A CLINICAL STUDY OF INTUSSUSCEPTION IN CHILDREN

Background: Intussusception is one of the classic subjects of paediatric surgery. It is defined as the telescoping of one segment of bowel into another. It is one of the most common paediatric emergencies under the age of 2 years and is an important cause of small bowel obstruction in children if left untreated leads to fatal complications.Early diagnosis helps to reduce mortality and morbidity.For many years open surgery has been its mode of treatment worldwide but since few years there is a paradigm shift in its management from immediate laparotomy after resuscitation to non-operative management. The current non-operative methods which are being used in the management of intussusception include hydrostatic and pneumatic method i.e., giving enema by using fluid or air. The pneumatic method of reduction of intussusception under ultrasound guidance is emerging as the method of choice for the management of intussusception in children.

Aims & Objectives

1.      To study the clinical profile of paediatric patients with intussusception.

2.      To assess the ultrasound guided pneumatic reduction of intussusception in children.

3.      To study the complications and recurrence rate after the ultrasound guided pneumatic reduction of intussusception.

Materials And Methods

After obtaining Ethical committee clearance from the VIMS Bellary, a prospective case series study of 50 children who were admitted in Vijayanagar Institute of Medical Sciences, Bellary with diagnosis of acute intussusception was conducted. The study period was between November 2012 to April 2014. Informed written consent was obtainedfrom all the cases. Thorough clinical history was taken and physical examination including per rectal examination was done. All children clinically suspected of having acute intussusception were evaluated by real time ultrasonography and those with positive findings on sonography confirming intussusception were entered into the study. Thusthe clinical profile of intussusception and ultrasound guided pneumatic reduction was studied.

Results: Higher male preponderance was observed in our study, out of 50 patients who reported to us, 36 (72%) were males and 14 (28%) were females with highest proportion of cases 34 (68%) seen in the age group of 0 to 1 year. Most of the clinical symptoms were overlapping. The predominant symptoms in most of the cases in our study are excessive crying/abdominal pain seen in all 50 patients (100% followed by vomiting and mass per abdomen seen in 40 (80%) of the cases respectively. Most of the cases 78 (39) were idiopathic type and 22 % (11) cases were secondary to lead points most common lead points being Mesenteric lymph nodes seen in 6 (54.5%) cases followed by Meckels diverticulum and gut associated lymphoma seen in 2 (18.1%) cases respectively. Appendix as a lead point was seen in 1 case (9.09%). The most common type of intussusception was found to be ileo-colic with 31 (62%) cases being reported.Out of the total 50 patients, 4 had spontaneous reduction of intussusception.Pneumatic reduction under ultrasound guidance was performed in 45 cases and directoperative intervention was carried out in 1 patient. Successful reduction was seen in 38 (84.4%) cases and failure of reduction was seen in 7 (15.55%) cases that were eventually taken up for surgery. No complications of pneumatic reduction, like intestinalperforation rectal tear, were observed in our study.

Conclusion: Intussusception is one of the most common paediatric emergencies. In ourstudy a higher male preponderance is seen with highest proportion of cases seen in theage group of 0 to 1 year. Two peaks of seasonal variation were observed in our study onein winter and other in summer. Most of the clinical symptoms were overlapping, thepredominant symptoms being excessive crying/abdominal pain, vomiting, mass per abdomen and red currant jelly stools. Majority of cases are idiopathic and are of ileo-colic type. Secondary intussusception occurs due to the presence of lead points. Most common lead points in our study are mesenteric lymph nodes, Meckels diverticulum,gut associated lymphomas and appendix.With the review of the available literature and observations made in our study, the standard mode of treatment in a child with acute intussusception is non operative.The present study on ultrasound guided pneumatic reduction in children with acute intussusception shows that ultrasound is a simple and reliable method for diagnosis of intussusception. The success rate achieved by Ultrasound guided pneumatic reduction ofintussusception is high with no or very few complication rates. The entire reductionprocess can be followed on real time ultrasound and in cases of non-reduction or partial reduction, repeated attempts can be safely performed in the same setting. The occurrenceof surgical lead points increases with age and indicates that the probability of non-operative reduction is unlikely, however ultrasound guided pneumatic reduction can stillbe safely tried in such cases.The use of ultrasound for guiding reduction also has the added advantage ofavoiding hazardous radiation exposure to the child as well as the attending surgeon.Ourdata in this study suggeststhat Pneumatic reduction performed under ultrasoundguidance is a simple, safe, reliable, accurate and less-messier technique for paediatricintussusception with high success rates.