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Prevalence and surgical outcomes of pediatric intussusception in ethiopia: a systematic review and meta-analysis
Yohannis Derbew Molla1, Desyibelew Chanie Mekonnen2, Hirut Tesfahun Alemu3
1Department of Surgery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. yderbew73@gmail.com.
Insights
Pediatric intussusception surgery in Ethiopia shows high complication and mortality rates, likely due to delayed presentation. Context-specific guidelines are needed to improve outcomes for children with this abdominal emergency.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Public Health in Low-Resource Settings
Background:
- Intussusception is a leading cause of pediatric abdominal emergencies globally.
- Ethiopia faces challenges with delayed presentation and limited non-surgical options for intussusception.
- Data on surgical outcomes for pediatric intussusception in Ethiopia are scarce.
Purpose of the Study:
- To evaluate the epidemiology of pediatric intussusception in Ethiopia.
- To assess the clinical presentation and surgical management of intussusception in Ethiopian children.
- To determine postoperative outcomes, including complications and mortality, in this population.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Data extraction from seven studies involving 672 pediatric patients.
- Meta-analysis using a random-effects model to pool outcomes and assess heterogeneity.
Main Results:
- The mean age of affected children was 12 months, with a 66% male predominance.
- Delayed presentation averaged 3.1 days; the classic triad was present in 52% of cases.
- High complication (26%) and mortality (9%) rates were observed, exceeding those in high-income countries.
Conclusions:
- Surgically managed pediatric intussusception in Ethiopia is associated with significant morbidity and mortality.
- Delayed presentation and advanced disease likely contribute to poor outcomes.
- Developing context-specific guidelines and exploring non-surgical techniques are crucial for improving care and survival.
Background:
Intussusception is the leading cause of pediatric abdominal emergencies worldwide, requiring timely diagnosis and intervention to prevent life-threatening complications. In low-resource settings such as Ethiopia, delayed presentation and limited access to non-surgical management often necessitate surgical intervention. However, comprehensive data on surgical outcomes and complications remain scarce. The aim of this study is to evaluate the epidemiology, clinical presentation, surgical management, and postoperative outcomes of pediatric intussusception in Ethiopia.
Methods:
A systematic review was conducted following PRISMA guidelines. Relevant studies were retrieved from PubMed, Scopus, Web of Science, and Google Scholar. Data were extracted on patient demographics, clinical presentation, diagnostic. methods, surgical procedures, complications, and mortality. Quality assessment was performed using the Newcastle-Ottawa Scale. Meta-analysis was conducted using a random-effects model with heterogeneity assessed by I² statistics. Publication bias was evaluated using Egger's test.
Results:
Seven studies with a total of 672 patients were included. The mean age of affected children was 12 months (95% CI: 11.35, 12.67), with a male predominance (66%). Delayed presentation was common, with a mean time of 3.1 days from symptom onset. The classic triad of symptoms-abdominal pain, bloody stools, and a palpable mass-was present in 52% of cases (I² = 96.24%). Ultrasound was the most common diagnostic tool (74%). The most frequent surgical intervention was manual reduction (62%), followed by bowel resection with anastomosis (35%) and stoma creation. The overall complication rate was 26%, with surgical site infections (15%) being the most common. The pooled mortality rate was 9% (95% CI: 5%, 13%), significantly higher than in high-income countries. Egger's test (p = 0.03) suggested potential publication bias.
Conclusion:
This study found that surgically managed pediatric intussusception in Ethiopia had a high morbidity and mortality rate. These outcomes may reflect delays in presentation, and advanced disease at intervention. The development and implementation of context-specific clinical guidelines could help optimize care and improve survival rates. In addition, further research is needed to evaluate the impact of non-surgical reduction techniques.
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