Childhood intussusception, interventional study

Background: Intussusception occurs when a portion of the alimentary tract is telescoped into an adjacent segment. It is the most common cause of intestinal obstruction between 5 months and 3 years of age. Most cases are idiopathic. Aim of study: To study the epidemiology and clinical manifestations of intussusception and the relation between age and residency with time of presentation and mode of management, and to find out the impact of delay in presentation on the outcome. Patients & methods: A prospective study was performed on 35 patients that were presented with signs and symptoms consistent with intussusception and admitted to the emergency unit and pediatrics surgical ward in Child's Central Teaching Hospital in Baghdad during a period of seven months from the first of July 2016 to the 31st of January 2017. The age range was between 2 months to 3 years. History was taken and examinations, plain x-ray of abdomen, ultrasound of abdomen was done. The diagnosis was made clinically and confirmed by ultrasound. Patients treated either by pneumatic reduction under ultrasound guidance or surgically. Pneumatic reduction was attempted in all patients excluding those older than 2 years, presentation after 72 hours , poor general condition with signs of small bowel obstruction, and patients with shock or peritonitis. Intraoperative notes were collected looking for data regarding the mode of management, the type of intussusception and complications. Results: Peak age was between 6-12 months (60%) , male affected more than female with male: female ratio of 1.7:1. Most patients (68%) were presented after 24 hours; most patients from rural areas (82%) were presented lately after more than 24 hours. The most presenting features were screaming attack (94.3%), bloody stool (91.4%) and vomiting (80%). Twenty one patients (60%) had palpable abdominal mass and red currant jelly stool was found in 28 patients (80%) on examination. Pneumatic reduction was attempted in 22 cases, success rate was 77%., Pneumatic reduction was most successful in patients aged between 6-12 months (80%) and those presented early less than 24 hours (90%). Nine patients (81 %.) with duration of symptoms of less than 24 hours were treated by pneumatic reduction, while 11patients (91.7%) with duration of symptoms of more than 48 hours were managed surgically (8 patients by surgical reduction and 3 patients by bowel resection). Two cases had bowel perforation, one of them was associated with bowel ischemia, and both of them were presented after 48 hours. Conclusion: The most important predictor of the outcome is duration of symptoms. Delayed diagnosis increases the risk of failure of pneumatic reduction and increases the probability of surgical intervention and resection of bowel. The delay in presentation is due to the variability of signs and symptoms, seeking medical advice from non-specialized individuals, misdiagnosis of intussusception and delayed referral.