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[Intussusception in infants]
1Dana Children's Hospital, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University.
Insights
Intussusception, a common cause of intestinal obstruction in children, can present with apathy, not just irritability. Early diagnosis and treatment within 24 hours improve outcomes, especially in younger children.
Area of Science:
- Pediatric Gastroenterology
- Surgical Emergencies
- Abdominal Pain in Children
Context:
- Intussusception is the leading cause of bowel obstruction in children post-neonatal period.
- While often idiopathic, 2-12% of cases stem from underlying abnormalities.
- Typical symptoms include sudden screaming, pallor, vomiting, and irritability.
Purpose:
- To analyze how age and time to admission influence intussusception presentation and outcomes.
- To investigate the correlation between presenting symptoms (irritability vs. apathy) and patient demographics.
- To determine the efficacy of hydrostatic pressure reduction based on age and promptness of care.
Summary:
- This study evaluated intussusception cases, noting incidence peaks in spring and autumn.
- A significant finding was that 42% of children presented with apathy, highlighting its importance as a symptom.
- Outcomes were significantly better for younger children and those admitted within 24 hours, with higher rates of successful hydrostatic reduction.
Impact:
- Highlights the critical need for increased clinician awareness of apathy as a key presenting symptom in pediatric intussusception.
- Emphasizes that early diagnosis and intervention, particularly within 24 hours of symptom onset, can double the success rate of non-surgical reduction.
- Suggests that prompt management and recognition of atypical symptoms can significantly improve the prognosis for children with intussusception.
Abstract:
Intussusception, the invagination of a portion of the intestine into an adjacent segment, is the most common cause of intestinal obstruction in post neonatal children. Most cases are idiopathic, but in about 2-12% the intussusception evolves secondary to an underlying abnormality. Classically, there is sudden onset of attacks of screaming, accompanied by pallor, vomiting, and irritability in a previously health child. Some gradually become weaker and lethargic. We evaluated variations in presenting symptoms and outcome as related to age and time until admission. There were incidence peaks in the spring and autumn. 48% developed irritability, while 42% were described as apathetic. These results emphasize the importance of awareness that apathy can be a major presenting symptom. The younger the child, the greater the rate of success of reduction by hydrostatic pressure. In those admitted within 24 hours of onset, the rate of reduction was twice that in those admitted later. Awareness of atypical symptoms and early diagnosis may affect treatment and improve prognosis.