A E Ajao1, T A Lawal2, D I Olulana2, O O Ogundoyin2. 1. Department of Surgery, Bowen University Teaching Hospital, Ogbomoso, Nigeria. 2. Department of Surgery, University College Hospital, Ibadan, Nigeria.
Abstract
BACKGROUND: Acquired, and largely, preventable conditions are the predominant reasons for bowel resection in children in developing countries. This is in contrast to known indications in developed countries, where congenital conditions predominate. It is however, unknown, if the situation has changed with recent public health awareness initiatives. AIM: To examine the current indications, pattern and outcome of bowel resection in children in our center. METHODOLOGY: This was a retrospective review of the records of children 14 years and below who had had bowel resection procedures within a 90-month period at the University College Hospital, Ibadan. Patients who had colonic resections for Hirschsprung's disease were excluded from this study. RESULTS: A total of 91 children (57 boys, 34 girls) aged 6 hours to 14 years with a median of 7 months had bowel resections during the study period. There were 10 (11%) neonates, 51 (56%) infants and 30 (30.9%) children > 1 year. Common indications for bowel resection were intestinal atresia in neonates, intussusception in older infants and typhoid intestinal perforation/adhesive intestinal obstruction in children > 1 year. Overall, intussusception was the commonest indication in 54 (59.3%) followed by typhoid intestinal perforation in 9 (9.9%). The resection types were right hemicolectomy in 56 (61.5%), segmental small bowel resection in 31 (34.1%) and colonic resection in 4 (4.4%) patients. Thirty-seven (40.7%) patients developed post-operative complications, mostly surgical site infection in 25 (27.5%) and 17 (18.7%) developed long-term complications such as incisional hernia in 9 (9.9%). The mortality rate was 5.5% (5 patients). CONCLUSION: Intussusception and typhoid ileal perforation accounted for the majority of bowel resections in children in this study; late presentation was common and associated with high morbidity. Early presentation with prompt and effective management would improve outcome.
BACKGROUND: Acquired, and largely, preventable conditions are the predominant reasons for bowel resection in children in developing countries. This is in contrast to known indications in developed countries, where congenital conditions predominate. It is however, unknown, if the situation has changed with recent public health awareness initiatives. AIM: To examine the current indications, pattern and outcome of bowel resection in children in our center. METHODOLOGY: This was a retrospective review of the records of children 14 years and below who had had bowel resection procedures within a 90-month period at the University College Hospital, Ibadan. Patients who had colonic resections for Hirschsprung's disease were excluded from this study. RESULTS: A total of 91 children (57 boys, 34 girls) aged 6 hours to 14 years with a median of 7 months had bowel resections during the study period. There were 10 (11%) neonates, 51 (56%) infants and 30 (30.9%) children > 1 year. Common indications for bowel resection were intestinal atresia in neonates, intussusception in older infants and typhoid intestinal perforation/adhesive intestinal obstruction in children > 1 year. Overall, intussusception was the commonest indication in 54 (59.3%) followed by typhoid intestinal perforation in 9 (9.9%). The resection types were right hemicolectomy in 56 (61.5%), segmental small bowel resection in 31 (34.1%) and colonic resection in 4 (4.4%) patients. Thirty-seven (40.7%) patients developed post-operative complications, mostly surgical site infection in 25 (27.5%) and 17 (18.7%) developed long-term complications such as incisional hernia in 9 (9.9%). The mortality rate was 5.5% (5 patients). CONCLUSION: Intussusception and typhoid ileal perforation accounted for the majority of bowel resections in children in this study; late presentation was common and associated with high morbidity. Early presentation with prompt and effective management would improve outcome.
Authors: O J Goulet; Y Revillon; D Jan; S De Potter; C Maurage; S Lortat-Jacob; H Martelli; C Nihoul-Fekete; C Ricour Journal: J Pediatr Date: 1991-07 Impact factor: 4.406