Transanal protrusion of intussusceptions in children.

Abstract

The aim of the following study is to report our management experience and outcome of transanal protrusion of intussusceptions. Retrospective analysis of all cases of intussusceptions protruding through the anal opening from January 2008 to June 2013. Of 62 cases of intussusceptions, transanal protrusion occurred in 10 patients (16% anal protrusion rate) with a male:female ratio of 2:3. They were aged 4-96 months (mean 22.6 ± 30.7, median 7.5 months). Six were infants while four were above 1 year. Duration of symptoms ranged from 2 to 14 days (mean 5.9 days ± 3.4) with only two patients presenting within 48 h. Clinical features included vomiting (100%), abdominal pains (100%), bloody mucoid stool (100%), abdominal distension (90%), and palpable left iliac fossa mass (70%). Three patients had preceding diarrhoea (30%) and two had preceding upper respiratory tract infection (20%). Duration of hospital stay ranged from 5 to 23 days (mean 12 days ± 5.6). Findings at surgery included seven ileocolic and two colocolic intussusceptions (one patient died before surgery). Operative procedures were right hemicolectomy (5), operative manual reduction (3), left hemicolectomy (1) giving a 67% bowel resection rate. One patient died giving a 10% mortality rate. Transanal protrusion occurred more in females and is associated with late presentation, older age, high bowel resection rate, and high mortality.