Abstract
IntroductionIntestinal 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.MethodsA 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.ResultsThe 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%.ConclusionThe 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.
Highlights
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
Operative management was undertaken in 120 (55.3%) where bowel gangrene was noted in 39 cases, with the majority (18, 46.2%) being secondary to intussusception (Table 3)
Adhesive bowel disease was the predominant cause of IO in children between the ages of 11 and 15 years and the second most common cause of IO in those between the ages of 6 and 10 years
Summary
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. Conclusion: The most common causes of mechanical bowel obstruction in this series were ascariasis, adhesions, and intussusception. Intestinal obstruction (IO) occurs when there is impedance to the flow of intestinal contents due to a congenital or acquired pathology It is a common paediatric surgical emergency and can be associated with significant mortality, especially when associated with bowel gangrene [1,2,3]. The pattern of IO in children in the tropics, Kenya included, is buried within the wider spectrum of IO people of all ages [2]. This study was conducted to ascertain the etiology, presentation, management, and outcomes of IO in children in the region and to compare these findings with those of other studies
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