Current Trends in Paediatric Intususceptions

Abstract

Intussusception is the major cause of acute intestinal obstruction in infants. The classic clinical triad of intussusception is colicky abdominal pain, vomiting and bloody stools. However, only 20% of patients present with this triad. OBJECTIVES: The objective of this article with a series of cases of intussusception is to review the spectrum of clinical presentation of this disease entity and also to study the effectiveness of non-surgical intervention in children with intussusception using barium enema reduction under fluoroscopy. METHODS AND RESULTS: This prospective study spread over a period of 3 year and six months from October 2010 to march 2014 was carried out in tertiary care hospital in south Bangalore. Complete review of medical records for clinical and demographic information was only performed for those cases fulfilling diagnostic certainty (Definite intussusception). During the surveillance period, A total of 40 patients, diagnosed cases were included in this study. The majority (78.4%) of the cases occurred in the first year of life. The male: female ratio was 2.4: 1. Intussusception cases occurred round the year with no distinct seasonality. No intussusception-associated death was recorded. Cases identified in the study were similar in presentation and demographics as those observed in other south East Asian settings. Clinical presentation of the patients were pain abdomen, vomiting, blood in stools, fever and loose stools. Among the patients who were admitted the time between the onset of symptoms and hospitalization was between 36 to 48 hours, After stabilizing them haemodynamically they were subjected to definitive procedure, Barium enema reduction was tried in all patients, exclusion criteria was patients with clinical and radiological sign and symptoms of peritonitis, duration of symptoms more than 30hours and massive abdominal distension. Out of forty cases, thirty seven (81.8%) were reduced by fluoroscopic guided barium enema, those who failed among them, one (2.5) was reduced by pneumatic reduction, one (2.5) was reduced by ultrasound guided pneumatic reduction and only one (2.5%) patient required surgical interventions, reduced manually during surgery. No mortalities were recorded during the study. There was one recurrence noted in our study 15 days after discharge and was subsequently treated with fluoroscopic guided contrast reduction. CONCLUSION: Surgical intervention in intussusception can be prevented by non-operative reduction especially if presented early and no signs of peritonitis.