The Predictors, Prevalence and Outcome of Burst Abdomen in Emergency Paediatric Surgical Centre

Abstract

Background: Combination of certain risk factors in children may predict burst abdomen, a preventable postoperative complication. We sought to determine the prevalence, outcome, and predictors of burst abdomen in emerging pediatric surgical centers.

Methods: Cases of laparotomy on children at two referral pediatric surgical centers in Nigeria between January 2002 and June 2009 were analyzed in a retrospective study that determined the prevalence, outcome, and predictors of burst abdomen.

Results: A prevalence rate of 31 (2.1%) was recorded among 1465 children who had open laparotomy. They were mainly neonates [19 (61.3%)] during index laparotomy with a mean age 14.8 ± 6.7 months (range 2 days to 12 years), and a male: female ratio 1.5: 1 (18 males/12 females). Burst abdomen occurred between 4-10days in 5 (3%) children after resection/anastomosis due to gangrenous/perforated bowels, 4 (5.5%) following colostomy creation, 3 (7.7%) after open reduction of intussusception, 2 (1.7%) of exploratory laparotomy, 3 (33.3%) after enterocutaneous fistula closure, 9 (39.1%) following primary closure of bowels perforation, 1 (20.0%) after drainage of intra-abdominal abscess, and 4 (1.9%) following resection of intra-abdominal malignant tumour. Only 54.8% children survived, 19.4% having incisional hernia and 12.9% ugly abdominal scars. Surgery on neonates, late referral, emergency laparotomy, infective indication, intraperitoneal soiling, inanition, and postoperative abdominal distension owing to protracted ileus that occurred in different combinations were predictive of burst abdomen in these cases.

Conclusion: The prevalence of burst abdomen is high with attendant poor outcome, but identifying the predictors may influence early institution of preventive measures.