RESUMO
Background: Intestinal obstruction is a common presentation in pediatric surgical emergencies and presents with different etiologies depending on country or region. Its morbidity and mortality are high in low-income and middle-income countries, with variable influencing factors. The aims of this study were to determine the etiologies, morbidity and mortality of pediatric intestinal obstruction and to assess the factors associated with the outcomes of these conditions in Rwanda. Methods: This was a cross-sectional study conducted on pediatric patients with intestinal obstruction in two Rwandan university teaching hospitals. The patients were followed from admission until discharge, and we documented their basic characteristics, diagnosis, operative details and postoperative outcomes. Data were collected using data collection form and were electronically captured and analysed using SPSS software. Results: A total of 65 patients were enrolled in this study. They were predominantly male (n=49, 75.4%), and the majority of patients (86.2%) were below age 6 years. Intussusception was the most common etiology (n=22, 33.8%). Other common etiologies were Hirschsprung's disease (n=13, 20%), incarcerated inguinal and umbilical hernias (n=6, 9.2%), intestinal worms' impaction (n=5, 7.7%) and adhesions (n=5, 7.7%). Mortality and morbidity were 9.2% and 39.7%, respectively. The most common complications were surgical site infection (n=6, 9.5%) and sepsis (n=6, 9.5%). Preoperative anemia (p=0.001), finding of gangrenous bowels (p=0.003) and bowel resection at the time of laparotomy (p=0.039) were factors associated with postoperative complications. Conclusions: The etiologies of intestinal obstruction are variable and common in children below 6 years in Rwanda. The associated morbidly is high and is influenced by the preoperative anemia, finding of gangrenous bowels and bowel resection.
RESUMO
BACKGROUND: Emergency laparotomy is a common procedure with high morbidity and mortality. The aim of this study was to assess if the time of surgery (day versus night and weekend) affects the morbidity and mortality in a low-resource setting. METHODS: A retrospective study was conducted in 2 university teaching hospitals in Rwanda. Patient characteristics, time of laparotomy, operative details and postoperative outcomes were recorded. Chi-square and Wilcoxon rank sum tests were used to determine factors and outcomes associated with time of surgery. Logistic regression was used to determine factors associated with mortality. RESULTS: In 309 patients, who underwent emergency laparotomy, 147 (48%) patients were operated during the daytime, 123 (40%) patients were operated during the night shift and 39 (12%) patients were operated on the weekend. Common diagnoses were intestinal obstruction (n = 141, 46%), peritonitis (n = 101, 33%) and abdominal trauma (n = 40, 13%). The overall mortality rate was 16% with 14% in patients operated during day and 17% in patients operated during night and weekends (p = 0.564). Overall, the morbidity rate was 30% with 27% in patients operated during the day compared with 32% in patients operated during night/weekends (p = 0.348). After controlling for confounding factors, there was no association between time of operation and mortality or morbidity. CONCLUSION: Morbidity and mortality associated with emergency laparotomy are high but the time of day for emergency laparotomy did not affect outcome in Rwandan referral hospitals.