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Childhood intussusception: a 9-year review
B T Ugwu1, J N Legbo, N K Dakum
1Department of Surgery, Jos University Teaching Hospital, Nigeria. ugwub@unijos.edu.ng
Insights
Intussusception in children often presents with a quartet of symptoms, not just the classical triad. Surgery is common, with various causes identified, including lymphadenopathy and inflamed Peyer
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Intussusception is a significant cause of bowel obstruction in children.
- Accurate diagnosis and timely management are crucial for favorable outcomes.
Purpose of the Study:
- To review intussusception cases managed at Jos University Teaching Hospital.
- To analyze clinical presentation, surgical findings, and outcomes.
Main Methods:
- Retrospective review of 64 consecutive intussusception cases (infants and older children).
- Data collected on patient demographics, clinical signs, surgical interventions, and complications.
Main Results:
- The quartet of symptoms (pain, bloody stools, abdominal mass, rectal mass) was more frequent (70%) than the triad (32%).
- Common causes included idiopathic (41%), polyps (3%), and appendiceal stump (5%).
- Ileo-colic intussusception occurred in 50%, with 67% successful manual reduction.
Conclusions:
- The quartet of symptoms is a more sensitive indicator for intussusception.
- Prompt surgical intervention is necessary, with a variety of underlying causes.
- Wound infection and adhesive obstruction are common post-operative complications.
Abstract:
Sixty-four consecutive cases of intussusception in 48 infants and 16 older children managed at Jos University Teaching Hospital between January 1990 and December 1998 are reviewed. The age range was between 3 months and 15 years (mean 2.2 years) and the male to female ratio was 3.6:1. The quartet of abdominal pain, bloody mucoid stools, abdominal mass and palpable rectal mass was present in 70% compared with the classical triad (abdominal pain, bloody mucoid stools and abdominal mass) which occurred in only 32%. All the children had surgery. In 26 (41%) of the children, no associated cause was found, in three polyps formed the lead point and in five children a buried appendicectomy stump formed the lead point. In 30 (47%) other children, mesenteric lymphadenopathy and inflamed Peyer's patches were noted. Ileo-colic intussusception occurred in 32 (50%) children. Manual reduction was successful in 67%. Bowel resection for gangrene, irreducibility and an iatrogenic colonic tear was done in 30% of patients. Two (3%) had spontaneous reductions. There were four deaths. The commonest complications were wound infection and adhesive intestinal obstruction.