Abstract
Objective
To evaluate if a correlation exists between the clinical and radiologic characteristics at presentation; and the success of conservative management, morbidity and outcome of patients with intussusception.
Methods
All patients (total 179) treated for intussusception in our unit between 1993 and 2003, were retrospectively reviewed to find out the effects of physical examination (general appearence, consciousness, body temperature, abdominal distention and tenderness, blood on rectal examination), laborat (leukocyte count) and radiologic (air-fluid level on X-ray, free abdominal fluid on ultrasonography) findings on selection of first step therapeutic modality, conservative management (reduction with barium or air) success rate and surgical complication (serosal defect, intestinal perforation) rate. Additionally, the patients were subdivided into three subgroups as group A (patients for whom surgical management was performed primarily), group B (the ones who were operated after failure of reduction attempt with barium or air), group C (patients who had successful conservative reduction). These groups were compared within each other with regard to duration of nasogastric suction, antibiotic therapy; onset of oral feeding and duration of hospitalization. The chi-square, Kruskal-Wallis and ANOVA tests were used for the statistical analysis and p value less than 0.05 was considered to be significant.
Results
Incidence of selecting conservative treatment primarily was lower in patients with toxic appearence (p=0.02) and with free fluid on ultrasonography (p=0.007). Success rate of conservative treatment was lower in patients with moderate general appearence (p=0.000), lethargy (p=0.011), blood on rectal examination (p=0.004), air-fluid level on X-ray (p=0.039), free fluid on ultrasonography (p=0.001). Surgical complication rate was higher in patients with moderate general appearence (p=0.000), lethargy (p=0.007), air-fluid level on radiograph (p=0.009). In group A; the duration of N/G suction, antibiotic therapy and hospitalization was longer; the onset of oral feeding was later than the other two groups (p=0.000). In group B; the duration of N/G suction, antibiotic therapy and hospitalization was longer; the onset of oral feeding was later than group C (p=0.000).
Conclusion
Toxic appearence, lethargy and air-fluid level on radiograph not only decrease the success rate of conservative management, but increase the surgical complication rate as well. Thus, these parameters deserve more importance in the management scheme. Reduction with conservative management is the most important factor which decreases the morbidity. Morbidity is lower in cases who are operated after failure of conservative management than the ones for whom surgery is performed primarily. Thus, conservative management should be tried for all patients unless there is a clear cut contraindication such as peritonitis and/or pneumoperitoneum.
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References
O’Neill, Rowe, Grosfeld, Fonkalsrud, Coran. Pediatric Surgery 1998; 2:1185–1195.
Littlewood Tele, Vogel SA. Intussusception:the paediatric radiologist’s perspective. Pediatr Surg Int 1998; 14:158–162.
Britton I, Wilkinson AG. Ultrasound features of intussusception predicting outcome of air enema. Pediatr Radiol 1999; 29:705–710.
Okuyama H, Nahai H, Okada A. Is barium enema reduction safe and effective in patients with a long duration of intussusception? Pediatr Surg Int 1999; 15:105–107.
Beasley SW. Enema reduction is safe and effective regardless of the duration of symptoms. Pediatr Surg Int 1999; 15:596.
Lai AH. Intussusception: a three-year review. Ann Acad Med Singapore 2002; 31:81–85.
Hadidi A, Shal NE. Childhood intussusception: A comparative study of nonsurgical management. J Pediatr Surg 1999; 34:304–307.
Weng HF, Kong MS. Pneumatic reduction of intussusception in children. J Formos Med Assoc 1995; 94:702–704.
Kim MC, Strouse PJ, Peh WC. Clinics in diagnostic imaging. Ileocolic intussusception. Singapore Med J 2002; 43:645–648.
Saxton V, Katz M, Phelan E. Intussusception:a repeat delayed gas enema increases the nonoperative reduction rate. J Pediatr Surg 1994; 29588–589.
Eshed I, Witzling M, Gorenstein A. Reduction of intussusception by air enema in children- experience over a 13-year period. Harefuah 2003; 142:659–661.
Guo JZ, Ma XY, Zhou QH. Results of air pressure enema reduction of intussusception:6396 cases in 13 years. J Pediatr Surg 1986; 21:1201–1203.
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Yalcin, S., Ciftci, A.O., Karaagaoglu, E. et al. Presenting clinical features and outcome in intussusception. Indian J Pediatr 76, 401–405 (2009). https://doi.org/10.1007/s12098-009-0129-7
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DOI: https://doi.org/10.1007/s12098-009-0129-7