Pediatric intussusception in Uganda: differences in management and outcomes with high-income countries

Ahsan²,

et al. 2021

World Jnl Ped Surgery

BackgroundAlthough hydrostatic reduction of intussusception with ultrasound (US) or fluoroscopy guidance is well known, it is not yet well established in many low-income and middle-income countries. The aim of the study is to report our results of hydrostatic reduction with intermittent radiography, which has the potential to be practiced in resource-limited settings.MethodsWe retrospectively analyzed our patients with intussusception from 2009 to 2019 (11 years). Hydrostatic reduction was performed using water-soluble contrast medium (iopamidol), and reduction was followed with intermittent X-rays taken after every 50 mL of diluted contrast injection. The procedure was not continuously monitored by US or fluoroscopy. Differences in outcome based on age and gender, and yearly trends of admission for intussusception, types of treatment and mortality were analyzed.ResultsAmong 672 patients, the ratio of boys to girls was 2.46:1.0, and their ages ranged from 1 month to 15 years (median 8 months). Hydrostatic reduction was performed successfully in 351 (52.23%) patients; 308 (45.83%) patients underwent surgery; and 13 (1.93%) patients died before any intervention. There were significant differences in age between patients with successful hydrostatic reduction (median 7 months) and patients needing surgery (median 9 months) (p<0.001). The number of successful hydrostatic reductions increased during the 11 years of the study (R2=0.88). One patient (0.15%) died after hydrostatic reduction, and 10 (1.49%) died after surgery.ConclusionHydrostatic reduction with intermittent radiography was performed successfully in more than half of the patients with acceptable complication rates.

Section: Discussionmentioning

confidence: 99%

“…Often, in such cases, they are treated as bacillary dysentery, and by the time they are referred to surgical facilities, bowel compromise and its sequelae become irreversible. 23 24 …”

Section: Discussionmentioning

confidence: 99%

Hydrostatic reduction of intussusception with intermittent radiography: an alternative to fluoroscopy or ultrasound-guided reduction in low-income and middle-income countries

Ahsan²,

et al. 2021

World Jnl Ped Surgery

“…If intussusception is longlasting, perforation occurs, diffuse peritonitis and shock evolve, and death is possible [23,24]. Authors of a study from 2018 from Uganda reported a mortality rate of 32% for patients with this condition [23,28]. Early diagnosis and appropriate treatment are critical to prevent this outcome.…”

Section: Ileocolic Intussusceptionmentioning

confidence: 99%

Intestinal intussusceptions in children population

Kopystecka

Kopeć

Mitek-Palusińska

et al. 2022

J Educ Health Sport

Intussusception is an invagination of a proximal segment of the bowel into an immediately adjacent, distal portion of the bowel. Ileocolic intussusception is one of the most common causes of bowel obstruction in children. The peak incidence occurs in infants between five and seven months of age. The etiology of intussusception in children is typically idiopathic, approximately 5-10% of patients have a pathological lead point. Postoperative intussusception is one of the rare causes of intussusception. Children with ileocolic intussusception often present abdominal pain, palpable mass, rectal bleeding, fussiness, and emesis. The most effective imaging method for the diagnosis of intussusception is ultrasound. The treatment of ileocolic and ileoileal intussusceptions is different, the first type requires invasive treatment.

“…Most intussusception can be managed with nonoperative reduction through fluoroscopic-guided barium enema and pneumatic reduction, and emergency surgery should still be performed for cases in which nonoperative reduction fails [ 3 ]. In terms of surgical planning and patient management, it is of great importance to detect potential complications early, as any delay may result in the impairment of intestinal circulation, which can cause intestinal necrosis, perforation or life-threatening secondary peritonitis, resulting in bowel resection and mortality [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

A promising new predictive factor for detecting bowel resection in childhood intussusception: the lymphocyte-C-reactive protein ratio

et al. 2021

Background The most critical concern for the management of childhood intussusception is bowel resection due to intestinal ischemia and necrosis. The early prediction of this problem is of great importance. We investigated the value of various combinations of inflammatory factors to predict intestinal necrosis and resection. Methods We retrospectively reviewed the medical records of pediatric patients with intussusception who underwent surgical management. During the research period, 47 patients who underwent intestinal resection due to intestinal necrosis and 68 patients who did not undergo intestinal resection were enrolled. We evaluated the diagnostic value of various combinations of inflammatory markers from preoperative laboratory analyses using the receiver operating characteristic (ROC) method. Results In the current cohort, 115 patients underwent operations for intussusception; among them, 47 patients (40.9%) underwent intestinal resections. In the patients with intestinal resection, the neutrophil count(p = 0.013), CRP level(p = 0.002), platelet–lymphocyte ratio (PLR, p = 0.008), NLR (neutrophil–lymphocyte ratio, p = 0.026), and LCR (lymphocyte–CRP ratio, p < 0.001) values were significantly higher than those in the patients without any resection. The receiver operating characteristic (ROC) analysis results showed that the combination of lymphocytic count along with C-reactive protein levels (LCR) demonstrated the highest correlation with intestinal resection due to intussusception compared with other parameters in the patients, with a sensitivity of 0.82 (0.73–0.86) and specificity of 0.80 (0.57–0.94) for the diagnosis of strangulation. Conclusion The preoperative LCR level is a useful marker to predict the need for intestinal resection due to intestinal necrosis in patients with intussusception.