L’INVAGINATION INTESTINALE PROLABEE A L’ANUS CHEZ L’ENFANT : ETUDE CLINIQUE ET ASPECTS THERAPEUTIQUES: ETUDE CLINIQUE ET ASPECTS THERAPEUTIQUES

Abstract

Aim: To analyze clinical and therapeutic aspects of prolapsed intussusceptions in Dakar. Patients and methods: A retrospective study was conducted from June 1998 to November 2009 in the Pediatric Surgery Department. Nine children including 7 boys and 2 girls with an average age of 7.6 months presented prolapsed intussusception. Clinical aspects taken into consideration were the consultation period, complains and general and physical signs. Therapeutic aspects studied were the intervention period, operative findings, therapeutic methods and post-operative recovery. The mean follow-up period was 30 months. Results: All children were referred for rectal prolapse. History taken from parents revealed: vomiting (8/9), excessive crying (7/9) and rectal bleeding (4/9). Five children presented malnutrition and dehydration. Physical examination revealed abdominal distension in all cases. Characteristics of the prolapsed mass and the presence of a sulcus between it and the rectal wall allow the diagnosis of prolapsed intussusception. Surgery discovered a long mesentery (8/9) and lack of colic apposition (7/9). In 5 children, a disinvagination by manual expression was successful. Bowel resection was performed in 4 children who presented intestinal necrosis. The post-operative course was uneventful in 4 cases; evisceration was noted in one case and one child presented wound suppuration. Three children died within 48 hours post-operatively. Conclusion: Clinical aspects allow to differentiate rectal prolapse from prolapsed intussusception. Surgical treatment is safer because of the delayed presentation. Key words: prolapsed, intussusceptions, children, sulcus, surgical treatment