or systemic dysfunctions (Cancer, diabetes, and pulmonary embolism).

Socio-demographic characteristics: In our study, we found that among the patients presenting to study settings (hospitals) with peritonitis, the majority (50%) were aged between 18 and 28 years. The medium age in our study was found to be 32, 2 years, with a range of age from 18-72 years.

Peritonitis is a frequently encountered surgical emergency in tropical countries like Burundi, mostly affecting young people, an observation that has been seen in this study.

The same observation has been reported by Rutabasibwa, who has revealed that most patients with generalized peritonitis (38.7%) were in the age range of 21-30 years, with a mean age of 32.3, range 11-82 years.[9]

On the contrary, other authors found different ranges and mean age, like Ndayizeye, who found that peritonitis due to perforated appendix or appendicitis was predominant in the age range of 11-20 years (39.62%), and the rate decreases as the age range increases until none after 60 years. The mean age he found was 22, 37 years, ranging from 6 to 60 years.[10]

Traoré has reported that patients who were operated for peritonitis due to typhoid ileal perforation had a mean age of 21.9 years, with 80.9% of patients who had an age of less than 30 years.[11] This study revealed that females constituted the majority (50.95%), mostly related to post CS pelvi-peritonitis, 54 females vs. 52 males (49.05%); the male-to-female ratio was 0.96/1 in favor of females.

The results of this study have differed somewhat from other authors ‘findings; Ndayizeye in his study on acute appendicular peritonitis, found a male to female ratio of 1.51/1 in favor of males, whereas Nguyen in his study on peritonitis due to typhoid ileal perforation in the tropics.[12,13] and Sidibe Y on generalized peritonitis in Mali, have found a predominance of males at 64. 4% and 71.4% respectively.[14]

Clinical and para-clinical data: Abdominal pain was the most frequent chief complaint at the rate of 100%, difficulty in passing gas and stool at the rate of 93.39%, fever at the rate of 89.62%, and nausea/vomiting at 78.30%.

Our study revealed that 100% of all patients had pain (a severe and constant abdominal pain) mostly associated with fever (89.62%) see graph 5-6. These results were common to different authors who found, apart from abdominal pain, an infectious syndrome in peritonitis comprising fever, nausea, vomiting, and sometimes anorexia.[15]

Functional signs: The results of this study revealed that the most common functional sign reported by all patients was abdominal pain, 100%, but diarrhea was recorded in 13 patients (12.26%), mostly linked with typhoid.

From the results of our study, abdominal pain dominated since it is constant. The rate of 100% had been obtained. Our results were in accordance with Ndayizeye, Nguyen, and Traoré. Their findings match ours in their studies.[11-13] Ndahabonayo found low rates compared with ours, 90, 62, and 90, 3%.[15] Vomiting and nausea are frequent and early signs, but not specific to peritonitis. In our study, vomiting was revealed at the rate of 78.3%. These results were compatible with Ndayizeye’s, who in his study found 77, 35% of cases of vomiting, some were 43,39% food, 50,94% bile, and 5.66% fecal (linked with peritonitis due to typhoid ileal perforation).[12]

Traoré and Goita found in their study only typhoid perforations and appendicular peritonitis, with an inferior rate to ours, 52, 9, and 75%.  Steeb G found a high rate of 90%.[11,16]

The difficulty of passing gas and stool was revealed in our study on 99 patients (93.39%); Then, we have also recorded 99 patients (93.39%) of constipation and 13 (12.26%) of diarrhea (Diarrhea was linked to peritonitis due to typhoid ileal perforation). Low rates compared to our findings have been revealed by several authors:

Ndayizeye found a rate of 49.05% of no stool and gas passing and 13.20% for constipation. Whereas CIZA found acute peritonitis in 67 cases, a rate of 68, 65%. According to him, constipation is characterized by passing stool at least 3 times a week.[12] Our study also reported diarrhea in 13 patients who had peritonitis due to typhoid ileal perforation (12, 26%). Other authors reported high rates, 26, 5 found the rate of 35%.[17]

General signs: High temperature was observed in 95 patients (89.62%). Nevertheless, low blood pressure was recorded in 22 patients at the rate of 20.75%.

From the results of our study, high temperature was occupied by 89.62% and tachycardia by 86.79%. These findings were comparable to Traoré’s, whose study on peritonitis due to ileal perforation secondary to typhoid, found 85.3% for fever, but also Nguyen.[11,13]

Physical signs: Most patients whose abdominal distensions revealed 94.33% and abdominal guarding were the same as diffuse abdominal rigidity had the rate of 89.62%, respectively.

