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Burden of Complicated Intra-Abdominal Infections in Children in Nigeria: Recent Experience and Systematic Review

Justina Onyioza Seyi-Olajide1, Ugochukwu Ezidiegwu2, Emmanuel Adoyi Ameh2

  • 1Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria.

Surgical Infections
|May 27, 2020
PubMed

Insights

Complicated intra-abdominal infections (cIAIs) in Nigerian children are often caused by typhoid perforation or appendicitis. High complication rates and mortality underscore the need for further research and improved surgical management in low- and middle-income countries.

Area of Science:

  • Pediatric Surgery
  • Infectious Diseases
  • Global Health

Background:

  • Intra-abdominal infections (IAIs) present a spectrum of severity, from simple appendicitis to fecal peritonitis.
  • The epidemiology and clinical burden of complicated intra-abdominal infections (cIAIs) in pediatric populations within low- and middle-income countries (LMICs) remain poorly understood.
  • This study addresses the knowledge gap by reporting recent clinical experience and conducting a systematic review of cIAIs in Nigerian children.

Purpose of the Study:

  • To describe the epidemiology and outcomes of pediatric cIAIs in Nigeria.
  • To systematically review existing literature on pediatric cIAIs in LMICs.
  • To highlight the need for research and improved management strategies for pediatric cIAIs in resource-limited settings.

Main Methods:

  • Retrospective analysis of 85 pediatric patients with cIAIs treated at a Nigerian facility.
  • Systematic literature review of publications on pediatric cIAIs in LMICs.
  • Data collection included primary causes, surgical complications, re-operation rates, re-admissions, and mortality.

Main Results:

  • Typhoid intestinal perforation (63.5%) and complicated appendicitis (23.5%) were the most frequent causes of cIAIs in the study cohort.
  • High complication rates were observed post-surgery, including surgical site infection (57.6%), intra-abdominal abscess (16.5%), and wound dehiscence (15.3%).
  • Re-operation (22.4%) and re-admission (14.1%) were common, with an overall mortality rate of 9.4% due to overwhelming infection. The systematic review identified a paucity of comprehensive data.

Conclusions:

  • Pediatric cIAIs in Nigeria are predominantly linked to typhoid intestinal perforation and complicated appendicitis, presenting significant surgical challenges.
  • High rates of postoperative complications, re-operations, and mortality necessitate urgent attention.
  • Increased investment in research and a focus on optimizing source control strategies are crucial for improving outcomes in pediatric cIAIs within LMICs.

Keywords:
appendicitischildrencomplicationsintra-abdominal infectionsource controltyphoid perforation

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