RESUMO
We aim to determine the profile and determinants of outcome of pediatric abdominal surgical emergencies in southeastern Nigeria. We prospectively analyzed 115 children with abdominal surgical emergencies managed at the University of Nigeria Teaching Hospital, Enugu, Nigeria, from January 2008 to June 2009. The emergencies were typhoid intestinal perforation (TIP) 22 (19.1%), intussusception 20 (17.4%), obstructed hernia 17 (14.8%), neonatal intestinal obstruction 11 (9.6%), appendicitis 11 (9.6%), trauma 8 (6.9%), ruptured omphalocele/gastroschisis 8 (6.9%), Hirschsprung's disease 7 (6.1%), adhesive bowel obstruction 7 (6.1%), and malrotation 4 (3.5%). The mean time to diagnosis was 3.5 days (range, 4 hours to 12 days). Ninety-three cases had an emergency operation, while 22 were managed nonoperatively. After a mean hospital stay of 10.8 days (range, 2-38 days), 35 (37.6%) of the operated patients had one or more postoperative complications. There were 10 (8.7%) deaths. Overall, TIP had a higher postoperative complication rate (P < 0.001), while neonates had a higher mortality (P < 0.001). Delayed presentation and lack of neonatal and pediatric intensive care facilities were daunting challenges. A pediatric abdominal surgical emergency in our setting has high morbidity and mortality. Efforts geared towards improvement in time to diagnosis and perioperative care may result in better outcomes.
Assuntos
Emergências , Gastroenteropatias/cirurgia , Doença Aguda , Adolescente , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Países em Desenvolvimento , Feminino , Gastroenteropatias/epidemiologia , Hospitais de Ensino , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Nigéria/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos ProspectivosRESUMO
A ruptured omphalocele is a very rare complication in conjoined twins. Some cases have prompted emergency neonatal separation of the twins with varying results. We report a case of ruptured omphalocele in a thoraco-omphalopagus twin managed by primary repair of the defect at the University of Nigeria Teaching Hospital, Enugu. The twins later had a successful elective separation. Challenges of managing this case in our setting and the advantages of avoiding emergency neonatal separation are highlighted.
