Paediatric surgical abdominal emergencies in a north central Nigerian centre

Abstract

Background/objective Paediatric surgical abdominal emergencies (PSAEs) account for 2.4–3.1% of all paediatric admissions. The causes of PSAEs vary worldwide, and the management is challenging, often with unimaginably poor outcome if not carefully handled. The aim of this study was to determine the patterns and factors influencing the outcome of PSAE at a tertiary healthcare centre in Nigeria.
Patients and methods The biodata, clinical features, perioperative findings and outcome of management of 100 consecutive children aged up to 12 years with confirmed PSAE were prospectively collected and analysed using SPSS 15.0 software, taking P-value to be < 0.05. Five children who had undergone an initial surgical intervention and those who were discharged against medical advice during care were excluded.
Results The 100 children included in this study constituted 38.3% and 3.4% of the total paediatric surgical operations and paediatric admissions that took place during the study period, respectively. Their mean age was 4.6 ±0.469 years, and the male-to-female ratio was 2.5 : 1. About 64% of patients presented within the first 5 days of onset of symptoms with abdominal pain/distension and/or vomiting as chief complaint. Fourteen (63.7%) of patients with perforated typhoid ileitis presented after a week, whereas 10% presented with the same symptoms after 2 weeks. Mechanical intestinal obstruction was the most common cause of PSAE among neonates and infants, whereas peritonitis was the main presenting cause in late childhood (7–12 years). Only 54 patients underwent surgical intervention within 24 h of presentation. Twenty-four (24%) patients underwent surgical intervention after 48 h. The main causes of delay for surgical intervention were hospital logistics in 58 patients and lack of funds to procure drugs and consumables in nine patients. The overall median hospital stay was 10 days. Eighty-nine (89%) patients were discharged, whereas 11 (11%) died. Mortality was significantly higher in neonates and infants (P = 0.016) and in those with peritonitis (P = 0.008).
Conclusion PSAE constitutes a large percentage of the paediatric surgical workload at our centre. Mechanical intestinal obstruction in neonates and infants is the leading cause. Aggressive resuscitation, accurate diagnosis, and prompt surgical intervention, in addition to provision of paediatric intensive care facilities, will assist in reducing morbidity and mortality among these children.

Keywords: abdominal emergencies, acute abdomen, children, morbidity, mortality