ABSTRACT
Background: Delayed presentation might affect the ultimate management of children with congenital bowel obstructive bowel anomalies (CBA). We evaluated the profile, challenges of treatment and outcome of CBA presenting after neonatal age. Methods: We did a retrospective analysis of data of children with CBA presenting after neonatal age from January 2013 to November 2017. We used the Statistical Package for Social Sciences (SPSS) for data entry and analysis. Results: There were 57 cases in total comprising of Hirschsprung's disease (HD; 37 cases), anorectal malformation (ARM; 15 cases), and duodeno-jejunal web (5 cases), with median age of 9 months (IQR 4 months - 2 years) on presentation. Overall, 52 (91.2%) patients had one or more complications on presentation. Definitive procedure did not differ from established operations, but only 9 (15.8%) had primary procedures and 48 (84.2%) cases required multi-stage treatment. After an average follow up period of 19.5 months (range: 1-45 months), 18 (31.6%) cases developed procedure-related complications and 3 (5.3%) had residual bowel dysfunction, but there was no mortality. The morbidity was limited to cases with HD and ARM. Conclusion: In our setting, HD is the commonest bowel anomaly that presents after the neonatal age. The delayed presentation may predispose to complications and preclude single-stage treatment in some cases. Training of healthcare providers to improve recognition and early referral of these anomalies may lead to early diagnosis and minimize morbidity.
Subject(s)
Anorectal Malformations/epidemiology , Delayed Diagnosis , Hirschsprung Disease/epidemiology , Infant, Newborn, Diseases/etiology , Intestinal Obstruction/congenital , Intestinal Obstruction/epidemiology , Intestine, Small/abnormalities , Anorectal Malformations/diagnosis , Child, Preschool , Female , Hirschsprung Disease/diagnosis , Hospitals, Teaching , Humans , Infant , Infant, Newborn , Infant, Newborn, Diseases/diagnosis , Infant, Newborn, Diseases/epidemiology , Intestinal Obstruction/etiology , Malawi/epidemiology , Male , Retrospective StudiesABSTRACT
BACKGROUND/OBJECTIVE: This study evaluates the outcome of Wilms tumor (WT) following introduction of multidisciplinary team management and patient treatment stratification by tumor histology in two referral centers in southeastern Nigeria. METHODS: We analyzed histologically confirmed WT cases managed from January 2008 to June 2017. RESULTS: There were 45 patients, peak age incidence of 2 to 5 years who presented after mean symptom duration of 4.9 months (range, 1-12 months), with mean tumor weight of 1040 g (range, 350-4200 g). Overall, 14 (31.1%) had unfavorable histology of WT. A total of 22 (48.9%) patients received preoperative chemotherapy, 43 (95.6%) received postoperative chemotherapy based on stage of disease and histopathology, but none received adequate radiotherapy. Of these, 19 (44.2%) patients complied with chemotherapy regimen, 15 (33.3%) were lost to follow-up and 12 (26.7%) cases relapsed. With 30 cases available for evaluation and mean follow-up duration of 23 months (range, 6-80 months), the overall 5-year survival is 53.3% (16 cases). Survival in children who complied with postoperative chemotherapy was 73.7%, and abandonment-sensitive survival was 35.6%. Persisting challenges were late presentation, poor compliance to treatment, and lack of radiotherapy treatment. CONCLUSION: Multidisciplinary team management and chemotherapy based on tumor histology might have resulted in slight improvement of outcome since our last report. However, to ensure survival that may approach global benchmarks, there is need for public health measures to improve time to diagnosis, and improvement of facilities and healthcare funding to ensure compliance to all phases of standard therapy.