The pattern of gastro-intestinal obstruction in Trinidadian children

ABSTRACT

A review is presented of 156 children admitted to hospital with gastro-intestinal obstruction. The common underlying causes were obstructed hernia (46.8 percent), intussusception (23.7 percent) and pyloric stenosis (16 percent) of cases. There was a marked male proponderance in each of these three groups, and the predominance of patients of African extraction in the hernia group reached 100 percent when the hernia was umbilical. Well-known observations in children with obstructed inguinal hernias which were confirmed were a right-sided prediliction, and a tendency for tecurrent obstruction in the absence of early repair. All of the patients with intussusception were under the age of one year, and this was associated with an unusually low incidence of discomfort or irritability as a presenting complaint, and a paucity of anatomical lead points. Fifteen bowel resections were required in 14 children, seven for gangrenous or irreducible intussusceptions. There were nine fatalities, four in the group with intussusception, and the details of these suggest that all fatalities could be eliminated with improvements in respiratory care, and pre-and intra-operative management (AU)