Non-traumatic abdominal surgical emergencies in children

Abstract

Background: In developing countries, non-traumatic childhood abdominal surgical emergencies (NTCASE) are associated with high morbidity and mortality and include acquired diseases like acute appendicitis, intussusception and congenital abdominal anomalies such as gastroschisis. This study sought to identify the etiologies and outcomes of NTCASE at Moi Teaching and Referral Hospital (MTRH), Kenya. Methods: A prospective descriptive study that involved children below 18 years operated on for non-traumatic abdominal surgical emergencies between January 2015 and January 2016. Relevant data on clinical presentation, duration of onset of symptoms, investigations and intraoperative findings were entered into the data collection sheet. Daily follow-up was done until discharge or in-hospital death, and outcomes recorded. Results: A total of 140 patients were studied. Age of the patients ranged from 1 day to 17 years, with a mean of 3.0 (SD±2.9) years. Children below 2 years constituted 72.9% of the study participants. The male to female ratio was 2.1:1. The most common aetiologies were intussusception (17.9%) and gastroschisis (17.9%). The complication rate was 17.9% (n=25), average length of hospitalization 8.6±7.6 days, and in-hospital mortality 20%. Conclusion:The commonest aetiologies of NTCASE in MTRH are intussusception and gastroschisis. Mortality and morbidity rates are high. Factors co-related with mortality in patients with NTCASE are deranged potassium level, ASA classification grade 3 and 4, neonates, normal haemoglobin level, duration of illness presentation <24 hours, and development of complications