An audit of paediatric intussusception radiological reduction at the Bloemfontein Academic Hospital Complex, Free State, South Africa

Abstract

RESEARCHBackground. Intussusception remains the most common cause of bowel obstruction in infants and toddlers and can result in considerable morbidity and mortality if not properly treated. The aim of this study was to determine the success rate of air intussesception reduction (AIR), and to identify factors predicting an unsuccessful procedure, among paediatric patients diagnosed with idiopathic intussusception at the Bloemfontein Academic Hospital Complex, Free State, South Africa. Methods. This retrospective analytic cohort study assessed data from the records of all paediatric patients with the diagnosis of idiopathic intussusception discharged from the Department of Paediatric Surgery between 1 January 2003 and 30 September 2011. Results. Thirty-five children with intussusception were identified. AIR enemas were performed in 18 children (51.4%), with successful reduction in 2 (11.1%). Seventeen children (48.6%) were primarily treated surgically without attempting radiological reduction. Successful AIR was more likely if the duration of symptoms was <48 hours. Sixteen patients in whom AIR was attempted eventually required surgical intervention, either due to perforation during AIR or irreducibility. Approximately 94% of children required bowel resection at surgery. In 37.5% of cases AIR was complicated by perforation, making surgical treatment mandatory. Nine patients (56.3%) had unsuccessful AIR without perforation, but needed bowel resection at surgery. One patient (6.3 %) required manual reduction only, without the need for bowel resection at surgery. No deaths were recorded during the period covered by this audit. Conclusions. Our institution's radiological reduction outcomes were not comparable to international standards. The only statistically significant predictor of poor outcome of AIR was time delay before attempted reduction.S Afr J CH 2013;7(2):60-64.

Geospatial distribution of severe paediatric intussusception in KwaZulu-Natal province, South Africa

“…A large proportion of SA patients with paediatric intussusception present late to healthcare facilities [ 3 ]. Pneumatic reduction for intussusception is most effective if performed within two days following the emergence of symptoms [ 2 ], which explains the high rate of surgical intervention in SA reports on the condition [ 2 , 3 ]. The incidence of mortality in the current study was much lower than the 9.4% that was previously reported for intussusception in SA settings [ 3 ].…”

“…Firstly, some parents might have insufficient knowledge and awareness of intestinal obstruction or intussusception [ 12 ] and therefore would not suspect that their child has a potentially life-threatening condition which requires urgent medical treatment. Secondly, parents might initially attempt to treat the condition over several days with home remedies or traditional methods [ 2 , 3 ]. It would appear that improving the knowledge and awareness of paediatric intussusception and/or intestinal obstruction amongst parents might reduce delays in presentation to a healthcare facility and subsequent diagnosis of the condition.…”

“…This approach can be extended to the general community through the use of community health workers. From the healthcare practitioners´ point of view, paediatric intussusception can be a diagnostic challenge [ 2 ].…”

“…Intussusception refers to the invagination of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment [ 1 ]. The condition may involve the ileum, the colon or both [ 2 ]. Although intussusception occurs in both adults and children, children appear to be disproportionately affected by the condition and it remains an important cause of intestinal obstruction in this group.…”

“…A mortality rate of 9.4% has been reported in paediatric patients who have not received timely medical or surgical intervention for intussusception [ 3 ]. Conservative approaches, such as pneumatic reduction, are effective in managing paediatric intussusception in high-income countries [ 4 ], however success rates in SA settings are less convincing and surgery at specialist paediatric surgical units is often indicated [ 2 , 3 ]. Surgical intervention rates of up to 80% have been reported in SA settings [ 3 ].…”