Intestinal volvulus: aetiology, morbidity, and mortality in Nigerian children.
In developed countries, intestinal volvulus in children is most frequently due to malrotation. To review the experience in Nigeria, a retrospective analysis of 28 patients managed over 25 years at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, was undertaken. There were 22 boys and 6 girls with an age range of 4 days to 14 years (median 4 years). There were equal numbers over and less than 5 years of age. Vomiting (89%) and abdominal distension (79%) were the most prominent features. Thirteen children (46%) had fever, associated with bowel gangrene in 5, while 8 (29%) presented with severe dehydration and shock. A plain abdominal radiograph was the only investigation performed, but the features were not specific for volvulus. In 11 children (39%) the volvulus was idiopathic, in 9 (32%) due to adhesions or bands, in 5 (18%) to malrotation, and in 1 each a Meckel's diverticulum, internal herniation, and ventriculoperitoneal shunt. Twenty-three patients had a small-bowel, 4 sigmoid, and 1 caecal volvulus. The bowel resection rate for gangrene was 46% (small bowel 9, sigmoid 3, caecum 1). All patients with malrotation had Ladd's procedure performed. Wound infections occurred in 10 patients (36%), complete wound dehiscence in 1, and recurrence in 1 (idiopathic terminal ileal volvulus). The mortality was 21%, mostly from overwhelming infection (2 neonates, 11-year-old, 3 >/= 5 years). Intestinal volvulus in our environment differs in aetiology from other reports. The resection rates are similar, however. This condition carries high morbidity and mortality.
Ameh
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Paediatric Surgery Unit, Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Nmadu
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D015746:Abdominal Pain; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever; D013271:Gastric Dilatation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D007422:Intestines / Q000002:abnormalities / Q000601:surgery; D008297:Male; D009017:Morbidity; D009549:Nigeria / Q000453:epidemiology; D015996:Survival Rate; D014839:Vomiting