title: The Spectrum of Paediatric Intestinal Obstruction in Kenya.
abstract: BACKGROUND
  Intestinal obstruction (IO) occurs when there is impedance to the flow of intestinal contents due to a congenital or acquired pathology, and is a common paediatric surgical emergency. This study aimed to assess the pattern and outcome of paediatric IO in western Kenya.
  
  
  METHODS
  A retrospective review of all recorded cases of mechanical IO in patients aged 15 years or below admitted at Tenwek Hospital between January 2009 and December 2013.
  
  
  RESULTS
  The cohort included a total of 217 children (130 boys and 87 girls). The mean age was 6.7 years (range: newborn-15 years), with most (65, 30%) cases aged 1-3 years. Vomiting (161, 74.2%), abdominal pain (152, 70%), abdominal tenderness (113, 52.1%), constipation (111, 51.2%), and abdominal distension (104, 47.9%) were the predominant signs and symptoms. The most common causes of IO were ascariasis (96, 44.2%), adhesions (34, 15.7%), and intussusception (30, 13.8%). Intussusception was the leading cause of IO in children aged ≤ 1 year, ascariasis in children aged 1-5 and 6-10 years, and adhesions in children aged 11-15 years. Operative management was undertaken in 120 (55.3%) cases with 39 (32.5%) of these having gangrenous bowel. The overall mortality rate was 5%.
  
  
  CONCLUSIONS
  The most common causes of mechanical bowel obstruction in this series were ascariasis, adhesions, and intussusception. Ascariasis remains a significant cause of paediatric IO in this region, thus public education, improved sanitation and deworming campaigns may be helpful in reducing the worm burden.
authors.affiliation: Department of Surgery, Tenwek Hospital, Bomet, Kenya.
authors.forename: Philip Blasto
authors.initials: PB
authors.lastname: Ooko
authors.affiliation: Department of Surgery, Tenwek Hospital, Bomet, Kenya.
authors.forename: Patricia
authors.initials: P
authors.lastname: Wambua
authors.affiliation: Department of Surgery, Tenwek Hospital, Bomet, Kenya.
authors.forename: Mark
authors.initials: M
authors.lastname: Oloo
authors.affiliation: Department of Surgery, Tenwek Hospital, Bomet, Kenya.
authors.forename: Agneta
authors.initials: A
authors.lastname: Odera
authors.affiliation: Department of Surgery, Tenwek Hospital, Bomet, Kenya.
authors.forename: Hillary Mariko
authors.initials: HM
authors.lastname: Topazian
authors.affiliation: Department of Surgery, Tenwek Hospital, Bomet, Kenya.
authors.forename: Russell
authors.initials: R
authors.lastname: White
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000367:Age Factors; D001196:Ascariasis / Q000150:complications* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D007443:Intussusception / Q000150:complications* / Q000453:epidemiology; D007630:Kenya / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000150:complications* / Q000453:epidemiology
keywords: Intestinal obstruction; Kenya; ascariasis; children; intussusception