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Colonic intussusceptions in children
Insights
Primary colonic intussusceptions are common in African children, often linked to Ascaris lumbricoides infestation. Delayed diagnosis is frequent due to varied presentations and inadequate clinical assessment.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Tropical Medicine
Background:
- Primary colonic intussusceptions occur with high frequency in African infants and children.
- Ascaris lumbricoides infestation is a significant contributing factor in many cases, particularly caecocolic intussusception.
- This study reviews 37 cases to analyze the clinical presentation and diagnostic challenges.
Observation:
- Caecocolic intussusception (16 patients) often presents with mild intestinal upset, colic, and vomiting.
- Colocolic intussusception (13 patients) typically involves acute abdominal symptoms, intestinal obstruction signs, and a palpable left colon mass.
- Sigmoid intussusceptions (8 patients) in infants are frequently misdiagnosed due to overlooked anal prolapse.
Findings:
- Ascaris lumbricoides infestation frequently complicates caecocolic intussusception, leading to diagnostic delays.
- Occult blood in stools is a key indicator for colocolic intussusception.
- Inadequate assessment of anal prolapse hinders timely diagnosis of sigmoid intussusceptions.
Implications:
- Improved diagnostic strategies are needed, especially for intussusception associated with parasitic infections.
- Enhanced clinical examination, focusing on anal prolapse, can improve early detection of sigmoid intussusception.
- Understanding regional variations in intussusception etiology and presentation is crucial for pediatric care in Africa.
Abstract:
There is a high incidence of primary colonic intussusceptions in infants and children in Africa. The case histories of 37 patients are reviewed. Of the varieties described, the caecocolic intussusception (16 patients) presents as an intestinal upset, often mild, with symptoms of colic and vomiting. In many of these patients there is known to be an intestinal infestation with Ascaris lumbricoides. This often leads to a delay in establishing the correct diagnosis. Colocolic intussusception (13 patients) gives rise to more acute abdominal symptoms. On clinical assessment, signs of intestinal obstruction are found and there is usually an intra-abdominal mass which can be palpated in the left colon. Further confirmatory evidence of intussusception is the finding of occult blood in stools. There is an unusually high incidence of sigmoid intussusceptions in infants (8 patients). The diagnosis of this form of intussusception is often delayed owing to inadequate clinical assessment of prolapsed bowel at the anal orifice. The length of the prolapsed bowel, the curved nature of the prolapse and the possible demonstration of a sulcus between the prolapsed bowel and the anal canal wall, aid in diagnosis.