Vol 9, No 3 (2007)
Published online: 2008-01-04
Intussusception in children - a change in management strategy
Chirurgia Polska 2007;9(3):162-169.
Abstract
Background: Intussusception is one of the most frequent causes of intestinal obstruction in children
created by telescope-like invagination of the proximal bowel into the adjacent distal bowel.
This study is a comparison of methods and results of treatment of children with intussusception treated in
one centre of pediatric surgery during two periods of time.
Material and methods: The incidence of intussusception regarding the sex and age of children, the method of treatment, as well as the number and kind of complications was analyzed in two groups; group 1 - 15 children (10 boys and 5 girls), aged 3 days to 24 months (mean 8.1 months), hospitalized during 1993-1998, and group 2 - 25 children (19 boys and 6 girls), aged 3 months to 10 years (mean 17 months), treated during the period of 1999-2005.
Results: In both examined groups, boys prevailed (67% and 76%) and intussusception occurred more frequently in children between 2 and 9 months of age. All children from group 1 underwent surgery, while in group 2 the operation was performed in 8 patients (32%) and in the remaining 17 children (68%) hydrostatic contrast enema under fluoroscopy was done. It was successful in 16 patients, in 1 instance a conversion to the open operation was done. Complications such as necrosis and perforation were observed in 3 children (20%) from group 1 and in 3 patients (12%) from group 2. In all these patients, a segmental resection of the intestine with following anastomosis or creation of the stoma was performed.
Conclusions: A change in management strategy enabled one to limit the indications for operative treatment in children with intussusception (37% vs. 100%), while not causing an increase of the frequency of complications at the same time. The majority of complications was observed in patients not meeting criteria for a hydrostatic enema and qualified for a laparotomy. A hydrostatic contrast enema, while keeping strict criteria regrading qualifications, is, in the authors’ opinion, the treatment of choice in children with intussusception.
Material and methods: The incidence of intussusception regarding the sex and age of children, the method of treatment, as well as the number and kind of complications was analyzed in two groups; group 1 - 15 children (10 boys and 5 girls), aged 3 days to 24 months (mean 8.1 months), hospitalized during 1993-1998, and group 2 - 25 children (19 boys and 6 girls), aged 3 months to 10 years (mean 17 months), treated during the period of 1999-2005.
Results: In both examined groups, boys prevailed (67% and 76%) and intussusception occurred more frequently in children between 2 and 9 months of age. All children from group 1 underwent surgery, while in group 2 the operation was performed in 8 patients (32%) and in the remaining 17 children (68%) hydrostatic contrast enema under fluoroscopy was done. It was successful in 16 patients, in 1 instance a conversion to the open operation was done. Complications such as necrosis and perforation were observed in 3 children (20%) from group 1 and in 3 patients (12%) from group 2. In all these patients, a segmental resection of the intestine with following anastomosis or creation of the stoma was performed.
Conclusions: A change in management strategy enabled one to limit the indications for operative treatment in children with intussusception (37% vs. 100%), while not causing an increase of the frequency of complications at the same time. The majority of complications was observed in patients not meeting criteria for a hydrostatic enema and qualified for a laparotomy. A hydrostatic contrast enema, while keeping strict criteria regrading qualifications, is, in the authors’ opinion, the treatment of choice in children with intussusception.
Keywords: intussusceptionoperative treatmenthydrostatic contrast enemacomplicationschildren
