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Presenting clinical features and outcome in intussusception
Sule Yalcin1, Arbay O Ciftci, Ergun Karaagaoglu
1Department of Pediatric Surgery, Hacettepe University Medical Faculty, Ankara, Turkey.
Indian Journal of Pediatrics
|May 5, 2009
Summary
Certain clinical and radiologic findings in intussusception patients, such as toxic appearance and air-fluid levels, indicate lower success rates for conservative management and higher surgical complication risks. Early conservative treatment attempts are crucial for reducing morbidity.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Background:
- Intussusception is a common surgical emergency in infants and children.
- Conservative management is the preferred initial treatment modality.
- Predicting the success of conservative management and potential complications is crucial for optimal patient outcomes.
Purpose of the Study:
- To investigate the correlation between initial clinical and radiologic characteristics of intussusception patients and the success of conservative management.
- To assess the impact of these factors on patient morbidity and overall outcome.
- To compare outcomes among patients treated primarily with surgery, those treated after failed conservative attempts, and those successfully managed conservatively.
Main Methods:
- Retrospective review of 179 intussusception patients treated between 1993 and 2003.
- Analysis of physical examination findings, laboratory values (leukocyte count), and radiologic findings (X-ray, ultrasonography).
- Statistical analysis using chi-square, Kruskal-Wallis, and ANOVA tests to determine significance (p < 0.05).
Main Results:
- Toxic appearance and free abdominal fluid on ultrasonography were associated with lower rates of primary conservative treatment.
- Lower success rates for conservative management were observed in patients with moderate general appearance, lethargy, blood on rectal examination, air-fluid levels on X-ray, and free fluid on ultrasonography.
- Higher surgical complication rates were noted in patients with moderate general appearance, lethargy, and air-fluid levels on radiograph.
Conclusions:
- Toxic appearance, lethargy, and radiologic air-fluid levels are indicators of decreased conservative management success and increased surgical complications.
- Conservative management, when successful, significantly reduces patient morbidity.
- Surgical intervention after failed conservative management results in lower morbidity compared to primary surgical treatment; thus, conservative management should be attempted in all cases without clear contraindications.
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