Duodenal Obstruction: Etiology, Morbidity and Mortality among Edo State Children, Nigeria

Abstract

Duodenal obstruction in children is associated with poor outcome which has improved in developed but remained poor in developing countries. The objective of this study was to ascertain the etiology, morbidity, mortality and factors that contributed to poor outcome in a developing country. Retrospective analysis of pediatric duodenal obstruction treated at the University of Benin Teaching Hospital, Benin City, Nigeria, between January, 1998 and December, 2007 was carried out. Sixty-three children aged 2 days and 12 years (mean 1.5 years ± 2.7) comprising 41 males and 22 females with male/female ratio 1.9:1 were treated. This accounted for 0.8% pediatric operations but contributed 15.3% to total pediatric surgical mortality. Congenital anomalies (atresia, webs, malrotation, complex abdominal mass and annular pancreas) were the major etiologies, while preoperative sepsis, hypoglycaemia, hypothermia, fluid/electrolytes derangement as well as post operative wound infection, burst abdomen, inanition, respiratory insufficiency, aspiration and anastomotic leakage, were the morbidities that culminated in 24 (38.1%) mortality. This was compounded by non availability of organized neonatal intensive care unit, pediatric ventilator, total parenteral nutrition and functional incubators. Majority presented as neonates delivered to low socioeconomic rural dwellers that sought medical attention late. Therefore, an extremely significant statistical difference was observed when the outcome was compared with children delivered in hospital and had prompt medical attention (P<0.0012). Poor outcome was due to preventable causes and there is need to increase health awareness campaign, provision of basic pediatric surgical facilities and improvement in government policies which will allow children have access to free medical treatment

Key Words: Duodenal obstruction, Etiology, Morbidity, Mortality, Children