Radiographic findings among children operated for acute abdomen at Moi Teaching and Referral Hospital, Eldoret Kenya

Abstract

Background: Acute abdominal pain is the most common gastrointestinal symptom in the emergency department, accounting for over 900,000 visits annually in US children less than 15 years of age. The challenge is in identifying those who may require urgent surgical intervention, as children present differently from adults and the symptoms and signs may not be straightforward. Radiological imaging is immensely important as a paraclinical aid to diagnosis. Plain abdominal radiography is the first-line modality in the evaluation of this subset of patients. Identification of pertinent radiographic features is important for early consultation and intervention thus reducing morbidity and mortality. Objective: To describe the radiographic findings among children presenting with acute abdomen and operated upon at MTRH. Methods: The study setting was Moi Teaching and Referral Hospital Paediatric Surgery ward and the Radiology and Imaging department. A retrospective review of abdominal radiographs done among children operated for acute abdomen over a seven month period was conducted. Paediatric patients aged 0-14years who presented with acute abdomen and underwent abdominal radiography and laparotomy formed the study population. A census of thirty (30) patients operated was conducted. Data collection instruments with patient demographic information, clinical history, pre- and post-operative surgical notes were used in data collection. Interpretation of images was done with three senior radiologists blinded to the operative findings to minimise bias. Descriptive statistics like mean, median and mode were used for continuous variables while proportions, percentages, frequency tables, bar graphs and pie charts were used for categorical data. Results: A total of 30 children were consecutively sampled, with their ages ranging from 3 days to 14 years old. Mechanical obstruction was found in 12 cases and the remainder had peritonitis. All x-rays reviewed were abnormal. Supine view followed by a combination of Supine and Cross- table were the most common radiographic views. The most common radiographic findings were absent rectosigmoid air with bowel distension in mechanical obstruction, and ground glass opacity with fluid levels in peritonitis. Conclusion: Absent rectosigmoid air followed by small bowel distension and ground glass appearance were the most common radiographic findings encountered (60%, 57% and 53% respectively). Recommendation: There is need for collaboration between the surgical and radiology departments in abdominal radiograph interpretation. The combination of Erect abdomen and Cross -table views should be abandoned.