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Childhood intussusception: Impact of delay in presentation in a developing country
Olakayode Olaolu Ogundoyin1, Dare Isaac Olulana1, Taiwo Akeem Lawal1
1Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Insights
Delayed presentation of intussusception in children leads to a high rate of bowel resection. Early diagnosis and prompt referral are crucial for improving surgical outcomes and reducing complications.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
Background:
- Intussusception diagnosis and nonoperative reduction success remain suboptimal despite advances in imaging.
- Operative management is often necessary for intussusception, highlighting the need to understand factors influencing surgical outcomes.
Purpose of the Study:
- To evaluate the impact of delayed presentation on bowel resection rates and hospital stay in pediatric intussusception.
- To assess the outcomes of surgical treatment for intussusception.
Main Methods:
- Retrospective study of surgically treated pediatric intussusception cases.
- Data collected from January 2002 to December 2011 at University College Hospital, Ibadan, Nigeria.
Main Results:
- Majority of patients presented 2-3 days after symptom onset.
- 49.1% of patients underwent manual reduction; 3.6% had spontaneous reduction.
- Bowel resection was necessary in 26 patients (47.3% of those operated on); overall mortality was 5.5%.
Conclusions:
- Delayed presentation significantly increases the likelihood of bowel resection in pediatric intussusception.
- Efforts to achieve early diagnosis and prompt referral are essential for better surgical outcomes.
- While mortality is decreasing, reducing bowel resection rates remains a key challenge.
Background:
The classical cases of intussusception are readily diagnosed clinically, and despite recent improvements in radiological techniques, the diagnosis of intussusception and success in its nonoperative reduction has been suboptimal, thus making operative management a veritable backup. This study examined the impact of delays in presentation on the rate of bowel resection, length of hospital stay, and appraised the outcome of operative treatment.
Patients And Methods:
This was a retrospective study of consecutive children admitted and treated surgically for intussusception between January 2002 and December 2011 at the University College Hospital, Ibadan, Nigeria.
Results:
The mean age at presentation was 13.4 months with a male: female ratio of 1.8:1. Fourteen patients (25.5%) presented within the first 24 h of onset of symptoms with majority (36.4%) presenting between 2 and 3 days of onset of symptoms. The primary surgical intervention was performed on 47 patients (85.5%), and the secondary operative intervention was performed on eight patients (14.5%) who had failed initial nonoperative management of intussusception. Manual reduction of intussusception was performed on 27 patients (49.1%), 26 patients had resection of gangrenous bowel with end-to-end anastomosis while two patients (3.6%) had spontaneous reduction of intussusception which was discovered at laparotomy. The mean duration of hospital stay was 12.1 days (range 3-60 days). The overall mortality was 5.5% (three patients), and three patients (5.5%) had recurrence of intussusception.
Conclusion:
Although mortality is reducing, a high rate of bowel resection is a consequence of delayed presentation and effort should be made to make an early diagnosis of intussusception and make prompt referral to improve outcome.
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