Early Recurrent Acute Intussusception in Children

Abstract

Acute intussusception in children is not a common condition. Spence and Court (1950) traced every child with this condition in the City of Newcastle-upon-Tyne during a six-year period and found the incidence was 3.8 per 1,000 births, or one case per family practitioner during that time. Recurrence of acute intussusception in children can be expected even less often. Thorndike (1932) reported five cases but found only 75 others in the literature. Since then Killins and Clagett (1941) and Mastin (1942) have described one case each, but the number even with the four cases reported here remains small. The following cases show that a recurrence can occur in the immediate post-operative period, a fact which does not seem to have been emphasized before.Case 1 A female child aged 7 months was admitted to Bridgend General Hospital on January 22, 1950. She was an onlv child, was breast-fed until weaning one month previously, and had been quite well until the previous evening, when she began to have attacks of severe abdominal pain which, the mother stated, made the child draw up her knees. There had been some vomiting of food shortly after its ingestion. The bowels had been regular, but no action had occurred since the previous day. There were no urinary symptoms. On examination the child was seen to be in good general condition, and well nourished, and showed no signs of dehydration. Examination of the abdomen was difficult, as the child had repeated attacks of colic. No tumour was felt on abdominal or rectal examination, but whilst the latter was being performed the child had a bowel action with streaks of bright blood and mucus. A presumptive diagnosis of intussusception was made and operation undertaken immediately.First Operation.-Under general anaesthesia a lower right paramedian incision was made and an ileo-colic intussusception was found, the apex of which had reached the splenic flexure. This was easily reduced. Enlarged mesenteric glands were noted but no cause was found for the intussusception.The post-operative course was uneventful until January 30, when the child became restless and was obviously in some pain. There was mild infection of the wound but no physical signs were elicited on abdominal examination. Rectal examination revealed a small quantity of foulsmelling soft faeces but no blood. There was some dehydration which warranted an intravenous transfusion of halfstrength Hartmann's solution. Examination of the urine showed a moderate growth of coliform organisms. On the following day the abdomen was obviously distended and the bowel sounds were greatly increased and high pitched. A diagnosis of acute small-bowel obstruction was made and laparotomy undertaken.Second Operation.-Under general anaesthesia a lower left paramedian incision was made and an ileo-ileal intussusception was found with distension of the proximal small intestine. The origin of this intussusception was proximal to the Previous one, the distal bowel now appearing normal, and, except for the enlarged mesenteric glands previouslv...