Childhood intussusception: Impact of delay in presentation in a developing country

Abstract

Background:The classical cases of intussusception are readily diagnosed clinically, and despite recent improvements in radiological techniques, the diagnosis of intussusception and success in its nonoperative reduction has been suboptimal, thus making operative management a veritable backup. This study examined the impact of delays in presentation on the rate of bowel resection, length of hospital stay, and appraised the outcome of operative treatment.Patients and Methods:This was a retrospective study of consecutive children admitted and treated surgically for intussusception between January 2002 and December 2011 at the University College Hospital, Ibadan, Nigeria.Results:The mean age at presentation was 13.4 months with a male: female ratio of 1.8:1. Fourteen patients (25.5%) presented within the first 24 h of onset of symptoms with majority (36.4%) presenting between 2 and 3 days of onset of symptoms. The primary surgical intervention was performed on 47 patients (85.5%), and the secondary operative intervention was performed on eight patients (14.5%) who had failed initial nonoperative management of intussusception. Manual reduction of intussusception was performed on 27 patients (49.1%), 26 patients had resection of gangrenous bowel with end-to-end anastomosis while two patients (3.6%) had spontaneous reduction of intussusception which was discovered at laparotomy. The mean duration of hospital stay was 12.1 days (range 3–60 days). The overall mortality was 5.5% (three patients), and three patients (5.5%) had recurrence of intussusception.Conclusion:Although mortality is reducing, a high rate of bowel resection is a consequence of delayed presentation and effort should be made to make an early diagnosis of intussusception and make prompt referral to improve outcome.

Clinical predictors and outcome of bowel resection in paediatric intussusception

“…This is usually a late complication resulting from the entrapment of the mesentery of the affected part of bowel, compromising blood supply. This, therefore, implies that a significant number of our patients present late in the disease as have been previously documented in this centre 14 . The median duration of symptoms in the present study was three days (range: 2 hours – 21 days) and more than half of the patients presented after 48 hours of onset of observed symptoms.…”

“…This was in keeping with findings from other studies where prolonged duration of symptoms was associated with the need for operative management and/or bowel resection in the management of childhood intussusception 5 – 7 , 20 , 21 . Delayed presentation, either by the parents or by referring health centres, has remained a challenge in this setting 10 , 14 .…”

“…However, the surgery rate remains high in many developing countries, ranging from 74–100% in some reports 9 – 13 . This has generally been due to delayed presentation from ignorance of parents and/or delayed referral from peripheral hospitals 10 , 12 – 14 . Specialist paediatric surgical care and radiological facilities and expertise for non-surgical reductions have also been limited in these settings and these may have been contributory factors.…”

Intestinal Resection in Children: Our Experience in Enugu, Nigeria

“…It is noteworthy that this late presentation is common in developing countries, which may be due to poverty and ignorance [7] . Early presentation reduces the rate of intestinal resection [8] . In developed countries, the majority of children are hospitalized within 24 hours of onset of their symptoms [9,10] .…”

Predictors and outcome of acute kidney injury after non-cardiac paediatric surgery

“…Therefore, it is important to pay close attention to the treatment of sepsis, in low-to middle-income settings, considering that one quarter of the patients had preoperative sepsis in this study. Delayed presentation could have contributed to the extent of sepsis seen among the patients [30].…”