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ORIGINAL ARTICLE Table of Contents   
Year : 2008  |  Volume : 5  |  Issue : 2  |  Page : 61-64
Acute gastrointestinal emergencies requiring surgery in children


1 Department of Surgery, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, India
2 Department of Surgery, Indra Gandhi Medical College, Nagpur - 4420013, India

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   Abstract 

Background: Although abdominal pain is common in the paediatric age group, problems of misdiagnosis and serious consequences are more particular in an emergency setting. This study examined the aetiologies of acute abdominal emergencies in children. Materials and Methods: This was a retrospective study of 100 children below the age of 12 years presenting with acute abdominal emergencies (gastrointestinal) requiring operative interventions. All patients were operated on an emergency basis and the intraoperative findings were correlated with the clinical findings. Results: Acute abdominal emergencies in the paediatric age group were heterogenous, with a myriad of aetiological factors. Overall, 73% of patients were greater than 3 years of age. Early neonatal period formed the second most common group (12%). Acute appendicitis was the most common cause except in the infancy period where congenital abnormalities predominated. Conclusion: The correct diagnosis of acute abdomen in children requires attention to clinical details and a high degree of suspicion. Early surgical intervention in doubtful cases may be necessary to solve diagnostic problems.

Keywords: Abdominal emergencies, aetiology, children

How to cite this article:
Pujari AA, Methi R N, Khare N. Acute gastrointestinal emergencies requiring surgery in children. Afr J Paediatr Surg 2008;5:61-4

How to cite this URL:
Pujari AA, Methi R N, Khare N. Acute gastrointestinal emergencies requiring surgery in children. Afr J Paediatr Surg [serial online] 2008 [cited 2019 Jun 25];5:61-4. Available from: http://www.afrjpaedsurg.org/text.asp?2008/5/2/61/44177

   Introduction Top


Abdominal pain in infancy and childhood is always a source of anxiety to the family doctor and parents. The very young patient may not be able to give any history, and when they do, the history may be unreliable. Problems of misdiagnosis and serious consequences are, therefore, more common in the paediatric age group, particularly in abdominal emergency.

The paediatric age group constitutes a precious 30-40% of the total population in many countries. [1] There are a few specialized centers in most developing countries that cater to this precious group. Most of them are located in metropolitan cities far from the reach of the rural masses. Because delay in surgical intervention is an important determinant of successful outcome, early diagnosis and treatment is important. The purpose of this study was to examine the aetiologies of acute abdominal emergencies in children for which surgical intervention is required.


   Materials and Methods Top


The present study was carried out at the Department of Surgery, Indira Gandhi Government Medical College and Hospital, Nagpur, from June 2004 to December 2006. One hundred children below the age of 12 years who presented in OPD/CASUALTY with acute abdominal emergencies requiring operative interventions were studied. Acute abdominal emergencies, which were managed nonoperatively, and children operated for causes other than gastrointestinal origin were excluded. Similarly, children with abdominal trauma and children who were previously operated were also excluded.

Data regarding patient's biodata, resuscitation, history, laboratory and radiological investigations, surgery and intraoperative findings were collected on standard protocol and analysed using SPSS software (Microsoft Inc.).


   Results Top


There were 100 children, 69 (69%) were males and 31 (31%) were females (M:F=2.22:1). Mean age of presentation was 7.09 years. Seventy-three (73%) patients were greater than 3 years of age. Early neonatal period formed the second most common group (12%) [Table 1],[Table 2].

The different aetiological factors of acute abdominal emergencies in children are summarised in [Table 2]. The largest group in this study was acute appendicitis (58%). It was followed by intestinal obstruction (32%). Perforation peritonitis accounted for 7% of the cases. Other causes were primary peritonitis (2%), gastric volvulus (1%) and necrotising enterocolitis without perforation (1%). One patient had features of intestinal obstruction due to Meckel's diverticulum, having band and intraoperative finding of inflammed appendix.

Majority of the acute appendicitis (46.55%) occurred in the age group of 10-12 years. The most common symptom of acute appendicitis was abdominal pain and the most common sign was tenderness at McBurney's point. The rate of appendicular perforation was 13.79%. In the neonatal age group, necrotising enterocolitis was one of the most common causes of neonatal perforation peritonitis. There were two cases of primary peritonitis. Both were below 5 years of age. The morbidity and mortality rates are presented in [Table 3].


   Discussion Top


Majority of the patients (50%) presented in less than 1 year of age. In the study of Belokar et al. , [2] 33.4% of the patients were below the age of 1 year. In both these series, incidence decreased with age.

Males were more commonly affected than females except in abdominal tuberculosis, which showed slight female preponderance. It is possible that the apparent male preponderance could be due to a higher rate of referral of the male child than the female child to the tertiary health centers.

