Childhood intussusception at the Moi teaching and Referral Hospital Eldoret: management challenges in a rural setting
1Department of Surgery, Faculty of Health Sciences, Moi University, Eldoret, Kenya.
Insights
Delayed diagnosis of intussusception in children significantly impacts outcomes. Early detection and improved surgical care are crucial for better results in pediatric intussusception cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Public Health
Background:
- Intussusception is a common surgical emergency in children.
- Timely diagnosis and management are critical for favorable outcomes.
Purpose of the Study:
- To review the management of childhood intussusception.
- Identify factors influencing outcomes at Moi Teaching and Referral Hospital.
Main Methods:
- Retrospective descriptive study (January 2000 - December 2003).
- Analysis of 36 pediatric cases of intussusception.
- Review of diagnostic and surgical management strategies.
Main Results:
- High proportion of male patients (78%) and referrals (61%).
- Low initial diagnostic accuracy (17%); delayed presentation (mean 5 days).
- High rates of operative intervention (100%), perforation (22%), gangrene (31%), and mortality (14%).
Conclusions:
- Early diagnosis and presentation are vital for improving intussusception outcomes.
- Enhanced peri-operative care is essential for reducing complications and mortality.
Objective:
To review the management of childhood intussusception at the Moi Teaching and Referral Hospital, Eldoret and identify factors that require attention for improved outcome.
Design:
A retrospective descriptive study covering the period January 2000 to December 2003.
Setting:
Moi Teaching and Referral Hospital, Eldoret.
Patients:
Thirty six children.
Results:
Of the 36 children, 28 (78%) were males and eight (22%) females giving a ratio of 3.5:1. Median age was six months with a range of 2-72 months. The duration of symptoms was a mean of 5 days with a range of 1-14 days. Sixty one percent were referrals. Initial diagnosis of intussusception based on signs and symptoms was made in 6 out of 36 (17%) patients. The rest were initially treated for other problems. Decision to refer to surgeons, was based on abdominal distension. Plain x-ray was done in four patients and barium enema in one patient. Seventy five percent of the patients required fluid resuscitation before operation. All patients (100%) were managed operatively. Seventy two percent had ileo-colic intussusception, 8% ile-oileal and 22% colo-colic. Perforation was found in 22% and gangrene in 31%. Sixty seven percent were successfully reduced by "milking" while 33% required resection and anastomosis/or stoma creation. Complications included: anastomatic breakdown, bronchopneumonial renal failure, sepsis, recurrent intussusception and death. Mortality was 14% overall.
Conclusion:
Early diagnosis and presentation coupled with improved peri-operative management are essential in improving outcome.
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