Outcome of management of neonatal intestinal obstruction at a tertiary center in Nigeria

Abstract

Background:Intestinal obstruction in a newborn remains a significant emergency in pediatric surgery. Clinical presentation is often subtle with sudden deterioration of their clinical states. Clinical outcome in the developing countries is poor owing to a variety of factors.Objective:The objective of this study is to identify the factors affecting the management outcome in our environment.Patients and Methods:Data on clinical presentation, management, and outcome of all neonates managed for intestinal obstruction over a 13-year period at a tertiary center in Nigeria were retrospectively reviewed. Analysis of factors affecting the management outcome was also performed.Results:One hundred and seventeen neonates comprising 85 (72.7%) boys and 32 (27.3%) girls were managed for intestinal obstruction. The age at presentation ranged from 0 to 29 days, with a mean of 6.86 ± 8.4 days. Seventy-five (64.1%) patients presented within a week of onset of symptoms and 42 (35.9%) patients later. Eighty-five patients (72.6%) presented with symptoms from birth. The most common causes of intestinal obstruction included anorectal malformation in 62 (53%) neonates and Hirschsprung's disease in 16 (13.7%) neonates. Other causes included obstructed inguinoscrotal hernias, duodenal atresia, jejunoileal atresia, malrotation, and annular pancreas. Eleven patients died with a mortality rate of 9.4%. The age at presentation (P = 0.001) and the presence of postoperative complications (P = 0.009) were significantly related to the duration of hospital stay. Furthermore, the presence of postoperative complications (P = 0.012) was significantly associated with postoperative mortality.Conclusion:Early presentation and postoperative complications significantly affected the morbidity and mortality associated with the management of neonates with intestinal obstruction.

Ultrasound in pediatric intestinal obstruction: Assessing its full potential

“…Reason for male sex predominance is not known, but it may be due to less attention towards female child by social custom in our society. Most common age group involved in our study was 1month to 1 year (34%) followed by neonatal age group (22%) [3,7,8]. Uba et al also studied and observed that 74% of patients were less than 1year [11].…”

Iron-deficiency anemia with lithobezoar (pica): a rare cause of intestinal obstruction in a 5-year-old Nigerian child

“… 20 In Nigeria, lithobezoar remains an uncommon cause of intestinal obstruction despite a high prevalence of IDA. 21 , 22 …”

Acute mechanical intestinal obstruction in children at zinder national hospital, Niger: Aetiologies and prognosis

“…Acute intestinal obstruction (AIO) in children is a common cause of paediatric surgical emergency. [ 1 2 3 4 ] Causes of AIO not only vary from neonatal period to older children but also based on geographical distribution. [ 3 5 6 ] In the advanced countries, the prognosis is improved by rapid diagnosis and quality of perioperative care.…”

“…[ 1 2 3 4 ] Causes of AIO not only vary from neonatal period to older children but also based on geographical distribution. [ 3 5 6 ] In the advanced countries, the prognosis is improved by rapid diagnosis and quality of perioperative care. [ 3 6 7 8 ] Contrariwise, in sub-Saharan Africa and other developing countries, delay in admission or management, lack of neonatal and paediatric intensive care, hard access to hospital and limited resources have been responsible for the poor prognosis of AIO.…”

“…[ 3 5 6 ] In the advanced countries, the prognosis is improved by rapid diagnosis and quality of perioperative care. [ 3 6 7 8 ] Contrariwise, in sub-Saharan Africa and other developing countries, delay in admission or management, lack of neonatal and paediatric intensive care, hard access to hospital and limited resources have been responsible for the poor prognosis of AIO. [ 1 2 3 4 5 8 9 10 ] The aim of this study was to describe the aetiological and prognostic aspects of acute mechanical intestinal obstruction (AMIO) in children at Zinder National Hospital (ZNH) (Niger).…”