Peritonitis in Children: Experience in a Tertiary Hospital in Enugu, Nigeria
Abstract
Background: Peritonitis may be associated with significant morbidity and mortality. The aim of this study was to evaluate our experience with the management of secondary peritonitis in children.
Methods: This was a retrospective study of children who had undergone laparotomy for peritonitis in the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH) in Enugu, Nigeria over a five-year period.
Results: There were 52 cases of laparotomies for peritonitis, with an age range of two weeks to 14 years (median: nine years) and a male to female ratio of 3.3:1. The etiologies of peritonitis were typhoid intestinal perforation in 25 cases (48%), ruptured appendix in nine cases (17.3%), perforated intussusception in eight cases (15.4%), perforated external hernia in three cases (5.8%), perforation due to adhesive intestinal obstruction in three cases (5.8%), perforated necrotizing enterocolitis in three cases (5.8%), and bowel perforation due to trauma in one case (1.9%). The following definitive surgical procedures were performed: closure of bowel perforation in 26 cases (50%), appendectomy plus abscess drainage in nine cases (17.3%), right hemicolectomy with ileotransverse anastomosis in eight cases (15.4%), segmental bowel resection in six cases (11.5%), and insertion of peritoneal drains in three cases (5.8%). The median duration of symptoms prior to presentation and the median duration from presentation to surgery were four days and two days, respectively. Twenty-four patients (46.2%) developed complications that included surgical site infection in 12 cases (23.1%), enterocutanous fistula in five cases (9.6%), intra-abdominal abscess in four cases (7.7%), and wound dehiscence in three cases (5.8%). There were seven deaths, accounting for 13.5% of the patients.
Conclusion: Typhoid intestinal perforation was the most common cause of peritonitis in the present study.
Keywords: Children; peritonitis; developing country; single center