African Journal of Paediatric Surgery About APSON | PAPSA  
Home About us Editorial Board Current issue Search Archives Ahead Of Print Subscribe Instructions Submission Contact Login 
Users Online: 2027Print this page  Email this page Bookmark this page Small font size Default font size Increase font size 
 
 


 
ORIGINAL ARTICLE Table of Contents   
Year : 2009  |  Volume : 6  |  Issue : 2  |  Page : 85-87
Bowel resection in Nigerian children


Department of Surgery, Paediatric Surgery Unit, University of Ilorin Teaching Hospital, Ilorin, Nigeria

Click here for correspondence address and email

Date of Web Publication29-Jul-2009
 

   Abstract 

Background : Although bowel resections are commonly done for congenital malformations in children in developed countries, they usually follow neglected and preventable acquired diseases of the intestine in developing countries. Objectives : To determine the indications and outcome of bowel resections in children of a developing country in a university teaching hospital. Materials and Methods: Data of the patients operated (from birth to 15 years) was retrospectively collected over eight years (January 1999 to December 2006). The biodata of children included the following: Indications for operation, type of operations, duration of admission, and outcome of treatment including complications. Patients with Hirschsprung's disease were excluded from the study because bowel resection forms part of their definitive surgical management. Results : There were 70 patients (38 boys and 32 girls). The age ranged between four hours to 15 years (median, five months). There were 16 (22.9%) neonates, 26 (37.1%) infants, and 28 (40%) grown children. The indications were congenital anomalies in the 16 neonates. Also, 23 (88.5%) infants had intussusception, 2 (7.7%) had midgut vovulusm and 1 (3.8%) had congenital small intestine band. Among the grown children, typhoid ileal perforation (TIP) was seen in 14 (50.0%), intussusception in 5 (17.9%), and other causes in nine patients. Overall, intussusception was the most common indication for bowel resection, followed by TIP. A total of 24 patients developed 33 complications. Complications included wound infection in 47.8% and anastomotic leak in 42.8%. The duration of admission ranged between 4-35 days (median, 15 days). The overall mortality was 17.1% -; which was highest among neonates (56.3%), followed by the infants (26.9% -). Conclusion : Bowel resections are mainly done for intussusception and complications of TIP at our centre. Late presentation, preexisting malnutrition, and nonavailability of parenteral nutrition contributed to unacceptable morbidity and mortality.

Keywords: Atresia, intestinal resection, intussusception, typhoid

How to cite this article:
Abdur-Rahman L O, Adeniran J O, Taiwo J O, Nasir A A, Odi T. Bowel resection in Nigerian children. Afr J Paediatr Surg 2009;6:85-7

How to cite this URL:
Abdur-Rahman L O, Adeniran J O, Taiwo J O, Nasir A A, Odi T. Bowel resection in Nigerian children. Afr J Paediatr Surg [serial online] 2009 [cited 2020 Apr 9];6:85-7. Available from: http://www.afrjpaedsurg.org/text.asp?2009/6/2/85/54769

   Introduction Top


The need for bowel resection in children in developed countries is commonly indicated for congenital anomalies of the intestinal tract. The outcome is usually good because of availability of supportive measures even in critically ill children. [1],[2] However, in developing countries bowel is usually resected following preventable conditions of the intestinal tract, [3] and these may be accompanied by high morbidity and mortality. [4] These patients often present late with septicaemia, and facilities for intensive supportive therapy such as ventilation, parenteral feeding, and appropriate antibiotics may not be readily available. We review the pattern and outcome of children who had bowel resection at our centre to highlight the challenges faced during their care.


   Materials and Methods Top


This study was conducted by a retrospective collection of data over eight years (January 1999-December 2006) using the paediatric surgery unit register and operating theatre records. Children aged from birth to 15 years were included in the study. From the biodata of children following information was extracted: Indications for operations, types of operation, duration of admission, outcome of treatment, and complications. Patients with Hirschsprung's disease were excluded from the study because bowel resection in them was part of the definitive surgical management.


