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Childhood intussusception: 17-year experience at a tertiary referral centre in Hong Kong
Carol W Y Wong1, Ivy H Y Chan1, Patrick H Y Chung1
1Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
Insights
Non-operative reduction for pediatric intussusception is highly successful with low complications. However, a palpable abdominal mass indicates a higher risk of failure, suggesting timely surgical intervention may be necessary.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes
- Intussusception Management
Background:
- Intussusception is a common surgical emergency in children.
- Effective management strategies aim to reduce complications and recurrence.
Purpose of the Study:
- To review outcomes of pediatric intussusception over 17 years.
- To identify factors influencing treatment success and complications.
Main Methods:
- Retrospective case series of 173 pediatric patients.
- Data collected on symptom duration, treatment modalities, and outcomes.
- Analysis of complication rates and risk factors.
Main Results:
- Non-operative reduction (pneumatic/hydrostatic) was successful in 79.4% of 160 patients.
- Complications included 1.9% bowel perforation and 3.1% early recurrence with non-operative treatment.
- A palpable abdominal mass was a risk factor for operative treatment (RR=2.0).
Conclusions:
- Non-operative reduction is effective and safe for pediatric intussusception.
- Palpable abdominal mass predicts failure of non-operative reduction.
- Prompt surgical intervention is advised for difficult or uncertain non-operative reductions.
Objectives:
To review all paediatric patients with intussusception over the last 17 years.
Design:
Retrospective case series.
Setting:
A tertiary centre in Hong Kong.
Patients:
Children who presented with intussusception from January 1997 to December 2014 were reviewed.
Main Outcome Measures:
The duration of symptoms, successful treatment modalities, complication rate, and length of hospital stay were studied.
Results:
A total of 173 children (108 male, 65 female) presented to our hospital with intussusception during the study period. Their median age at presentation was 12.5 months (range, 2 months to 16 years) and the mean duration of symptoms was 2.3 (standard deviation, 1.8) days. Vomiting was the most common symptom (76.3%) followed by abdominal pain (46.2%), per rectal bleeding or red currant jelly stool (40.5%), and a palpable abdominal mass (39.3%). Overall, 160 patients proceeded to pneumatic or hydrostatic reduction, among whom 127 (79.4%) were successful. Three (1.9%) patients had bowel perforation during the procedure. Early recurrence of intussusception occurred in four (3.1%) patients with non-operative reduction. No recurrence was reported in the operative group. The presence of a palpable abdominal mass was a risk factor for operative treatment (relative risk=2.0; 95% confidence interval, 1.8-2.2). Analysis of our results suggested that duration of symptoms did not affect the success rate of non-operative reduction.
Conclusions:
Non-operative reduction has a high success rate and low complication rate, but the presence of a palpable abdominal mass is a risk factor for failure. Operative intervention should not be delayed in those patients who encounter difficult or doubtful non-operative reduction.
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