Paediatric Blunt Abdominal Trauma: Challenges of Management in a Developing Country

Chirdan, Lohfa B.; Uba, AF; Yiltok, SJ; Ramyil, VM

doi:10.1055/s-2007-965008

Cited by 24 publications

(24 citation statements)

References 10 publications

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Section: Discussionsupporting

confidence: 86%

“…It also occurred more in males which is in tandem with patterns documented in literature 25,26 . Although the liver and spleen were the most injured intra-abdominal organs in blunt abdominal trauma [25][26][27] , there was a slightly higher incidence of traumatic gut perforation in our study. Nigeria by Ameh et al and Chirdan et al 18,25,26 had shown that a sizeable proportion of children with blunt abdominal injuries can be managed non-operatively.…”

Section: Discussionsupporting

confidence: 86%

“…Although the liver and spleen were the most injured intra-abdominal organs in blunt abdominal trauma [25][26][27] , there was a slightly higher incidence of traumatic gut perforation in our study. Nigeria by Ameh et al and Chirdan et al 18,25,26 had shown that a sizeable proportion of children with blunt abdominal injuries can be managed non-operatively. There is also a growing trend towards splenic conservation (splenorrhaphy) even in those with splenic laceration (grade I-III).…”

Section: Discussioncontrasting

confidence: 51%

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Surgical Abdomen in School Age Children: A Prospective Review From Two Centers In SouthWestern Nigeria

Etonyeaku¹,

Talabi²,

Akinkuolie³

et al. 2017

East. Cent. Afr. J. Surg.

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Background: Surgical abdomen traverses all age groups. We sought to define the aetiology, patients' characteristics, and outcome of management amongst children Methods: Two years prospective review of patients aged 5-15 years managed for surgical abdomen at the Wesley Guilds Hospital Ilesa and Mishmael Medical Centre Akure, Nigeria. Results: Fifty two patients were treated. The male: female ratio was 1:1. The age range was 5years to 15years (mean=11.25 ±2.24years). Mean duration of illness was 29.5hours (range 2-72hours). Gut perforation was the most common aetiology (n=39; 75%); with perforations due to infections most prevalent (n= 34; 87.2%). Ten cases (19.2%) were trauma related and showed male predominance. Obstructed gut accounted for 15.4% (n=8) of cases; and showed female predominance. Five out of the eight small bowel obstructions (62.5%) were due to post operation adhesions. Pre-operative and post-operative diagnoses were congruent in 90.4% (n=47) of cases. Major post-operative complications were surgical site infection (20; 38.5%), and pneumonia (5; 9.6%). The average hospital stay was 9days (range 4-21days). Mortality rate was 1.9% (n=1). Conclusion: Acute abdomen requiring surgical intervention is mainly infective origin. The male child is more at risk of abdominal trauma while gut obstruction was more common in females.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 86%

Section: Discussioncontrasting

confidence: 51%

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Surgical Abdomen in School Age Children: A Prospective Review From Two Centers In SouthWestern Nigeria

Etonyeaku¹,

Talabi²,

Akinkuolie³

et al. 2017

East. Cent. Afr. J. Surg.

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“…The organ most often injured was the spleen, similar to reports from Nigeria. [18] As a result, many spleens were removed for various grades of splenic injuries. Since 2003, we have reviewed our stand on exploratory laparotomies for all cases of hemoperitoneum involving the spleen, taking into consideration the immunologic role of the spleen and the improvement of the diagnostic tools for blunt abdominal trauma in our hospital, and have evolved nonoperative methods of management of most splenic injuries, as accepted in many centers worldwide.…”

Section: Discussionmentioning

confidence: 99%

The range of abdominal surgical emergencies in children older than 1 year at the komfo anokye teaching hospital, Kumasi, Ghana

