‘’MANAGEMENT OF PAEDIATRICS INTUSSUSCEPTION IN TERTIARY CARE CENTRE’’

Abstract

Background- Intussusception is a medical emergency that occurs in children when a part of the bowel 'telescopes' (folds) into another part of the bowel. This causes pain, vomiting, and obstruction, preventing passage. If left untreated, the bowel can perforate, resulting in passage of its contents into the abdominal cavity, causing further complications. In rare cases, these events can cause death. Prompt diagnosis and management reduces associated risks and the need for surgery.

Aims and objective- ‘’Management of paediatrics intussusception in tertiary care centre’’.

Methods- This prospective study included paediatric patients with acute intussusception admitted to the Department of Paediatric Surgery, SMS medical college and hospital Jaipur, from January 2023 to June 2023 for six months periods. The inclusion criteria were- age 0–10 years, diagnosed with intussusception. The exclusion criteria were- combined with other surgical acute abdominal conditions, history of previous abdominal surgery and missing data. All children were diagnosed by abdominal ultrasound, showing a “target ring sign” or a “concentric circle sign” in the transverse section and a “sleeve sign” in the longitudinal section. The clinical data of all children were prospectively collected from historical medical recorders, including sex, age, month of onset, disease duration, etiology, clinical symptoms, intussusception depth, treatments, outcomes, and relapses. Statistical analysis SPSS 19.0 (IBM, Armonk, NY, USA) was used for data analysis. Continuous data were expressed as means±standard deviation and analysed using Student’s t-test. Categorical data were expressed as n (%) and analysed using the chi-square test. Two-sided P-values5 years old.

Results- total 100 patients included in this study, males are most commonly affected than female, M/F =3/1 in this study. Most of the patient affected in age group of 12-24 months of age group. Most of the patient’s hospital visit time after symptoms are 12-24 hours. The disease onset was most frequent in April (25%), but it occurred throughout the time without an obvious central tendency. Among the 100 children, 86 (86%) had abdominal pain (young infants presented as paroxysmal crying), 50% have vomiting, and 10 patients (10%) had a typical triad of intussusception (abdominal pain +bloody stools +abdominal mass). Most of the patient have no any etiology for disease found, 10% have history of diarrhoea, 15% have vaccination history, 10% have infection history found. The average intussusception depth was 4.0±1.4 cm, with the shortest being 1.1 cm, the longest being 9.0 cm, and the median being 3.9 cm. 15% were treated with enema reduction, and those not relieved by the initial enema were given repeat air enema. Those who still could not be reduced by delayed enemas were considered as cases of reduction failure. The cases of reduction success were 15%. There were 5 cases of reduction failure, which were all successfully reduced by conversion to surgical reduction. Among them, one case of jejuno-ileal, 10% ileo-ileal and 9% colo-colic types. Most cases are ileo-colic types. No significant abnormalities were found during the intraoperative probing from the ileocecal to the proximal intestinal canal 1.5 cm in length. out of 100 patients, 2 patients come with recurrence of disease within one years. out of surgically repaired patients, two patients have wound infection and one patient goes into paralytic ileus, which managed conservatively.

Conclusions- Paediatric acute intussusception is common. There was no obvious etiology. The clinical manifestations are mostly atypical. Abdominal pain is the most common complaint. Air enema reduction is an effective treatment