Adhesive Intestinal Obstruction in Children: A 10-Year Experience in a Teaching Hospital in Enugu, Nigeria

Abstract

Background: Following an injury, the peritoneum tries to repair itself through biochemical and cellular responses. These responses result in the formation of adhesions that may cause bowel obstruction. Methodology: This was a retrospective review of children who presented, to our pediatric surgery unit, with adhesive intestinal obstruction (AIO) between January 2008 and December 2017. The patients were reviewed for age at diagnosis of AIO, gender, age at initial surgery, time interval from the initial surgery to the development of AIO, type of initial surgery, duration of symptoms before presentation, treatment and outcome. Result: Thirty four children were admitted with AIO. There were 24 males and 10 females with 36 episodes of bowel obstructions. The mean age of the patients at diagnosis of AIO was 81.5 months (range: 12 - 168) whereas the mean age of the patients at initial surgery was 59.7 months (range: 1 - 144). The mean interval between the initial surgery and onset of AIO was 23.2 months (range: 11-48). Majority of the patients (44.1%) developed AIO within 12 months after their initial surgery. Laparotomy for typhoid intestinal perforation was the most common initial procedure that led to AIO. Non-operative treatment was successful in twenty three patients (67.6%) while ten patients (29.5%) had surgery. One patient (2.9%) was discharged against medical advice. There was no mortality. Conclusion: AIO is uncommon in children. In this series, laparotomy for typhoid intestinal obstruction was the most common operation leading to AIO. Non-operative treatment was effective in two-third of our patients.