Indications and outcome of childhood preventable bowel resections in a developing country

Abstract

Background: While many bowel resections in developed countries are due to congenital anomalies, indications for bowel resections in developing  countries are mainly from preventable causes. The aim of the following study was to assess the indications for, morbidity and mortality following preventable bowel resection in our centre.

Patients and Methods: Retrospective analysis of all cases of bowel  resection deemed preventable in children from birth to 18 years from June 2005 to June 2012.

Results: There were 22 preventable bowel resections with an age range of
7 days to 17 years (median 6 months) and male:female ratio of 2.1:1. There were 2 neonates, 13 infants and 7 older children. The indications  were irreducible/gangrenous intussusceptions (13), abdominal gunshot
injury (2), gangrenous umbilical hernia (2), blunt abdominal trauma (1), midgut volvulus (1), necrotizing enterocolitis (1), strangulated inguinal hernia (1), postoperative band intestinal obstructions (1). There were
16 right hemicolectomies, 4 small bowel resections and 2 massive bowel resections. Average duration of symptoms before presentation was 3.9 days (range: 3 h-14 days). Average time to surgical intervention was 42 h for survivors and 53 h for non-survivors. Only 19% presented within 24 h of onset of symptoms and all survived. For those presenting after 24 h, the
cause of delay was a visit to primary or secondary level hospitals (75%) and ignorance (25%). Average duration of post-operative hospital stay is  14 days and 9 patients (41%) developed 18 complications. Seven patients died (31.8% mortality) which diagnoses were irreducible/gangrenous  intussusceptions (5), necrotising enterocolitis (1), midgut volvulus (1). One
patient died on the operating table while others had overwhelming sepsis.

Conclusion: There is a high rate of morbidity and mortality in these cases of preventable bowel resection. Typhoid intestinal perforation did not feature as an indication for bowel resection in this series. Original Article

Key words: Childhood, developing country, indications, outcome,  preventable bowel resection