   Results Top


There were 70 children (38 boys and 32 girls), between the age group of four hours to 15 years (median, five months). There were 16 (22.9%) neonates, 26 (37.1%) infants, and 28 (40%) grown children. The indications for resection in neonates were: Intestinal atresia 13 (81.3%); 1(14.3%) case each of mesenteric cyst, midgut vovulus, and enterocutaneous fistula in an omphalocele [Figure 1]. A total of 23 (88.5%) infants had intussusception, 2 (7.7%) had midgut vovulus, and 1 (3.8%) had congenital small intestine band. Among grown - children, typhoid ileal perforation (TIP) was seen in 14 (50%) patients, intussusception in 5 (17.9%), omphalomesenteric band and mesenteric cyst in 2 (12.5%) patients each [Table 1]. Traumatic small bowel perforation, strangulated umbilical, and inguinoscrotal hernia occurred in 1 (3.6%) patient each. Overall, intussusception was the most common indication for bowel resection [28 (40%) patients] followed by TIP [14 (20%)] [Figure 2]. The bowel resection types were right hemicolectomy in 35 (50%) patients, segmental small bowel resection in 27 (38.6%) patients (with length varying between 3 and 74 cm (median = 12cm). Also, 24 patients developed 33 complications, which occurred mostly among infants. Wound infection occurred in 47.8% and anastomotic leak in 42.8% mainly from peritoneal contamination or frank infection. Four anastomotic leaks (three TIP, one intussusception) had relaparotomy, resection, and anastomosis, while, 2 intussusception anastomotic leaks were managed conservatively. A second leak in two TIPs was managed by ileostomy and both did well. The duration of admission ranged between 4-35 days (median, 15 days). The overall mortality was 17.1%, which was the highest among neonates - (56.3%), followed by infants - (26.9%).


   Discussion Top


The most common indication for bowel resection in this series was intussusception, which incidentally accounted for the most common cause of intestinal obstruction in infants at our centre. [5],[6] These patients had right hemicolectomy indicated by gangrene, perforation or irreducibility of the involved bowel (usually ileocolic) from late presentation and a few with lead points. The bowel resection rate for intussusception at our centre is approximately 48.9%, [5] which is comparable with reports from other centres in developing countries. [7],[8] These patients would need long-term follow-up to ascertain possible derangement of bile metabolism because of the resected terminal ileum segment.

TIP accounted for the second most common cause of bowel resection, most are single perforations managed by trimming of ulcer edges and two-layer closure. [9],[10],[11] Most cases in the Zaria series were, however, managed by segmental resection of the bowel, [12],[13] with equally satisfactory results. Almost half of these patients had wound infection usually from contamination after peritoneal soilage in typhoid perforation. Anastomotic leakage was due to bowel anatomosis in the presence of infection, bowel edema and malnutrition. Parenteral nutrition, if readily available in our unit is presumed to have aided in wound healing and prevention of anastomotic leak. We have recently managed these patients with temporary ileostomy to allow early enteral feeding and control the peritoneal sepsis before reanastomosis. [14]

Intestinal atresia was the most common indication for bowel resection in neonates in our study unlike in developed countries [15],[16] where- measures have been taken to minimise the morbidity seen in gastroschisis to reduce the need for bowel resection. [17] In Zaria, incarcerated and strangulated inguinal hernias in children also account for a high proportion of bowel resection. [18]

The overall mortality rate in our series is 17.1%. It is relatively lower than what is reported in other series. [3],[4] All patients with intussusception had operative intervention, not only because they presented late, but also because there were no facilities for air or barium enema reduction. The mortality in typhoid patients is due to the late presentation, and the fact that typhoid, being a pan-systemic disease, also affects other vital organs especially the heart, lungs, and kidneys. Adequate preoperative resuscitation, stabilisation, and meticulous surgical technique will reduce morbidity in these children. Mortality is high in the neonates because of lack of facilities for intensive neonatal care.

In conclusion bowel resection is done in our unit for bowel atresias in neonates, intussusception in infants, and typhoid ileal perforation in the grown children. Early diagnosis at peripheral hospitals, prompt resuscitation, and good surgical technique and provision of facilities for intensive care are needed to reduce morbidity and mortality.