2009

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Background: Acute abdominal conditions are a common reason for emergency admission of children. Little is available in the literature about such conditions in our subregion, especially Ghana. Objective: The aim of this study was to investigate the range of emergency abdominal surgical conditions amongst children in the subregion, with particular reference to Komfo Anokye Teaching Hospital, Kumasi, Ghana. A prospective survey of all children older than 1 year undergoing an emergency abdominal surgery was carried out. Methods: Details of all children (except infants) operated for an acute surgical abdominal condition over a 5-year period were entered into a specially designed form, capturing patient characteristics, surgical causes of the emergency, operative procedure, complications, morbidity and mortality rates. Results: Nine hundred fi fty-fi ve children aged Ͼ1 year but Ͻ15 years were enrolled in the study. The mean age was 8.8 Ϯ 3.2 years. The leading causes of surgical abdominal emergencies were typhoid perforation (TP) of the gastrointestinal tract (GIT), 68%; acute appendicitis, 16%; abdominal trauma and intestinal obstruction (including intussusception), 4.7% each; irreducible external hernias, 2.5%; primary peritonitis, 1.0%; gallbladder disease and gastric perforation, 0.8% each. Many children died from the TP group; case fatality for TP alone was 12.6%. The overall mortality was 9.7%. Morbidity was infl uenced by the presence of major peritoneal contamination, continuing peritonitis and surgical site infections (SSIs), which led to long hospital stay. Conclusions: In our hospital, TP of the GIT, acute appendicitis, intestinal obstruction, irreducible external hernias and primary peritonitis were the most common abdominal emergencies encountered in children after infancy. The high morbidity and mortality in TP is attributable to ignorance, poor sanitation and delay in reporting to hospital for treatment.

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“…[2,[9][10][11][12][13][14][15][16][17][18][19][20] In developing countries, such as Nigeria, however, lack of imaging facilities or inability to afford them even when available make it a great challenge to embark on non operative management. [1,[20][21][22][23][24][25] In view of this, laparotomy with splenorrhaphy or splenectomy continued to remain the standard treatment in this centre. [20] Splenorrhaphy in children who reside in regions where malaria is endemic is very difficult as the splenic capsule is attenuated and holds sutures poorly.…”

Section: Introductionmentioning

confidence: 99%

Splenic injuries in children: The challenges of non operative management in a developing country

Osifo

Ovueni

2007

J Indian Assoc Pediatr Surg

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Aim: This is to report the challenges and experience gained with non operative management of splenic injuries in a developing country where sophisticated imaging facilities are either not available or exorbitantly expensive. Materials and Methods: All patients who presented with splenic injury at the University of Benin Teaching Hospital between January, 2000 and December, 2006 were assessed and those who met the criteria were recruited for non operative management. Diagnosis of splenic injury was made by combining clinical assessment and ultrasound findings. Results: A total of 24 children with a mean age 12 ± 0.04 years and male/female ratio 1.7:1 were treated during the period. Road traffic accident, accounting for 50% of the cases was the major cause of trauma followed by falls from heights. Delay in presentation was a major concern as 62.5% of them were not referred until shock supervened. None of the patients could afford CT scan but ultrasound scan was able to confirm diagnosis in all. Basing decision on clinical parameters, non operative management was successfully done in 75% while 25% were operated as they could not meet the criteria. No mortality was recorded in the non operated group while one was recorded in those operated. The average length of hospitalization was two weeks. Conclusion: Non operative management of splenic injuries can be successfully done in a developing country using clinical parameters as a guide. The 75% of patients with splenic injury treated can be improved upon by health awareness campaign/improvement in government policy that will result in early presentation.

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Paediatric Blunt Abdominal Trauma: Challenges of Management in a Developing Country

Abstract: Blunt abdominal trauma in children resulted mainly from road traffic accidents. The use of a simple protocol supported by ultrasound scan could reduce the laparotomy rate in countries with limited facilities.

Cited by 24 publications

References 10 publications

Surgical Abdomen in School Age Children: A Prospective Review From Two Centers In SouthWestern Nigeria

Surgical Abdomen in School Age Children: A Prospective Review From Two Centers In SouthWestern Nigeria

The range of abdominal surgical emergencies in children older than 1 year at the komfo anokye teaching hospital, Kumasi, Ghana

Splenic injuries in children: The challenges of non operative management in a developing country

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