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Intussusception in children: international perspective
D E Meier1, C D Coln, F J Rescorla
1Department of Surgery, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas 75235, U.S.A.
Insights
Children with intussusception in developing countries face worse outcomes due to treatment delays and inadequate care. Improving early recognition and postoperative monitoring is crucial for reducing mortality in these cases.
Area of Science:
- Pediatric Surgery
- Global Health
Background:
- Intussusception is a common surgical emergency in children.
- Outcomes for intussusception vary significantly between developed and developing countries.
Purpose of the Study:
- To compare intussusception treatment outcomes in a developing country with those in American hospitals.
- To identify factors contributing to poorer outcomes in developing nations.
- To recommend strategies for improving pediatric intussusception care globally.
Main Methods:
- Retrospective comparison of 50 consecutive pediatric intussusception cases from a developing country hospital with 100 cases from two American children's hospitals.
- Analysis of treatment approaches, symptom duration, bowel viability, and mortality rates.
Main Results:
- Developing country children experienced longer symptom duration, higher rates of nonviable bowel, and an 18% mortality rate.
- American hospitals reported no deaths and utilized nonoperative reduction, which was unavailable in the developing country.
- Poorer outcomes in the developing country were linked to delayed treatment, nonviable bowel, and insufficient nursing care.
Conclusions:
- Nonoperative reduction alone would not significantly reduce mortality in the developing country setting.
- Reducing mortality requires earlier diagnosis and treatment of intussusception.
- Enhanced postanesthetic care with improved monitoring is essential for managing postoperative complications promptly.
Abstract:
Fifty consecutive cases of children with intussusception treated at a hospital in a developing country were compared with 50 consecutive cases treated at an American inner city children's hospital and 50 consecutive cases treated at an American referral children's hospital. The plan was to recommend ways of improving the treatment of children with intussusception in the developing world. Nonoperative reduction was attempted in the two American hospitals but was not available in the developing world hospital where all children were treated operatively. Children in the developing world hospital had a significantly longer duration of symptoms, an increased incidence of nonviable bowel, and a mortality of 18%. There were no deaths in either American hospital. The poorer outcome for developing world children was related to delay in treatment, the higher incidence of nonviable bowel, and the lack of adequate nursing care for acutely ill children. The use of nonoperative reduction would not have significantly improved the mortality rate among the developing world children. The mortality can best be reduced by: (1) earlier recognition and treatment of the intussusception; and (2) improvement in the postanesthetic care with better monitoring leading to prompt recognition and treatment of postoperative complications.