DETERMINANTS OF BOWEL RESECTION IN CHILDHOOD INTUSSUSCEPTION
AbstractBackground: Intussusception is an acute surgical emergency and one of the most common causes of acute abdomen in early paediatric age group with peak incidence between 3 months to 3 years. It is considered the most common cause of intestinal obstruction in first two years of life. Early diagnosis and management may prevent major complications of bowel ischemia and necrosis thus avoiding morbidity and mortality. Our objective was to evaluate the risk factors or determinants of bowel resection in childhood intussusception. Methods: It is a prospective, descriptive and cross-sectional study in which 102 consecutive cases of intussusception presenting to The Children’s Hospital PIMS, from January 2018 to May 2019, were included. Results: Total 102 patients were included in the study. Seventy-three (71.6%) were male and 29 (28.4%) were female. Mean age at presentation was 16.30 months (ranged from 1 day to 9 years). Mean duration of symptoms was 3.1 days. 52.9% (53/102) patients had mass palpable on abdominal examination while 22.5% (23/102) had palpable mass on digital rectal examination (DRE). Mean haemoglobin at presentation was 10.2 g/dL (min 4g/dL, max 26g/dL) and mean haematocrit was 32.6 %. The most common type of intussusception was ileo-colic (57.8%) followed by ileo-ileal (21.6%). 36.3% (37/102) patients had to undergo bowel resection due to bowel gangrene/necrosis while in 66 (64.7%) patients had manual reduction. Statistically significant relationship was found between resection and duration of symptoms more than 24 hours (p=0.01, CI=95% OR= 6.24), haemoglobin less than 10g/dL (p=0.022, CI=95% OR=2.78) and haematocrit less than 30% (p=0.028, CI=95% OR=2.63). Conclusion: Prevention of anaemia and early presentation to a facility where trained paediatric surgeons are available can reduce the chances of bowel resection in childhood intussusception.Keywords: Intussusception; Paediatric age; Risk factors; Intestinal viability; Intestinal necrosis; Pakistan
Wong CW, Jin S, Chen J, Tam PK, Wong KK. Predictors for bowel resection and the presence of a pathological lead point for operated childhood intussusception: A multi-center study. J Pediatr Surg 2016;51(12):1998–2000.
Somme S, To T, Langer JC. Factors determining the need for operative reduction in children with intussusception: a population-based study. J Pediatr Surg 2006;41(5):1014–9.
Gadisa A, Tadesse A, Hailemariam B. Patterns and Seasonal Variation of Intussusception in Children: A Retrospective Analysis of Cases Operated in a Tertiary Hospital in Ethiopia. Ethiop Med J 2016;54(1):9–15.
Mirza B. Inverted Meckel's Diverticulum Simulating Pedunculated Polyp as a Lead Point for Ileoileal Intussusception in a Child. APSP J Case Rep 2013;4(1):6.
Ogundoyin OO, Olulana DI, Lawal TA. Childhood intussusception: A prospective study of management trend in a developing country. Afr J Paediatr Surg 2015;12(4):217–20.
Huang HY, Huang XZ, Han YJ, Zhu LB, Huang KY, Lin J, et al. Risk factors associated with intestinal necrosis in children with failed non-surgical reduction for intussusception. Pediatr Surg Int 2017;33(5):575–80.
Yao XM, Chen ZL, Shen DL, Zhou QS, Huang SS, Cai ZR, et al. Risk factors for pediatric intussusception complicated by loss of intestine viability in China from June 2009 to May 2014: a retrospective study. Pediatr Surg Int 2015;31(2):163–6.
Ogundoyin OO, Olulana DI, Lawal TA. Childhood intussusception: Impact of delay in presentation in a developing country. Afr J Paediatr Surg 2016;13(4):166–9.
Johnson B, Gargiullo P, Murphy TV, Parashar UD, Patel MM. Factors associated with bowel resection among infants with intussusception in the United States. Pediatr Emerg Care 2012;28(6):529–32.
Chalya PL, Kayange NM, Chandika AB. Childhood intussusceptions at a tertiary care hospital in northwestern Tanzania: a diagnostic and therapeutic challenge in resource-limited setting. Ital J Pediatr 2014;40(1):28.
Ekenze SO, Mgbor SO. Childhood intussusception: the implications of delayed presentation. Afr J Paediatr Surg 2011;8(1):15–8.
Ekenze SO, Mgbor SO, Okwesili OR. Routine surgical intervention for childhood intussusception in a developing country. Ann Afr Med 2010;9(1):27–30.
Ezomike UO, Ekenze SO, Igwilo IO. Comparative Analysis of Clinical Indices in Manual Reduction and Bowel Resection for Childhood Intussusception. Int J Med Health Dev 2017;22:3–7.