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Childhood intussusception in a regional hospital
R A Simon1, T J Hugh, A M Curtin
1Royal North Shore Hospital, Sydney, Australia.
Insights
Delayed diagnosis of childhood intussusception, a serious bowel condition, increases the need for surgery. Early recognition of subtle symptoms like pallor and lethargy is crucial for timely treatment.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Intussusception is a common surgical emergency in infants and children.
- Accurate and timely diagnosis is critical for successful management and preventing complications.
Purpose of the Study:
- To review the clinical presentation, management, complications, and outcomes of childhood intussusception.
- To identify factors associated with delayed diagnosis and adverse outcomes.
Main Methods:
- Retrospective review of 20 childhood intussusception cases treated over a 6-year period.
- Analysis of clinical data, management strategies (radiological vs. surgical reduction), and patient outcomes.
Main Results:
- Only one patient presented with all four classical intussusception symptoms.
- 14 out of 20 patients required surgery, with 4 failed radiological reductions.
- Delayed diagnosis (average 34 hours) was noted, associated with increased surgical intervention.
- Adverse features predicted increased likelihood of surgical resection.
Conclusions:
- Subtle clinical signs like pallor and lethargy in children with persistent vomiting warrant increased surgical awareness for intussusception.
- Early diagnosis is essential to reduce the need for primary surgical intervention.
- Identifying adverse features can guide decisions regarding radiological reduction attempts.
Abstract:
This study reviews all childhood intussusceptions treated over a 6 year period in a regional centre with six visiting general surgeons and two paediatricians. Clinical presentation, management, complications and outcomes were noted and an attempt was made to follow up all cases. There were 20 patients, with a median age of 6 months (range 10 weeks to 17 months). Only one patient had all four classical features of intussusception (pain, vomiting, 'red currant jelly' stools and abdominal mass). Seven patients were managed successfully by barium enema reduction, but 14 required operation, four following failed radiological reduction. There was one intestinal perforation due to attempted barium enema reduction and one patient required a reoperation for ileal gangrene following operative reduction. There were no deaths and there have been no subsequent recurrent intussusceptions although three cases were lost to follow up. There was a delay in diagnosis in some cases (average duration from onset to diagnosis was 34 h). Although delay was incurred by parents in some cases and in peripheral hospitals in others, there is a need for greater awareness by surgeons of the significance of subtle features such as pallor and lethargy in a child with persistent vomiting. Delay in diagnosis is likely to lead to an increased need for primary surgical intervention. Adverse features (age > 3 months or < 2 years; symptoms > 24 h; small bowel obstruction; dehydration > 5%) were predictive of an increased likelihood of surgical resection, and may help avoid inappropriate attempts at radiological reduction.(ABSTRACT TRUNCATED AT 250 WORDS)