European Journal of Cardiovascular Medicine

Intestinal obstruction is defined as failure of gastrointestinal luminal contents to pass distally. Intestinal obstruction in paediatric age group differs from that in adults in presentation, etiology and management.¹ The incidence of surgical emergency in a neonate ranges from 1 to 4 per 100 births.² Intestinal obstruction is the most common surgical emergency in neonatal period.² Neonatal intestinal obstruction occurs 1 in 1500 live births and potentially dire surgical emergencies and often requires a team approach for optimal management.³

Clinical presentation being Vomiting, distention of abdomen, history of not passing stools, fever ,drowsiness and the ability of the child to not convey these symptoms makes it difficult to understand ,the only means of acquiring the history is by the mother. Few of the congenital causes of intestinal obstruction in peadiatric age group are e.g. duodenal atresia, congenital pyloric stenosis, meconium plug syndrome, imperforate anus etc.⁴

Older children may present with pain and vomiting and the examination is difficult. Causes of intestinal obstruction in older children are mostly acquired e.g. intussusception, worn infestation, foreign body etc. many of them in these age group are not associated with any other anomalies. Management of intestinal obstruction in children differs from that in adults in terms of fluid requirement, electrolytes and drugs dosage, mode of anesthesia, surgical technique & post-operative monitoring as well as complications.⁵ Present study was aimed to study of various causes, symptomatology & management of intestinal obstruction in paediatric age group at a tertiary hospital

Present study was single-center, prospective, observational study, conducted in department of Surgery, at Basaveshwar Hospital attached to M.R Medical College, Gulbarga, India. Study period was from December 2017 to June 2019 (18 months). Study approval was obtained from institutional ethical committee.

Inclusion criteria

• Patients of both the genders and age less than 16 years of age, presented with intestinal obstruction, underwent surgical intervention and parents willing to participate in present study

Exclusion criteria

• Patients more than 16 years age
• Patients underwent conservative management
• Cases of Intestinal ileus due to electrolyte imbalance , functional constipation and post-operative obstruction.

Study was explained to patients in local language & written consent was taken for participation & study. On admission, a detailed history was taken regarding age, sex, chief symptoms, duration of symptoms, birth history. A thorough head to toe examination of these children’s was done for anthropometric assessment, associated anomalies and for signs of intestinal obstruction. Perineal examination and per rectal examination was also done.

All cases were investigated by routine lab tests for blood and urine and imaging in the form of x-ray of abdomen, barium enema, invertogram and ultrasound which ever appropriate or any specific tests. All patients were admitted, underwent resuscitation & appropriate management as per departmental protocols.

After preparation patients underwent appropriate surgical management, surgeries were done by senior surgeons (experience more than 10 years). All patients received standard pre- operative and post operative care. Data was collected and compiled using Microsoft Excel, analysed using SPSS 23.0 version. Statistical analysis was done using descriptive statistics.

During study period, 100 patients satisfied study criteria. Male cases were 75 (75.0%) and female were 25 (25.0%). Maximum number of cases were from the age groups of 1-12 months and 1years -5 years (27.0% each) followed by age group of < 1 month (26.0%) & age group 5-10 years (20 %). The mean age of males was 2.59 ± 3.23 and females were 2.97 ±3.93. There was no statistical significant difference of age among males and females

Table 1: Age and sex wise distribution of cases

In present study, common clinical features observed were distention (83 %), vomiting (66 %), constipation (44 %), pain abdomen and bleeding PR (24 % each).

Table 2: Clinical features

Figure 1

Among X-ray findings out 100 cases, 72 cases had multiple air fluid level (MAFL). In the invertogram findings 12 (12.0%) of cases had low anorectal malformation (LARA) and 8 (8.0%) of cases had high anorectal malformation (HARA).

Table 3: X-ray and invertogram findings

Figure 2

Common USG findings noted were mass (32 %), dilated bowel loop (12 %), distended loops (6 %) & adhesions with free fluid (4 %).

Table No.4: USG findings wise distribution of cases

Figure 3

In present study, intussusception (25 %) was most common diagnosis followed by imperforate anus (21 %), volvulus (10 %), CHPS (10 %), Hirschsprung's disease (8 %), Meckle’s band (6

%) & post operative adhesive (6 %).

Table 5: Diagnosis

Figure 4

In the present study, maximum number of cases underwent reduction procedure (18.0%), followed by anoplasty, pyloromyotomy, resection anastomosis (12 % each), colostomy, derotation (8 % each).

Table 6: Surgical modalities of treatment

Figure 5

Study reveals that, there was statistically very highly significant difference of distribution of mortality of patients among outcome of complicated and uncomplicated surgeries (P < 0.001) study reveals that, all deaths were occurred in complicated surgeries 11 (100.0%)

Also, there was statistical significant difference of distribution of modalities of treatment of patients among outcome of complicated and uncomplicated surgeries and outcome of expired and survived (P < 0.05)

Table 7: Comparison of outcome with mortality

Common post operative complications observed were septicemia (9 %), fever (8 %), wound infection (6 %) & respiratory distress (4 %).

Table 8: Post operative complications

Figure 6