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A Hospital-Based Multi-Centric Study to Determine the Clinico-Epidemiological Profile of Intussusception in
Alok Kumar Goyal1, R K Gupta1, Bhupesh Jain2
1Department of Pediatrics, SMS Medical College, Jaipur, Rajasthan, India.
Insights
Intussusception in children under two years old is common, with most cases occurring in infancy. Early detection and prompt hospital admission are crucial to potentially avoid surgery.
Area of Science:
- Pediatric Surgery
- Epidemiology
- Public Health
Background:
- Intussusception is a significant cause of intestinal obstruction in infants and young children.
- The introduction of the rotavirus vaccine in routine immunization programs necessitates monitoring its potential impact on intussusception incidence.
- Understanding the clinical and epidemiological profile is vital for effective management and prevention strategies.
Purpose of the Study:
- To assess the clinical and epidemiological characteristics of intussusception in children under two years of age.
- To evaluate the disease pattern following the implementation of the rotavirus vaccine in Rajasthan's Universal Immunization Programme.
Main Methods:
- A 2-year, multi-centric, hospital-based surveillance study was conducted in Rajasthan.
- 164 children under two years old admitted with intussusception (meeting Brighton's criteria) were enrolled.
- Data on demographics, clinical presentation, diagnosis, treatment, and outcomes were collected and analyzed.
Main Results:
- The median age for intussusception presentation was 7 months, with a 2:1 male-to-female ratio.
- Abdominal pain and bloody stools were the most common symptoms; ileocolic intussusception was most frequent.
- Surgical intervention was required in 89.6% of cases, with delayed admission increasing the need for surgery.
Conclusions:
- Intussusception management in children is critically dependent on the time from symptom onset to hospital admission.
- Timely diagnosis and referral are essential to improve outcomes and potentially reduce the need for surgical intervention.
- Continued surveillance is important to understand the long-term epidemiology of intussusception post-vaccine introduction.
Objective:
To determine the clinical and epidemiological profile of Intussusception in children aged <2 y after introduction of rotavirus vaccine in Universal Immunization Programme of Rajasthan.
Method:
This was a hospital-based multi-centric surveillance study conducted at three tertiary care sentinel sites in Rajasthan over a period of 2 y. Children <2 y of age admitted with intussusception as per Brighton's criteria 1 were enrolled. Demographic details including age, sex, clinical presentation, diagnostic methods, duration of symptoms, mode of treatment, and complications were recorded and analyzed.
Results:
During the study period of 2 y, the authors identified 164 cases of intussusception based on level-1 Brighton's criteria. Median age at presentation was 7 mo [Interquartile range (IQR) 5-10 mo] with a male to female ratio of 2:1. Pain abdomen and blood stained stool were the commonest presenting complaints (88.4% and 81.7%, respectively). Commonest site of intussusception was Ileocolic (82.32%). Pathological lead point was identified in 18.9% cases. Distinct seasonality was observed as maximum cases of intussusception were detected in the months of Jan-March (34.1%). Surgical intervention was required in the 89.63% cases. The median time duration between onset of symptoms and admission at sentinel site was 2 d (IQR 1-3 d). Proportion of cases that required surgery increased as the time interval between onset of symptoms and admission increases.
Conclusion:
Intussusception is a common surgical condition among children under-two years of age with majority of cases occurring during infancy. Case management is dependent primarily on time duration elapsed between symptoms onset and admission to tertiary care centre. Early case detection and timely referral may provide an opportunity to avoid surgical interventions.
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