A 30-Year Experience in Treatment of Intestinal Intussusception in Children by Own Technique

Abstract

The issues on objectification and selection of indications for conservative treatment of intestinal intussusception in children remain to be disputable.Materials and methods. The experience of treating 249 pediatric patients (172 boys and 77 girls) with intestinal intussusception at the age of 2 months - 13 years was analyzed. There were 265 cases of intestinal intussusception including 16 cases of the recurrence in 11 children. Conservative treatment was performed in 178 (71.5%) children, 71 (28.5%) children were operated on. To make the analysis, children were divided into 3 groups according to three ten-year periods.Results and discussion. The statistical analysis demonstrated the decrease in the number of patients with the increase in the number of children over 1 year of age over the past decade. The 1st decade was characterized by the introduction and experimental substantiation of flow-through pneumatic insufflation developed by the author with following refusal of X-Ray control. The methods of objectification of the criteria for non-surgical reduction of intussusception using flow-through pneumatic insufflation were developed experimentally. In the 2nd decade the algorithm for treatment of intestinal intussusception was developed; the indications for non-surgical reduction of intussusception were extended. 5 (22.7%) children out of 22 with disease duration of more than 24 hours and 6 (46.2%) children out of 13 over 1 year of age underwent non-surgical reduction of intussusception. In the 3rd decade the indications for non-surgical reduction of intussusception were extended. 11 (57.9%) children out of 19 with disease duration of more than 24 hours and 20 (74.1%) children out of 27 over 1 year of age underwent non-surgical reduction of intussusception. Only in 4 (28.5%) children out of 14 over 1 year of age who were operated on, we found out anatomical cause of the condition. We have analized the experience in treating 11 children with 16 recurrences of intestinal intussusception. In 7 cases non-surgical reduction was performed, 4 children were operated on. During surgeries there were observed no anatomical causes or predispositions to intussusception. Lethal outcomes were not registered.Conclusions. Thus, flow-through pneumatic insufflation is an effective and objective technique of non-surgical reduction of intestinal intussusception in infants. Non-surgical reduction of intestinal intussusception can be performed in the majority of patients without the signs of peritonitis. The duration of the condition, age of patients and the presence of recurrence should not be considered as absolute criteria in choosing treatment tactics in intestinal intussusception.