title: Exploratory laparotomy for acute intestinal conditions in children: a review of 10 years of experience with 334 cases.
abstract: OBJECTIVE
  The aim of this study was to review 10 years of experience in the management of children with acute intestinal conditions requiring exploratory laparotomy.
  
  
  METHODS
  This retrospective study included 334 children (244 boys and 90 girls) who underwent laparotomy for acute intestinal conditions between Jan 1, 2000 to Dec 31, 2009. Patients were grouped into two categories: group A (n = 44) included patients who needed laparotomy with terminal ileostomy and group B (n = 290) included patients who needed laparotomy without terminal ileostomy. We excluded neonates and patients with jejunoileal and colonic atresias, anorectal malformations, congenital pouch colon, neonatal necrotising enterocolitis, Hirschsprung's disease, appendicitis, abdominal trauma and gastrointestinal tumours.
  
  
  RESULTS
  During the last 10 years, 334 laparotomies were performed in children under 12 years: 59.88% for intestinal obstruction and 40.11% for perforation peritonitis. Causes in order of frequency were: ileal perforations 34.13%; intussusceptions 26.34%; Meckel's obstruction 10.17%; congenital bands and malrotation 6.88%; postoperative adhesions 5.98%; miscellaneous peritonitis 5.68%; miscellaneous intestinal obstructions 4.79%; abdominal tuberculosis 4.19% and roundworm intestinal obstruction 1.79%. Ileostomy closures (n = 39) was tolerated well by all except one. The mortalities were 28 (8.38%) in group B and 6 (1.79%) in group A.
  
  
  CONCLUSIONS
  The need for re-exploration not only increases the morbidity but also increases mortality as well. Diverting temporary ileostomy adds little cumulative morbidity to the primary operation and is a safe option for diversion in selected cases. The best way to further reduce the mortality is to create ileostomy at first operation.
authors.affiliation: Department of Paediatric Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh - 462 001, India. drrajendrak1@rediffmail.com
authors.forename: Rajendra K
authors.initials: RK
authors.lastname: Ghritlaharey
authors.forename: K S
authors.initials: KS
authors.lastname: Budhwani
authors.forename: Dhirendra K
authors.initials: DK
authors.lastname: Shrivastava
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007081:Ileostomy; D007223:Infant; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D007416:Intestinal Perforation / Q000175:diagnosis / Q000601:surgery*; D007813:Laparotomy / Q000379:methods*; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D010538:Peritonitis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D017678:Sex Distribution; D016896:Treatment Outcome