Abdominal distension: Abdominal distension revealed 94.33%. These results overlap with other authors’ findings, who found 76.47%.[18-20] This frequent sign during peritonitis refers to reflex paralysis of the intestines secondary to inflammation of the peritoneum.

Abdominal guarding: Abdominal guarding was at the rate of 89.62%, respectively. Some authors had the same findings, which were inferior to ours, respectively 58, 20% and 61, 76%, (64, 15%).[20,21] Abdominal rigidity or contracture was 89.62%. According to Traoré in his research on ileal perforation due to typhoid, abdominal muscle contracture occupied 86.8% of cases.[20]

Frequency of peritonitis causes: Our study revealed that among organic perforations, gastro-duodenal perforation was the most common cause of Peritonitis (32.00%), peptic ulcer disease being the absolute cause of these perforations. Ileal-caecal/typhoid perforations constituted (12.26%) and post-operative complicated CS, evisceration, and abdominal foreign body (18.00%). Appendicular perforation encountered for (17.92%), abdominal trauma (6.62%), and other perforations counted (31.12%).

Gastro duodenal perforations: Rutabasibwahas reported that gastro duodenal perforation was frequent in the age range of 21-30 years (13.7%), ileal perforation due to typhoid was much more frequent in the age range of 21- 30 years, 14.5%.[9]

Rutabasibwa’s study results are in accordance with our study in which Gastro duodenal perforation was much more common in age group 18-28 years (15.6%) for CHUK and Ileal perforation due to Typhoid was common in age group 18-28 years (13%) for CHUK and in the same group (10.34%) for KHH.

Lawal OO et al.[7] has supported these results by reporting that the advances in the medical treatment for peptic ulcer disease have led to a dramatic decrease in a number of elective surgeries performed. However, the number of patients undergoing surgical intervention for complications such as perforations remains relatively unchanged or probably has increased.

Small bowel perforations: Typhoid was the commonest (12, 26%) cause of ileal perforation peritonitis in our study. Different authors supported these results like Beniwal US et al.[2] who stated that Typhoid fever is a predominant cause of non-traumatic perforation in developing countries. The gut in typhoid fever is edematous and friable, especially in the terminal 60 cm of the ileum, as it was found by Rutabasibwa.[9]

In the setting of rural African hospitals, Morris demonstrated a decrease in overall mortality rate from 40% using one layer closure with chloramphenicol, gentamycin, and metronidazole. There was also a decrease in the overall mortality rate from 43% using less than 10ml/kg of intraoperative fluid administration to 14% when using more than 10ml/kg.[18]

Appendicular and colorectal perforations: Appendicular perforation was found in a higher frequency, 17.92%, in the young age group (18-28) from our study. This compares with other studies in which peritonitis due to a perforated appendix has been found mainly in the young age group.[6]

Early surgical intervention with appendectomy before perforation is the ideal treatment. Even if the detailed symptoms and signs of acute appendicitis make it possible to operate before perforation.[21]

Appendicular perforation encountered for (17.92%), abdominal trauma (6.62%), and other perforations counted (31.12%). These results are comparable to those of Rutabasibwa, who found that the other cause of small bowel perforation is blunt abdominal trauma, mostly from road traffic accidents, when patients go undiagnosed until they come back with peritonitis, which sets in.[9]

Morris et al revealed that TB peritonitis affects mostly the terminal ileum and ileocaecal junction and found that such patients may develop complications like obstruction, perforation, hemorrhage, and fistula.[18]

Complementary exams: Our study reported that results for most patients who benefited from Abdominal Plain x-ray, have shown pneumoperitoneum to 61 patients (41%) and for 9 patients (6%) air fluid levels. Patients who benefited from abdominal ultrasound, 38 (25%) showed peritoneal fluid, and 21 (14%) showed peritoneal irritation, but no patient benefited from CT-Scan by Ndayizeye and Harouna. Abdominal plain x-ray was performed on 47, 76%, 69, 11%, and 100%. Those X-rays also revealed 29, 85%, 14, 58%, and 24% of air-fluid levels.[12]

It is normal that in 5. 97%, 10, 8%, and 37. 5% of cases found pneumoperitoneum in 14. 92%, 29.41%, 63. 3% [13]. Different findings from various authors may be explained by the objectives set to achieve. On one hand, they studied socio-demographic characteristics and therapeutic outcomes; on the other hand. Prospective, retrospective, or both constituted another explanation.

Abdominal ultrasound: It has been revealed in our study that for 80 cases (75.4%) whose ultrasound findings were recorded, 25% had peritoneal effusion/fluid, 14% dilatation of intestinal angles, and 14% peritoneal irritation.

