Unintended harm: Paediatric surgical outcomes in untrained hands

Introduction: Owing to fundamental differences in anatomy, physiology, and disease behaviour, children require specialised surgical expertise. However, in low- and middle-income settings, paediatric surgical conditions are frequently managed by non-specialists, resulting in diagnostic errors and inappropriate interventions.Objective: To analyse the spectrum and consequences of mismanagement in paediatric surgical cases referred to a tertiary care paediatric surgery unit.Materials and Methods: A retrospective observational study was conducted in the Department of Paediatric Surgery in our institute from January 2021 to September 2024. Children from birth to 12 years of age referred after prior surgical or interventional management elsewhere were included. Demographic data, initial diagnosis and treatment, nature of mismanagement, final diagnosis, and resultant complications were analysed.Results: A wide range of mismanaged conditions was identified. Paediatric malignancies such as hepatoblastoma and rhabdomyosarcoma were misdiagnosed as infective pathologies and subjected to inappropriate drainage procedures. Congenital anomalies including intestinal malrotation and anorectal malformations were unrecognised and inadequately treated, leading to delayed referral and increased morbidity. In one case, circumcision was performed in a non-medical setting by an untrained person, and the subsequent application of ash to the operative site led to infection and progressive tissue necrosis. These errors resulted in disease progression, avoidable complications, prolonged hospital stay, and potential compromise of long-term outcomes.Conclusion: Mismanagement of paediatric surgical conditions remains a significant and preventable problem. Timely referral to trained paediatric surgeons, adherence to established guidelines, and strengthening of structured referral systems are essential to improve outcomes and reduce avoidable morbidity in children.