Outcomes analysis of laparotomy, ileostomy and relaparotomy for diverse abdominal pathologies in children

Background: Acute abdomen in children, arising from diverse surgical conditions, can be treated by open laparotomy or by laparoscopic intervention. This study aimed to assess the demographics, underlying etiologies, and outcomes of different surgical procedures performed to treat pediatric patients with acute abdomen. Methods: This retrospective, single-institution study was conducted in the Department of Pediatric Surgery at a tertiary care centre in central India. This study spanned from January 1, 2000, to December 31, 2022. This study included children from infancy to 12 years of age who underwent surgery for abdominal pathologies leading to acute intestinal obstruction or perforation peritonitis. Results: Over a 23-year study period, 704 children aged 0 to 12 years underwent surgery for intestinal obstruction or perforation peritonitis. The primary abdominal pathologies managed via laparotomy included intussusception (32.38%), bowel (ileal) perforation with peritonitis (26.13%), symptomatic Meckel’s diverticulum (12.21%), Koch’s abdomen (5.68%), congenital bands, cysts, and malrotation of the gut (7.95%), patent vitelline duct (3.97%), and a few others. Surgical interventions included segmental resection of the ileum with ileo-ileal anastomosis (180; 25.56%), wedge resection or repair of bowel perforation (166; 23.57%), ileostomy creation, adhesiolysis, and a few other procedures. Seventeen percent of children required creation of a diverting ileostomy, and seven percent required a relaparotomy for management of their postoperative complications. Despite management, 62 (8.8%) children died during the study period. Conclusions: Mortality was especially higher in children undergoing surgery for bowel perforation peritonitis, those requiring ileostomy, and those needing relaparotomy to manage postoperative complications.