Non-Obstetric Acute Generalized Peritonitis During Pregnancy: A Report of Two Severe Cases in the Democratic Republic of the Congo
Péritonite Aiguë Généralisée d'Origine Non Obstétricale Pendant la Grossesse : A Propos de Deux Cas Graves en République Démocratique du Congo
DOI:
https://doi.org/10.67260/hra.v4i8.7925Keywords:
peritonitis, colorectal cancer, perforated appendicitis, pregnancy, Eastern DR Congo, clinical caseAbstract
ABSTRACT
Acute generalized peritonitis during pregnancy represents a rare and dangerous surgical emergency. Diagnostic delays in resource-limited settings significantly increase maternal and fetal mortality. We report two cases of non-obstetric generalized peritonitis managed at Kitatumba General Referral Hospital in Butembo, Democratic Republic of the Congo. The first case involved a 25-year-old primiparous woman at 14 weeks of amenorrhea with septic shock secondary to a perforated right colon signet-ring cell adenocarcinoma (T3NxMx). The second case involved an 18-year-old primigravida at 29 weeks of amenorrhea who developed peritonitis from perforated appendicitis. Both patients underwent emergency midline laparotomy with extensive warm saline peritoneal lavage and intensive postoperative care. The surgical management achieved maternal survival in both cases after at least three weeks of hospitalization, although fetal outcomes were tragic, resulting in one spontaneous abortion and one stillbirth. These observations highlight the critical need to maintain a high index of suspicion for non-obstetric surgical conditions in pregnant women presenting with acute abdominal symptoms. Early surgical intervention remains the cornerstone of effective management to save maternal lives in resource-constrained environments.
RÉSUMÉ
La péritonite aiguë généralisée pendant la grossesse constitue une urgence chirurgicale rare et redoutable. Dans les pays à ressources limitées, le retard diagnostique accroît la morbi-mortalité fœto-maternelle. Nous rapportons deux cas de péritonite généralisée d'origine non obstétricale traités à l'Hôpital Général de Référence de Kitatumba, à Butembo (République Démocratique du Congo). Le premier cas concerne une primipare de 25 ans à 14 semaines d'aménorrhée, admise pour un choc septique secondaire à la perforation d'un adénocarcinome colique à cellules en bague à chaton (T3NxMx). Le second cas décrit une primigeste de 18 ans à 29 semaines d'aménorrhée, présentant une péritonite par appendicite perforée. Les deux patientes ont bénéficié d'une laparotomie en urgence avec toilette péritonéale abondante et réanimation intensive. La prise en charge a permis la survie maternelle dans les deux cas après au moins trois semaines de surveillance hospitalière, bien que l'issue fœtale ait été défavorable (un avortement spontané et un mort-né). Ces observations rappellent la nécessité de suspecter précocement une cause chirurgicale non obstétricale devant tout abdomen aigu de la femme enceinte. Une intervention rapide demeure le seul moyen d'optimiser le pronostic maternel en milieu sous-équipé.
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