Pediatric Intestinal Obstruction: Etiological Analysis and Factors Influencing Short Term Outcomes in Rwandan University Teaching Hospitals

Abstract

Introduction: 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 developing countries, with variable influencing factors. Both the etiologies and outcomes are not documented in Rwanda. Objectives: We conducted this study to determine the etiologies, morbidity and mortality of pediatric intestinal obstructions, and assess the factors associated with the outcomes of these conditions in Rwandan university teaching hospitals. Methods: This was a cross sectional observational study conducted on pediatric patients with intestinal obstruction in 2 Rwandan university teachings hospitals: CHUK and CHUB. The patients were followed since admission until discharge, and we documented their basic characteristics, diagnosis, operative details and post-operative outcomes. Data were collected using data collection form, electronically captured and analysed using SPSS software. Descriptive statistics were used to generate frequencies and percentages of categorical variables. Bivariate and multivariate analysis was done to assess correlations between variables and factors associated with morbidity and mortality. Results: In total, 65 patients have been followed in this study. They were predominantly male (75.38%). The majority of patients were below age 6 years and 86.15% had low socio-economic status. The mean duration of symptoms was 11.23 days. Intussusception was the most common etiology (33.85%). Other common etiologies were hirschsprung disease (20%), incarcerated inguinal and umbilical hernias (9.23%), intestinal worms’ impaction (7.69%) and adhesions (7.69%). The mortality and morbidity were 9.23% and 38.46% respectively. The most common complications were surgical site infection (9.23%) and sepsis (9.23%). The length of hospital stay was 8 6 days (range: 1-34 days). Preoperative anemia (Hb<10g/dl), and finding of gangrenous bowels at the time of laparotomy and bowel resection were the factors associated with post-operative complications. Conclusion: Intussusception is the most common etiology of pediatric intestinal obstruction in 2 Rwandan university teaching hospitals. The outcomes are influenced by the preoperative anemia, gangrenous bowels at the time of laparotomy and bowel resection. We recommend a countrywide survey on etiologies and outcomes of intestinal obstruction in pediatric patients.