Journal Reading Intussusepsi

7/21/2019 Journal Reading Intussusepsi

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INTUSSUCEPTION IN CHILDREN :

EXPERIENCE WITH 105 PATIENTS

IN A DEPARTMENT OF

PAEDIATRIC SURGERY, TURKEY

Journal reading


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Introduction

Intussusception (IN) is a common cause of bowelobstruction in infants and children. Usually acombination of one symptom and two signs are

noted: colicky pain, bloody stools, and a mass in theabdominal area

he diagnosis of IN is established by means ofphysical e!amination, a plain abdominal radiograph,

and ultrasonography (U"#). reatment modalitiesare both non$operati%e and operati%e.


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&aterial and methods

'ata on patients treated for IN between January and 'ecember *++ were studiedretrospecti%ely, looking at patient ages,

symptomatology, diagnostic and treatment methodsused, and operati%e findings

-bdominal U"# and barium enema e!aminationwere the primary diagnostic tools


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results

ne hundred and fi%e children with IN (* males, //females) were treated. he mean age of the patients

was *.0 years (range month $ 0 years)1 2* (03)

were younger than year, and of these *43 wererecei%ing treatment for upper respiratory tractinfection.


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'iscussion

he incidence of IN in children is $ 56.+++, and infantsaged /$4 months of age are the most commonly affectedgroup.

he mean age of the patients in our series was *.0 years,

which is older than generally reported. In our series 24.03were males, which is a higher proportion than reported inthe literature (2+3).

- history of %iral infection of the upper respiratory tract has

been reported in *+ $ 0+3 of patients with IN.In this series, *43 of the patients under year of age (n7/0)

were on treatment for upper respiratory tract infection.


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IN has been reported to be ileocolic in more than4+3 of cases.,/,5 In our series, patients (2.3)had ileocolic IN. his rate is lower than those

reported by others, and the difference may be due toa high number of leading points and postoperati%ecases of IN.

he incidence of leading points in the literature in

paediatric cases is nearly * $ *3. - leading pointwas detected in */ (*.3) of our patients, and2.23 of these were older than 5 years.


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&eckel8s di%erticulum,polyps and tumours ha%ebeen listed as the most common reasons for aleading point.4 In our series, the most common

leading points were &eckel8s di%erticulum and 9".he high rate of leading points may ha%e been due to

the facilities offered to these patients by a tertiaryhospital (able *).


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he main complaint on presentation was crampingabdominal pain, the pre%alence of which was 4*.43(n74)1 in the literature it has been reported to be +

$ 403., ther findings were %omiting (4.3),diarrhoea (.3) and con%ulsions (+.3).


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he pre%alence of bleeding determined by rectale!amination (4/ patients, 3) is higher than therates in other reported series. his high rate may

ha%e been due to delayed presentation and6or thehigh rate of leading points in our series.

- palpable abdominal mass was detected in 0 of ourpatients (05.*3), the pre%alence reported in the

literature being ** $ 4+3.


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;arium e!amination of the rectum and U"# areamong the imaging methods used in diagnosing IN

- plain abdominal radiograph aids in differentiating

between a soft$tissue mass and colonic gasIn a clinical study the sensiti%ity and specificity of

U"# were found to be ++3 and 4.03, respecti%ely


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;arium or pneumatic reduction is a method oftreating IN in cases with no acute abdominal andseptic findings.

he success rate of these methods ranges between3 and 403

he perforation rate with both methods has beenreported to be * $ /3


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he passage of barium or air to the terminal ileumhas been considered a criterion for a successfulreduction

;arium reduction was performed in 0 patients inour series and was successful in /2 (543). f thesepatients, +3 were under year of age.


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-ccording to orty per cent of patients submitted to surgery

underwent intestinal resection because ofperforation, peritonitis, gangrenous bowel, or failureto reduce e%en at surgery


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his incidence of surgery and bowel resection ismuch higher than those in some internationalsettings and is representati%e of the situation inde%eloping countries

-nother e!planation for the high rate of surgicalinter%ention in our series may be late presentationand6or delayed diagnosis.


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?onclusion

In conclusion, we recommend hydrostatic orpneumatic reduction for patients with IN under *

years of age when no acute abdominal and6or septicfindings are present

In patients o%er 5 $ 0 years of age, the presence of anunderlying leading point should be kept in minde%en if barium reduction is successful

It should also be remembered that the rate of leadingpoints may be higher in tertiary hospitals and inde%eloping countries.

Journal Reading Intussusepsi

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