Aetiologies and outcomes of non-traumatic abdominal surgical emergencies in children at Moi Teaching and Referral hospital

Abstract

Background: Childhood abdominal surgical emergencies are associated with high morbidity and mortality in developing countries. Non-traumatic childhood abdominal surgical emergencies (NTCASE) include acquired diseases like acute appendicitis, intussusception and congenital abdominal anomalies like gastroschisis. This study sought to identify the aetiologies and the outcomes of non-traumatic childhood abdominal surgical emergencies at Moi teaching and referral hospital (MTRH). Objective: To describe the aetiologies and outcomes of non-traumatic childhood abdominal surgical emergencies at MTRH. Method: This study was a hospital-based prospective descriptive study. It included 140 children (below 18 years based on WHO guidelines) who were operated on for non-traumatic abdominal surgical emergencies between January 2015 to January 2016.Patients were identified from the theatre register. Relevant data on clinical presentation, duration of onset of symptoms, intraoperative findings and definitive surgical procedure as per case notes were entered into the data collection sheet. The study end point was at discharge or in hospital death and at this point any complication reported in patients file was recorded together with duration of length of stay. The data was entered in Ms Access and later exported to SPSS version 20 for analysis. Bivariate analysis using Chi square and Fisher’s exact test was used for corelation between variables and mortality. Results: A total of 140 patients were studied. The age of the patients ranged from 1 day to 17 years old, with a median of 1.5 months. Neonates constituted 47.9 % (n=67) of the study participants. The male to female ratio was 2.1:1(n=95:45). Majority(70 %,n=98) of the patients presented to hospital more than 24 hours after the onset of symptoms.The four most common aetiologies were intussusception(17.9%,n=25), gastroschisis(17.9%,n=25), anorectal malformations(10.7%,n=15) and small bowel atresia(10.7%,n=15). The overall complication rate was 17.9%(n=25). The average length of hospitalization was 8.6 ± 7.6 days. The in-hospital mortality was 20% (n=28). Factors that had significant co-relation with mortality included development of complications (P-value 0.0001), duration of illness presentation <24hours (P-value 0.0098), haemoglobin level>12g/dl (P-value 0.0127), neonatal age group (P-value 0.0017), ASA classification grade 3,4 (P-value 0.0003) and deranged potassium levels (P-value 0.0005). Conclusion: The commonest aetiologies of NTCASE in MTRH are intussusception and gastroschisis. The mortality and morbidity rates from NTCASE are significantly high.The most important factors co-related with mortality in patients with NTCASE are development of complications, duration of illness presentation <24 hours, haemoglobin level>12g/dl, neonatal age group, deranged potassium level and ASA classification grade 3,4. Recommendation: There is need to reduce the increased morbidity and mortality in children with non-traumatic abdominal surgical emergencies at MTRH by considering the factors associated with it.