Bowel resection in children.

BACKGROUND

In developed countries, most bowel resections in children are for congenital anomalies and massive resection and short bowel syndrome are frequent problems.

OBJECTIVE

To review indications, morbidity and mortality of bowel resection in children in a developing country.

DESIGN

A retrospective study.

SETTING

Ahmadu Bello University Teaching Hospital Zaria, Nigeria.

SUBJECTS: Forty six children aged < or = 12 years who had bowel resection in a period of five years.

RESULTS

The commonest indication was typhoid perforation 25 (54%), 21 (84%) of them aged > 5 years. Intussusception was the indication in eight (17%), six less than one year. Bowel resection was performed for congenital anomalies in nine (18%) patients, seven of them < 1 month (abdominal wall defect in four, intestinal atresia in two, strangulating inguinal hernia in one, strangulating band in one, Meckel's diverticulitis, one). Resection for trauma and neoplastic conditions were few (2.4% each). Twelve patients (26%) developed 17 complications including would infection in seven (15%) anastomotic dehiscence, five (11%), abdominal wound dehiscence, three (14%), intra-abdominal abscess and stitch sinus, one (2%) each respectively. Most of the complications followed right hemicolectomy for intussusception and resection for typhoid perforation. Massive bowel resection was necessary in only one patient. There were nine deaths (20%). The mortality was highest in neonates and infants (38%).

CONCLUSION

The indications for bowel resection in this environment differ from that in developed countries. Most of the indications (74%) are preventable by improvements in sanitation and early presentation and treatment. The morbidity and mortality are highest in neonates and infants and meticulous attention to technical details may minimise them.