These results differ from other African authors’ findings, who reported that this test is less commonly performed; authors found that it was done at the rate of 17%, 65%, and 12% of cases. Ndayizeye and Ndahabonayo in their studies found 9, 43%, and 32%.[12,15]

Therapeutic data: The recurring themes of treatment in peritonitis are a) resuscitation, b) antibiotics, c) peritoneal lavage, and d) source control.

Post-operative antibiotherapy and analgesics: Bohnem in his study reported that antibiotics with adequate spectra to cover these organisms are required. He has used the combination of an aminoglycoside with an anti-anaerobic agent such as clindamycin or metronidazole throughout his career with excellent results. Once-daily aminoglycoside regimen is effective and safe. Fluroquinolones are being used more regularly as primary agents.[3]

The study of Bohnem is in accordance with our findings since it has been demonstrated that the combination Claforan, gentamycin, and Flagyl was highly prescribed at the rate of 37.00 %, and diclofenac was the most common analgesic used, but other antibiotics (Ciprofloxacin, anti-TB) were used at the rate of 4.50%.

Surgical techniques: This study revealed that all patients recorded (100%) benefited from explorative laparotomy and peritoneal irrigation on an emergency basis, and a high rate of 21.69% benefited from appendectomy with laparotomy and peritoneal irrigation.

Our results match with other findings from various authors that explorative laparotomy with peritoneal lavage for peritonitis is universally recommended.[17]

Various authors reported different surgical techniques used depending on the causes of peritonitis; As the incidence of perforated peptic ulcer has decreased in Western countries, the surgical treatment of those remaining has tended to be simple closures rather than resection.[10]

Surgical management of intestinal perforation remains a challenge. Since these patients have bowel edema that precludes any suturing, exteriorization of the perforation as a loop ileostomy is the safest and fastest procedure to be done. Closure of this loop ileostomy is performed electively after 6-8 weeks. A primary anastomosis (simple closure) is to be considered only when the patient presents early and the bowel is healthy.[16]

Rutabasibwa stated that early surgical intervention with appendectomy before perforation is the ideal treatment for appendicular peritonitis.[9] This statement is in accordance with our study findings, whereby every patient who was diagnosed with appendicular peritonitis benefited from both laparotomy and appendectomy.

Outcome: During the research, most patients (77.35%) had a simple post-operative course, and 3.77% had a complicated post-operative course, which included either Fistula, DVT, or wound sepsis. Septic shock was at the rate of (6.60 %) and 9 patients died (8.49%).

These results were high, compared to the findings of other authors such as Ciza, Ndayizeye who respectively worked on acute peritonitis and found the rate of 52, 23% and 54, 71%; They are also different than the results of some authors found a simple post-operative course respectively at 54 and 58, 82% of cases.[12,13] Our study revealed that wound infections or sepsis occupied (4%) and this was a little bit in discordance to the findings of Kriger who found that in the postoperative period, out of 691 patients with low degree of bacterial contamination, wound infection was seen in 7, 9%, intra-abdominal infection in 2, 5%, multiple organ insufficiency in 1, 0%.[6]

Morbidity: In our study, morbidity was 37.2%, these results are overlapped by the results of Rutabasibwa [16] who found in his research on generalized peritonitis, a mortality rate of 39.6%. However, other authors reported high mortality rate of 28, 57%, Tetas, Rakotoarisoa from Madagascar, and it as 2. 55 % and 18.1% of cases.[12,15]

Mortality: The study findings reported the rate of mortality which was 8.5% (see table 4-13 = 9 patients) to both study settings (CHUK and KHH) and Septicemic infections were at high rate among the causes of mortality associated with other organ or systemic dysfunctions (Cancer, diabetes, and pulmonary embolism). In the postoperative period of 256 patients with high degrees of bacterial contamination wound infection decreased to 6,0%, intra-abdominal infection increased to 4,2%, multiple organ insufficiency in 42,6%; mortality was 18,1%.[6]

Literature reveals that other authors have recorded high mortality comparing to our study findings. Rutabasibwa has reported a mortality rate of 21.8%. He attributed it, to late presentation with presence of advanced bacterial peritonitis at admission with well-established peritonitis with fecal or purulent contamination, and varying degree of septicemia.[6] These findings were in accordance to other studies, Mahendale reported a mortality rate of 31.5.[8]

Hospitalization duration: The hospitalization duration in our study revealed that the mean period was 16.5 days with the range from ≤7to ≥30days. Our results are a little bit inferior to those of Sidibé Y, who worked on acute peritonitis in two referral hospitals of Bujumbura (CHUK and HPRC), found the mean period of 15. 68 days with a range from 1-43 days.[14] In the study of Ndayizeye, the mean age was 15,5 days with a range from 1-28 days.[12]

Limitations of the study: The data collection was rendered difficult in all study settings by the loss of some detailed information on post-operative reports and complementary exam findings, which were not attached to the patient’s medical records.

