Intestinal Resection in Children: Our Experience in Enugu, Nigeria

Abstract

Background: Intestinal resection in children is an important surgical procedure because of the possible complications that may arise from it. Late presentation and ignorance in developing countries have made intestinal resection a frequent surgical procedure.

Methods: This was a retrospective study of children that had intestinal resection in the pediatric surgery unit of Enugu State University Teaching Hospital, Enugu, Nigeria. The medical records of the pediatric patients that underwent intestinal resection over a 10-year period were evaluated for the indications that prompted the surgery. The other parameters that were assessed included the patients’ demographics, the duration of symptoms before presentation, the time interval between presentation and intervention, the complications arising from the intestinal resection, and the outcome.

Results: There were 52 cases of intestinal resection with an age range of 1–168 months (median 10 months) and a male to female ratio of 2.25:1. There were 9 neonates (less than one month of age), 29 infants (greater than one month but less than one year of age) and 14 children (older than 1 year of age). The following were the indications for intestinal resection: gangrenous/irreducible intussusception (28 or 53.8%), strangulated external hernia (7 or 13.5%), typhoid intestinal perforation (6 or 11.5%), intestinal atresia (3 or 5.8%), gastroschisis (3 or 5.8%), midgut volvulus (3 or 5.8%), and abdominal trauma (2 or 3.8%). The following definitive surgical procedures were performed: right hemicolectomy with ileotransverse anastomosis (28 or 53.8%), segmental resection with end-to-end anastomosis (20 or 38.5%), and massive intestinal resection with end-to-end anastomosis (4 or 7.7%). The median duration of symptoms prior to presentation and the median duration from presentation to surgery were 3 days and 2 days, respectively. The mean duration of hospital stay was 15 days. Twenty patients (38.4%) developed complications, which included surgical site infection (8 or 15.4%), enterocutanous fistula (6 or 11.5%), intra-peritoneal abscess (4 or 7.7%), and adhesive intestinal obstruction (2 or 3.8%). There were 8 deaths, which accounted for 15.4% of the patients.

Conclusion: Intestinal resection was performed most often for intussusception. Late presentation and ignorance contributed significantly to the number of intestinal resections required.
 
Keywords: Children; intestinal resection; experience; intussusception; hernia