Factors affecting outcome of emergency paediatric abdominal surgery

Background: Paediatric surgical abdominal emergencies are important causes of morbidity and mortality in children. None of the previous studies on abdominal surgical emergencies specifically addressed the problem as it affects children. Methods: An eight-year retrospective review of all children aged 0 – 15 years who presented with acute abdominal emergency. Results: Two-hundred and fifty one (251) children, male to female ratio of 1.5:1 and median age of presentation of 78 months (range 1 day – 15 years). The median duration of symptoms before presentation to hospital was 96 hours. The median duration between admission and surgical intervention was 24 hours. Intestinal obstruction accounted for 87 (34.7%) of acute abdominal emergency. This was the commonest emergency encountered overall. Typhoid perforation (TP) was responsible for 71 (28.3%) of all acute abdominal emergencies and was the commonest condition encountered in children above the age of one year. Others included 55 (21.9%) cases of appendicitis, 18 (7.2%) of abdominal trauma, 6 (2.4%) anterior abdominal wall defects and 5 (2.0%) each of infantile hypertrophic pyloric stenosis and primary peritonitis. Postoperative complications were observed in 85 (33.9%) of patients. The commonest complications were wound infection 31 (12.4%) and wound dehiscence 23 (9.2%), while mortality rate was 16% overall, and 31.8% in the neonatal period. Overwhelming sepsis was responsible for 26 (63.4%) of all deaths recorded. Multiple congenital anomalies were the cause of death in 5 (12.2%). Other causes of death were prolonged ileus with malnutrition in 4 patients, respiratory insufficiency in 2 patients and a patient each died from necrotising enterocolitis, acute renal failure, enterocutaneous fistula and over hydration. Conclusion: intestinal obstruction was the commonest acute abdominal emergency in children. The high rates of postoperative morbidity observed could be attributed to delayed presentation to hospital. Key Words: Paediatric, emergency, abdominal surgery, outcome Nigerian Journal of Surgical Research Vol.5(1&2) 2003: 85-9