Abstract
BackgroundIntussusception remains a common cause of bowel obstruction in children and results in significant morbidity and mortality if not promptly treated. There is a paucity of prospective studies regarding childhood intussusception in Tanzania and particularly the study area. This study describes the pattern, clinical presentations and management outcomes of childhood intussusception in our setting and highlights the challenging problems in the management of this disease.MethodsThis was a prospective descriptive study of patients aged < 10 years operated for intussusception at Bugando Medical Centre. Ethical approval to conduct the study was obtained from relevant authorities. Data was analyzed using SPSS version 17.0.ResultsA total of 56 patients were studied. The male to female ratio was 3.3: 1. The median age was 6 months. Three-quarter of patients were < 1 year. Etiology was mainly idiopathic in 91.1% of cases. The classic triad of bloody stool, vomiting and abdominal distention/abdominal pain was found in 24 (42.5%) patients. The diagnosis of intussusception was mainly clinically in 71.4% of cases. All patients were treated surgically. Ileo-colic was the most frequent type of intussusception (67.9%). Twenty-six (46.4%) patients required bowel resection. The rate of bowel resection was significantly associated with late presentation > 24 hour (p = 0.001). Complication rate was 32.1% and surgical site infection (37.5%) was the most frequent complication. The median length of hospital stay was 7 days. Patients who had bowel resection and those who developed complications stayed longer in the hospital and this was statistically significant (p < 0.001). Mortality rate was 14.3%. Age < 1 year, delayed presentation, associated peritonitis, bowel resection and surgical site infection were the main predictors of mortality (p < 0.001). The follow up of patients was generally poorConclusionIntussusception in our setting is characterized by late presentation, lack of specialized facilities and trained personnel for nonsurgical reduction. Therefore, surgery remains the main stay of treatment in our centre. A high index of suspicion and proper evaluation of patients is essential for an early diagnosis and timely definitive treatment, in order to decrease the morbidity and mortality associated with this disease.
Highlights
Intussusception remains a common cause of bowel obstruction in children and results in significant morbidity and mortality if not promptly treated
The rate of bowel resection was significantly associated with late presentation > 24 hour (p = 0.001)
Three-quarters of patients were in the first year of life which is in agreement with other studies done elsewhere [1,16,21,22,23,24], but at variant with other reports in Nigeria that associated childhood intussusception with the above 5 years age group [25,26]
Summary
Intussusception remains a common cause of bowel obstruction in children and results in significant morbidity and mortality if not promptly treated. Intussusception is defined as the invagination of a proximal segment of the intestine into a distal segment of the intestine [1] It remains a common cause of bowel obstruction in infancy and young children and results in significant morbidity and mortality if not promptly treated [1,2]. In the United States, approximately two-thirds of cases occur below the age of 1 year [3]. Gender difference becomes marked; in patients older than 4 years, the male-to-female ratio is 8:1 [2,3]
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