The pattern and incidence of aetiologies of acute abdominal emergencies in children in the present study compared well with previous reports [Table 4],[Table 5],[Table 6]. [3],[4],[5]

The predominance of acute appendicitis in the present report agrees with the reports by Louw, [3] Jones, [4] Simpson et al. [6] and Mabiela-Babela et al . [5]

Similarly, intussusception was the most common aetiology for intestinal obstruction, accounting for 7% cases of acute abdominal emergencies in this study. Similar findings were reported by previous authors. [2],[3],[5],[7],[8],[9],[10],[11],[12]

Anorectal malformation was another predominant aetiology of intestinal obstruction in the present study. In a study by Sran et al. , [10] imperforate anus was the most common cause of intestinal obstruction in the paediatric age group. Moreover, it was the most common aetiology of intestinal obstruction in infancy, in the present study, accounting for 43.75% of the cases. Similar results were obtained by Belokar et al . [2]

The relative decrease in the incidence of ascariasis in the present series (3.13%) as compared with Dayalan et al. 's [7] study (20.7%) may be due to early deworming of children by paediatricians. Hence, the number of patients with surgical complications of intestinal worms has decreased.

There were seven cases of abdominal tuberculosis, with slight female preponderance and mostly in the age group of 5-12 years in this study, similar to the study by Agrawal et al . [13] The most common presentation of abdominal tuberculosis was that of intestinal obstruction, with 42.86% patients developing postoperative complications and hypoproteinemia. A higher incidence of tuberculosis of the abdomen may be the reemerging problem of tuberculosis associated with immunodeficiency and low socioeconomic status.

The most common cause of mortality was septicaemia. Peritonitis substantially increases the mortality rate. Perforation of the intestine is usually a culminating event in many pathologies and this further underlines the need to make an early diagnosis and treatment. Prompt diagnosis of relatively milder disorders like appendicitis serves to further decrease this abdominal catastrophe.

We conclude that acute appendicitis and intestinal obstruction are the most common causes of acute abdominal emergencies in children. Specially, in the postinfancy period, appendicitis is the predominant aetiology while intestinal obstruction due to congenital causes tends to predominate in the neonatal and the infancy period. Early admission and surgery may solve diagnostic problems. Morbidity and mortality rates associated with acute abdominal emergencies can be reduced by early diagnosis, timely intervention and proper care.

 
   References Top

1.National Family Health Survey NFHS 2 India 1998-1999.   Back to cited text no. 1    
2.Belokar WL, Subramanyam M, Anant KS, Ingole, Kolte R. Pediatric acute intestinal obstruction in central India. Indian J Paediatr 1978;45:201-6.  Back to cited text no. 2    
3.Louw JH. Abdominal complications of Ascariasis Lumbricoids infestation in children. Br J Surg 1966;53:510-21.  Back to cited text no. 3  [PUBMED]  
4.Jones PF. The acute abdomen in infancy and childhood. Practitioner 1979;222:473-8.  Back to cited text no. 4  [PUBMED]  
5.Mabiala-Babela JR, Pandzou N, Koutaba E, Ganga-Zandzou S, Senga P. Retrospective study of visceral surgical emergencies in children at University Hospital Center of Brazzaville (Congo). Med Trop (Mars) 2006;66:172-6.  Back to cited text no. 5  [PUBMED]  
6.Simpson ET, Smith A. The management of acute abdominal pain in children. J Pediatr Child Health 1996;32:110-2.  Back to cited text no. 6    
7.Dayalan N, Ramkrishnan MS. The pattern of intestinal obstruction with special preference to Ascariasis. Indian Pediatr 1976;13:47-9.  Back to cited text no. 7    
8.Adejuyigbe O, Fashakin EO. Acute intestinal obstruction in Nigerian children. Trop Gastroenterol 1989;10:33-40.  Back to cited text no. 8  [PUBMED]  
9.Olumide F, Adedeji A. Intestinal obstruction in Nigerian children. J Pediatr Surg 1976;11:195-6.  Back to cited text no. 9    
10.Sran HS, Dandia SD, Pendse AK. Acute intestinal obstruction - review of 504 cases. JIMA 1973;60:455-60.  Back to cited text no. 10  [PUBMED]  
11.Al-Bassam AA, Orfale N. Intussusception in infants and children: A review of 60 cases. Ann Saudi Med 1995;15:205-8.  Back to cited text no. 11    
12.Skipper RP, Boeckman CR, Klein RL. Childhood intussusception. Surg Gynecol Obstet 1990;171:151-3.  Back to cited text no. 12  [PUBMED]  
13.Agrawal P, Malsure. Surgical treatment for abdominal tuberculosis- review of 50 cases. Bombay Hospital J 1999;41:3-4.  Back to cited text no. 13    

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Correspondence Address:
Amit A Pujari
Department of Surgery, Laxminagar, Behind Rest House, Wardha - 442001, Maharashtra state
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-6725.44177

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]

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