 
   References Top

1.Matsuo Y, Kubota A, Imura K, Kamata S, Takagi Y, Okada A, et al . Long term prognosis after massive small bowel resection in children. Nippon Geka Gakkai Zasshi 1988;89:1406-9.  Back to cited text no. 1  [PUBMED]  
2.Rao PL, Shame AK, Yadav K, Mitra SK, Pathak IC. Acute intestinal obstruction in children as seen in Northwest India. Indian Pediatr 1978; 4:1017-23.  Back to cited text no. 2    
3.Nmadu PT. Preventable causes of bowel resection in Zaria, Nigeria: A report of 93 cases. East Afr Med J 1994;71:290-1.   Back to cited text no. 3  [PUBMED]  
4.Ameh EA. Bowel Resection in Children. East Afr Med J 2001;78:477- 9.  Back to cited text no. 4  [PUBMED]  
5.Abdur-Rahman LO, Yusuf AS, Adeniran JO, Taiwo JO. Childhood Intussusception in Ilorin; A revisit. Afr J Pediatr Surg 2005;2:4-7.  Back to cited text no. 5    
6.Abdur-Rahman LO. Pattern of Surgical Abdominal Emergencies in Children: University of Ilorin Teaching Hospital Experience. Dissertation submitted to the National Postgraduate Medical College for Award of Fellowship in Surgery. 2005.  Back to cited text no. 6    
7.Keita M, Barry OT, Doumbouya N, et al . Acute Intussusception: Aspects of Epidemiology, Clinical Features and Management at Children's Hospital, Donka, Guinea Conakry. Afr J Pediatr Surg 2006;3:1-3.  Back to cited text no. 7    
8.Workshop on Intussusception in Africa - African Rotavirus Network. Pan-African Paediatric Surgeons Association (PAPSA) conference, Malawi. Editorial, East Afr J Med 2004.  Back to cited text no. 8    
9.Rahman GA, Abubakar AM, Johnson AW, Adeniran JO. Typhoid ileal perforation in Nigerian Children: An analysis of 106 operative cases. Paediatr Surg Int 2001;17:628-30.  Back to cited text no. 9    
10.Irabor DO. Fifteen years of typhoid perforation in children in Ibadan: Still a milestone around the surgeon's neck. Nig J Surg Research 2003;5:92-8.  Back to cited text no. 10    
11.Uba AF, Chirdan LB, Ituen AM, Mohammed AM. Typhoid intestinal perforation in children: A continuing scourge in a developing country. Pediatr Surg Int 2007;23:33-9.  Back to cited text no. 11  [PUBMED]  [FULLTEXT]
12.Ameh EA Typhoid Ileal Perforation in children, a scourge in developing countries. Ann Trop Paediatr 1999;19:267-72.  Back to cited text no. 12    
13.Ameh EA, Dogo Pm, Attah MM, Nmadu PT. Comparison of 3 Operation for typhoid Perforation. Br J Surg 1997;84:558-9.  Back to cited text no. 13  [PUBMED]  
14.Adeniran JO, Taiwo JO, Abdur-Rahman LO. Salmonella intestinal perforation: (27 perforation in one patient, 14 perforations in another). Are the goal post changing? J Ind Assoc Pediatr Surg 2005;10:248-51.  Back to cited text no. 14    
15.Kosloske AM. The epidemiology and pathophysiology of necrotizing enterocolitis. Semin Neonatol 1997;2:231-8.  Back to cited text no. 15    
16.Tam PK. Necrotizing enterocolitis- surgical management. Semin Neonatol 1997;2:297-305.  Back to cited text no. 16    
17.Peiro JL, Guindos S, Lloret J, Marhuenda C, Torαn N, Castillo F, et al . New surgical strategy in gastroschisis: Treatment simplification according to its pathophysiology. Cir Pediatr 2005;18:182-7.  Back to cited text no. 17    
18.Ameh EA. Incarcerated and strangulated inguinal hernias in children in Zaria, Nigeria. East Afr Med J 1999;76:499-501.  Back to cited text no. 18  [PUBMED]  

Top
Correspondence Address:
L O Abdur-Rahman
Department of Surgery, Paediatric Surgery Unit, University of Ilorin Teaching Hospital, Ilorin, Kwara State
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-6725.54769

Rights and Permissions


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]

This article has been cited by
1 Challenges of management and outcome of neonatal surgery in Africa: a systematic review
Sebastian O. Ekenze,Obinna V. Ajuzieogu,Benedict C. Nwomeh
Pediatric Surgery International. 2016; 32(3): 291
[Pubmed] | [DOI]
2 Preparing for Safety Monitoring After Rotavirus Vaccine Implementation
Edouard Ngendahayo,Alex Bonane,Georges Ntakiyiruta,Aline Munyanshongore,Narcisse Muganga,Joel Bikoroti,Jason M. Mwenda,Jacqueline E. Tate,Fidele Ngabo
The Pediatric Infectious Disease Journal. 2014; 33: S99
[Pubmed] | [DOI]
3 Role of damage control enterostomy in management of children with peritonitis from acute intestinal disease
Ameh, E.A., Ayeni, M.A., Kache, S.A., Mshelbwala, P.M.
African Journal of Paediatric Surgery. 2013;
[Pubmed]
4 Exploratory laparotomy for acute intestinal conditions in children: A review of 10 years of experience with 334 cases
Ghritlaharey, R.K., Budhwani, K.S., Shrivastava, D.K.
African Journal of Paediatric Surgery. 2011; 8(1): 62-69
[Pubmed]



 

Top
 
 
  Search
 
 
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed3429    
    Printed187    
    Emailed0    
    PDF Downloaded464    
    Comments [Add]    
    Cited by others 4    

Recommend this journal