Laparotomies in children in low resource circumstances: Our experience in Chingola-Zambia

Abdominal conditions in children are always a challenge to a general surgeon working at a district hospital in a developing country like Zambia, in most situations working alone with limited resources. The situation is compounded by the shortage of specialized pediatric surgeons in the vicinity, shortage of specialized investigations like CT scan or MRI and limited laboratory investigations. Our focus of the research was Chingola, a mining town in the Copperbelt province of Zambia with a population of 200,000(2011 census). Below are the tools used and experience we had with children who presented with abdominal problems that needed operative surgery. This was a prospective study carried out from June 1997 to May 2002, a period of five years.At laparotomy the most frequent finding was peritonitis, seen in 26 patients. (54.2%), intestinal obstruction seen in 16 patients, (33.3%), worm infestations seen in 13 patients (27.1%) and abdominal trauma of about 5 patients(10.4%). There was a complication rate of 31.25%. The commonest complication was Pneumonia in 5patients (10.4%), wound site infection in 4 patients (8.3%), wound dehiscence in 2 patients (4.2%), sepsis in 2 patients (4.2%) and malnutrition in 2 patients (4.2%). All but two children were discharged from the hospital the average stay was 10.3 days.  Two children died from complications of surgery. Children who present with acute abdomen will be mostly from an infective process; therefore, taking a thorough history and physical examination will help in arriving at the diagnosis.