Adhesion intestinal obstruction in children in northern Nigeria.
In developing countries, reports on adhesion intestinal obstruction in children are scanty. We report 30 children managed for adhesion intestinal obstruction during a 16-year period. The age range was 10 weeks-14 years (median 9 years). There were 24 boys and 6 girls. Postoperative adhesion was the cause in 13 (43%) patients, inflammatory in 11 (37%), and in 5 (17%) no cause could be identified. In one patient, adhesion followed missed ileal perforation from blunt abdominal trauma. Duration of symptoms was 1-21 days (median 4 days). Only four of the 13 patients with postoperative adhesion obstruction were managed conservatively initially, but this failed in all; one was found to have an intestinal perforation at laparotomy. The remaining nine had immediate laparotomy owing to presence of features of strangulation at presentation; two required intestinal resection for gangrene. All other patients had laparotomy soon after resuscitation. The resection rate for gangrene was 13% and 3% required closure of perforations. Postoperatively six (20%) patients developed eight infective complications. There was recurrence in three of 27 (11%) surviving patients within 3 months. Mortality was three (10%). The presentation of adhesion intestinal obstruction in children in northern Nigeria is late and morbidity and mortality are high. Early presentation should improve the outcome.
Ameh
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Paediatric Surgery Unit, Department of Surgery, Ahmadu Bello UniversityTeaching Hospital, Zaria, Nigeria. ssrs.njsr@skannet.com
Nmadu
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D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007415:Intestinal Obstruction / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008297:Male; D008499:Medical Records; D009549:Nigeria / Q000453:epidemiology; D011183:Postoperative Complications; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery