Clinical outcome of intestinal obstruction in pediatric age group: A prospective study
Journal Title: INTERNATIONAL JOURNAL OF RECENT TRENDS IN SCIENCE AND TECHNOLOGY - Year 2016, Vol 20, Issue 2
Abstract
Background: Intestinal obstruction is one of the commonest cause of pediatric surgical emergency with a high morbidity and mortality. Very few previous studies address the problem regarding clinical outcome of these patients especially in Indian context. Materials and Methods: A two year (April 2011 to June 2013) prospective study of hundred consecutive pediatric intestinal obstruction cases aged 1 day to 12 yrs presenting at RCSMGMC and CPR hospital, Kolhapur was done to assess the pattern and factors affecting the outcome. Results: Hundred (100) children with male to female ratio of 1.1:1 were seen during study with peak incidence seen in neonates (40). The median duration of symptoms was 48 hrs (range 1hr to 10 days) with 52% of the delayed cases (more than 48 hrs) being previously treated symptomatically and referred. In present study, Intussusception was the commonest cause of obstruction in 20% of patients. Anorectal malformations were close second with total incidence of 19% followed by Hirschsprung’s disease (16%), Intestinal Atresias (8%), Adhesive obstruction (7%),Necrotizing enterocolitis (7%). Perforative peritonitis, Congenital Hypertrophic Pyloric Stenosis, Intestinal Malrotation, Meckel's Diverticulitis, Obstructed Exemphalos and worm obstruction were seen in 3% patients each. Obstructed Inguinal hernia (2%), Umbilical Hernia (1%), Meconium illeus(1%), Meconium plug syndrome (1%) were other causes. 61 cases were due to acquired causes while the rest were congenital causes. Also small bowel obstruction was more common than large bowel obstruction (65% as compared to 35%). Postoperative complications were seen in 39% cases with wound infection (17%) and wound dehiscence (9%) being the commonest. The mean hospital stay was 10.25 days (SD=5.14) , which was affected significantly by malnutrition (p=0.00027) and delayed presentation (p=0.018). Mortality rate was 6% with overwhelming sepsis (66%) and multiple congenital anomalies (33.33%) being the commonest causes. Mortality was more in neonatal group (83.33%). Conclusions: With improving health care, while mortality as an outcome of management is low, the morbidity is still on higher side in pediatric obstruction cases. Neonatal age, malnutrition and low birth weight in neonates, delay in presentation and delayed referral from primary health centers and general practitioners adversely affects the morbidity.
Authors and Affiliations
Shivprasad Hirugade, Harish N Patil, Amit Chopade, Shilpa S Hirugade
Keywords
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