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Intussusception in Children Presenting to the Emergency Department: An Asian Perspective
Eileen Yap Shiyi1, Sashikumar Ganapathy
1From the Departments of *Paediatric Medicine and †Emergency Medicine, KK Women's and Children's Hospital, Singapore.
Insights
Intussusception can occur in older Asian children, not just infants. A common presentation includes abdominal pain, leg drawing, and vomiting, differing from the classic triad.
Area of Science:
- Pediatric Emergency Medicine
- Gastroenterology
- Surgical Pediatrics
Background:
- Intussusception is a common pediatric surgical emergency, typically affecting infants under one year old.
- Previous studies have primarily focused on younger children, leaving a gap in understanding older pediatric populations, particularly in Asian demographics.
- The classical presenting triad of intussusception has limited diagnostic sensitivity.
Purpose of the Study:
- To investigate the clinical presentation of intussusception in children presenting to an emergency department in an Asian population.
- To specifically describe the characteristics and outcomes of older children (≥10 years) with intussusception.
- To identify alternative presenting symptom clusters in Asian children that may aid in earlier diagnosis.
Main Methods:
- A retrospective chart review of 391 children diagnosed with intussusception between 6 months and 15 years of age.
- Data collection occurred over a 5-year period (2009-2013) at KK Women's and Children's Hospital.
- Case identification and classification followed the Brighton Collaborative Intussusception Working Group criteria.
Main Results:
- The mean age of affected children was 2.59 years, with males predominantly affected (65.22%).
- Children aged 10 years or older constituted 3.33% of the cases.
- The classical triad (abdominal pain, vomiting, bloody stools) was present in only 3.58%, while abdominal pain, leg drawing, and vomiting occurred in 22.51% of Asian patients.
- Air enema was the primary treatment (76.73%), with 22 cases requiring surgery and 63 resolving spontaneously. No mortality was observed.
Conclusions:
- Intussusception occurs in older Asian children, challenging the traditional view of it being exclusive to infants.
- The classical triad for intussusception is not a reliable diagnostic indicator in this population.
- A combination of intermittent abdominal pain, drawing legs up, and vomiting may represent a more frequent presenting symptom complex in Asian children with intussusception.
Objective:
This project examines the presenting complaints of children with intussusception in the emergency department in an Asian population, with a focus on older children, which has not been well described in previous studies.
Methods:
A retrospective study was conducted on children aged 6 months to 15 years, whose conditions were diagnosed with intussusception in KK Women's and Children's Hospital for a 5-year period (2009-2013), based on the case definition established by the Brighton Collaborate Intussusception Working Group.
Results:
Three hundred ninety-one cases were identified to fulfill the case definition as per the Brighton Collaborative Intussusception Working Group. The mean age of children diagnosed with intussusception is 2.59 years, predominantly in males (65.22%). A total of 3.33% were 10 years or older. Only 3.58% presented with the classical triad-intermittent abdominal pain, vomiting, and bloody stools. In contrast, 22.51% of our Asian patients presented with a triad of intermittent abdominal pain, indrawing of legs, and vomiting. A total of 76.73% of our subjects were treated by air enema only, whereas 22 required surgical treatment after unsuccessful attempts of air enema, and 63 resolved spontaneously, including 7 with ileoileal intussusception. No mortality was documented.
Conclusions:
Intussusception is usually diagnosed in the younger population (age <1 year) and predominantly in males. Our study has established that older Asian children can also have intussusception. The classical triad is not a very sensitive diagnostic tool, but the combination of abdominal pain, indrawing of legs, and vomiting may be a more common presenting triad in Asian children.
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