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Bowel resection in children
1Paediatric Surgery Unit, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Insights
Pediatric bowel resections in Nigeria are primarily due to typhoid perforation and intussusception, differing from developed nations. Most cases are preventable, with highest mortality in infants, highlighting the need for improved sanitation and surgical care.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Public Health
Background:
- Pediatric bowel resections in developed countries often address congenital anomalies, leading to short bowel syndrome.
- In developing countries, indications and outcomes for pediatric bowel resection require specific investigation.
Purpose of the Study:
- To review the indications, morbidity, and mortality associated with pediatric bowel resection in a developing country setting.
- To compare these findings with those reported in developed nations.
Main Methods:
- A retrospective study was conducted over five years at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
- Data were collected from 46 children aged 12 years or younger who underwent bowel resection.
Main Results:
- Typhoid perforation (54%) and intussusception (17%) were the leading indications for bowel resection in children.
- Complications occurred in 26% of patients, with wound infection and anastomotic dehiscence being most common. Mortality was 20%, highest in neonates and infants (38%).
Conclusions:
- Indications for pediatric bowel resection in this Nigerian setting significantly differ from developed countries, with a high proportion being preventable through improved sanitation and timely treatment.
- Morbidity and mortality rates are highest in the youngest age groups, emphasizing the need for meticulous surgical technique and early intervention.
Background:
In developed countries, most bowel resections in children are for congenital anomalies and massive resection and short bowel syndrome are frequent problems.
Objective:
To review indications, morbidity and mortality of bowel resection in children in a developing country.
Design:
A retrospective study.
Setting:
Ahmadu Bello University Teaching Hospital Zaria, Nigeria.
Subjects:
Forty six children aged < or = 12 years who had bowel resection in a period of five years.
Results:
The commonest indication was typhoid perforation 25 (54%), 21 (84%) of them aged > 5 years. Intussusception was the indication in eight (17%), six less than one year. Bowel resection was performed for congenital anomalies in nine (18%) patients, seven of them < 1 month (abdominal wall defect in four, intestinal atresia in two, strangulating inguinal hernia in one, strangulating band in one, Meckel's diverticulitis, one). Resection for trauma and neoplastic conditions were few (2.4% each). Twelve patients (26%) developed 17 complications including would infection in seven (15%) anastomotic dehiscence, five (11%), abdominal wound dehiscence, three (14%), intra-abdominal abscess and stitch sinus, one (2%) each respectively. Most of the complications followed right hemicolectomy for intussusception and resection for typhoid perforation. Massive bowel resection was necessary in only one patient. There were nine deaths (20%). The mortality was highest in neonates and infants (38%).
Conclusion:
The indications for bowel resection in this environment differ from that in developed countries. Most of the indications (74%) are preventable by improvements in sanitation and early presentation and treatment. The morbidity and mortality are highest in neonates and infants and meticulous attention to technical details may minimise them.