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Mechanical small bowel obstruction in children at a tertiary care centre in Kashmir.

BACKGROUND
Small bowel obstruction is the commonest surgical emergency encountered in childhood. We observed that intestinal obstruction caused by ascariasis is one of the leading causes of death in our children and consumes a major portion of our hospital resources. Other causes include intussusception, adhesions, volvulus, hernias, and worm obstruction. The aim of this study was to analyze the presentation, diagnosis, management of mechanical bowel and complication of obstruction in children.


PATIENTS AND METHODS
The study was conducted from Jan 2005 to Dec 2007 in the Department of Pediatric Surgery at Sheri-Kashmir Institute of Medical Sciences, Srinagar, Kashmir. All patients who presented in the emergency department with the diagnosis of intestinal obstruction were recruited. Patients with a dynamic obstruction were excluded from the study. Diagnosis was based on history and radiological findings. Data regarding the type of management, operative findings, operative procedure and post-operative complications were collected.


RESULTS
There were 207 patients admitted for intestinal obstruction. Males and females were equally affected. Most of the children (55%) were aged 3-5 years. The causes of obstruction included ascariasis 131 (63.2%), adhesion 23 (11.1%), intussusception 21 (10.1%), obstructed hernia 17 (8.2%), and volvulus 11 (5.3%). One hundred twenty-six patients needed an operative intervention and 81 were treated conservatively. The operative procedures performed included enterotomy in 37 (29.3%), milking of worms in 18 (14.2%), resection anastomosis in 31 (24.6%) and adhesiolysis in 13 (10.3%). Appendicular perforation was seen in 4 (1.9%) and worm in gall bladder in 1 (0.5%) patients. Surgical complications were wound infection in 18 (14.2%), burst abdomen in 5 (3.9%) and fecal fistula in 3 (2.3%) patients.


CONCLUSION
Intestinal obstruction is associated with considerable morbidity and mortality in children. Obstruction by ascariasis constituted the majority of intestinal obstruction in this study. Efforts should be made to eradicate ascariasis in endemic areas through proper sanitation, hygiene and use of antihelminthics.