The data collection at CHUK was performed late due to hospital rehabilitation works, and medical records were stained with dust and colors; thus, some of them were not easily readable. In addition, medical records were in a mess, and it was difficult to find the ones related to our research topic.

Peritonitis remains a common surgical problem at CHU-Kamenge and KHH. Likewise, it continues to have a substantial impact on Burundi’s health care system. The most affected group was the young individuals. This is a working-class group that is mostly involved in social productivity, and thus has an impact on the economy of the country.

In our study, a total of 106 patients with peritonitis were recorded in the period of three years from August 2011 to August 2014. The study revealed that according to the pattern of peritonitis according to age, many affected patients (50%) are between 18-28 years, and the rate of female patients was 51%, and the male-to-female sex ratio was 0.96. Gastro-duodenal perforations were the most common diagnosis (32%) among causes of peritonitis linked to perforations, and appendicular peritonitis was the second most common (17.92%). On the diagnosis basis, our study revealed that it was firstly clinical, and the following findings show signs recorded abdominal pain (100%), vomiting (78, 30%), diarrhea (12, 26%) and difficulty of passing gas and stool (93, 39%).

General signs have been recorded, and High temperature occurred in 90% of cases, whereas tachycardia was present in 87% of patients, and low blood pressure was found in 21%. About physical signs, most patients revealed abdominal distension (94.33%), also abdominal guarding in 90%, and diffused abdominal rigidity in 90%.

Though peritonitis may be clinically diagnosed, complementary exams are necessary for certainty of the diagnosis. Our study reported the frequent imaging exams solicited. Abdominal plain x-ray findings showed pneumoperitoneum (61%) and air-fluid levels (9%), while abdominal ultrasound revealed peritoneal effusion/fluid (38%), agglutination of intestinal angles (21%), and peritoneal irritation (11%). The rate of Leukocytosis (15%) has been recorded. Unfortunately, other diagnostic means, which were found in other studies, such as CT-Scan, laparoscopy, or Culture of peritoneal fluid, were not able to be done for the patients in our study.

On a treatment basis, the study reported that aggressive resuscitation and early surgery were required; explorative laparotomy was done at the rate of (100%) and etiologic repair was performed to avoid the high morbidity and mortality. Major complications noticed are septic shock (6.60%), wound infection (3.77%), fistula (3.77%) and DVT (3.77%). Overall morbidity was (51%) and mortality was (8.49%); such morbidity was attributed to long hospital stay and septic shock constituted the first cause of mortality in our study (9.81%).

Parameters such as aggressive intravenous fluids (electrolyte resuscitation), supplemental oxygen, and the type of surgical procedures, plus the use of appropriate antibiotics, should be emphasized to improve survival.

I extend my sincere gratitude to the consultants, specialists, residents, registrars, and nurses at CHUK and Kibuye Hope Hospital for their invaluable support and assistance throughout every stage of this work. It has been a privilege to work alongside such a dedicated and supportive team.

Not reported

Corresponding Author:
Jean Pierre Hagenimana
Department of Anesthesia and Critical Care
Bushenge Provincial Hospital, Rwanda
Email: phagmanj@gmail.com

Co-Author:
Jason Fader
Department of General Surgery
Kibuye Hope Hospital, Burundi

All authors contributed to the conceptualization, investigation, and data curation by acquiring and critically reviewing the selected articles. They were collectively involved in the writing – original draft preparation, and writing – review & editing to refine the manuscript. Additionally, all authors participated in the supervision of the work, ensuring accuracy and completeness. The final manuscript was approved by all named authors for submission to the journal.

Prior to conducting this study, the 2 research settings, CHU Kamenge and KHH, had obtained authorization to carry on the research, considering the authorization given by the Burundian research board.

Not reported

None

https://doi.org/10.63096/medtigo3067114

Jean PH, Jason F. The Pattern, Causes, Management and Outcome of Peritonitis at Chu-Kamenge and Kibuye Hope Hospital in Burundi: A Retrospective Study on A Period Of 3 Years (From August 2011 to August 2014). medtigo J Anesth Pain Med. 2025;1(1):e3067114. doi:10.63096/medtigo3067114 Crossref