INTESTINAL OBSTRUCTION IN CHILDREN AT EL OBEID HOSPITAL, WESTERN SUDAN.
Abstract
Background: Intestinal obstruction is a common cause of childhood surgical emergency in the developing countries with considerable morbidity and mortality.
Objectives: To assess the magnitude, pattern and management outcomes of intestinal obstruction in children presenting to a General Surgical Unit at a rural setup, in Western Sudan.
Patients and Methods: The clinical records of all children below 15 years of age admitted to the University General Surgical Unit at El Obeid Teaching Hospital, in Western Sudan with the diagnosis of intestinal obstruction during the period from 2006 to 2007 were retrospectively reviewed. The mean age, gender, causes of obstruction and management outcomes were studied and analyzed.
Results: There were 72 patients. 48 were males (66.7%). Neonates and infants were 70% of patients. Hirschsprung’s disease, intussusception, obstructed hernias and ano-rectal anomalies accounted for 21.8%, 19.4%, 16.7% and 13.9% respectively. Less common causes were pyloric stenosis 8.3% and gut atresia 6.9%. Lymphoma, adhesions, peritonitis and faecal impaction were 2% each. The overall mortality rate was 13.9%.
Conclusions: The main causes of childhood intestinal obstruction at Western Sudan were congenital anomalies in neonates, intussusception in infants and obstructed hernias in elder children. The management was associated with high mortality due to poor hospital facilities and late presentations resulting in bowel ischaemia.
References
2. Pujari AA, Methi RN, Khare N. Acute gastrointestinal emergencies requiring surgery in children. Afr J Paediatr Surg. 2008; 5(2): 61-64.
3. Ameh EA, Chirdan LB. Neonatal intestinal obstruction in Zaria, Nigeria. East Afr Med J. 2000; 77(9): 510-513.
4. Uba AF, Edino ST, Yakubu AA, Sheshe AA. Childhood intestinal obstruction in Northwestern Nigeria. West Afr J Med. 2004; 23(4): 314-318.
5. Hadley GP. Perspectives on congenital abnormalities in the third world. Afr J Paediatr Surg. 2008; 5(1): 1-2.
6. Pini Prato A, Gentilino V, Giunta C, et al. Hirschsprung’s disease: do risk factors of poor surgical outcome exist? J Pediatr Surg. 2008; 43(4): 612-619.
7. Hajivassiliou CA. Intestinal Obstruction in Neonatal/Pediatric Surgery. Semin Pediatr Surg. 2003; 12(4): 241-253.
8. Osifo OD, Okolo JC. Neonatal intestinal obstruction in Benin, Nigeria. Afr J Paediat Surgery. 2009; 6(2): 98-101.
9. Bulmer RM, Hessel NS, van Baren R. Comparison between umbilical and transverse right upper abdominal incision for pyloromyotomy. J Pediatric Surge. 2004; 39(7):1091-3.
10. Kumar R, Abel R. Infantile hypertrophic pyloric stenosis. Surgery. 2005; 23(9): 323-325.
11. Doumi EA. Acute intussusception in children seen at El Obeid Hospital, Western Sudan. Sudan JMS. 2008; 3(4): 315-317.
12. Bode CO. Presentation and management outcome of childhood intussusception in Lagos: A prospective study. Afr J Paediatr Surg 2008; 5(1):24-28.
13. Blanch AJ, Perel SB, Acworth JP. Paediatric intussusception: epidemiology and outcome. Emerg Med Australas. 2007; 19(1): 45-50.
14. Justice FA, Auldist AW, Bines JE. Intussusception: trends in clinical presentation and management. J Gastrenterol Hepatol. 2006 ; 21(5) : 842-6.
15. Wald A. Management and prevention of fecal impaction. Curr Gastroenterol Rep. 2008; 10(5): 499-501.
16. Ratan SK, Rattan KN, Pandey RM, Sehgal T, Kumar A, Ratan J. Surgically treated gastro-intestinal obstruction in children: causes and implications (a letter). Indian Journal of Gastroenterology. 2006; 25: 320-321.
17. Hussain Z, Sheikh KA, Arif S, et al. Small bowel obstruction in children-A surgical challenge. JK-Practitioner. 2006; 13(4): 186-189.
18. Mishra PK, Agrawal A, Joshi M, Sanghvi B, Parelkar SV. Intestinal obstruction in children due to Ascaris: A tertiary health centre experience. Afr J Paediatr Surg. 2008; 5(2): 65-70.