R T Kuremu1. 1. Department of Surgery, Faculty of Health Sciences, Moi University, Eldoret, Kenya.
Abstract
OBJECTIVE: To review the management of childhood intussusception at the Moi Teaching and Referral Hospital, Eldoret and identify factors that require attention for improved outcome. DESIGN: A retrospective descriptive study covering the period January 2000 to December 2003. SETTING: Moi Teaching and Referral Hospital, Eldoret. PATIENTS: Thirty six children. RESULTS: Of the 36 children, 28 (78%) were males and eight (22%) females giving a ratio of 3.5:1. Median age was six months with a range of 2-72 months. The duration of symptoms was a mean of 5 days with a range of 1-14 days. Sixty one percent were referrals. Initial diagnosis of intussusception based on signs and symptoms was made in 6 out of 36 (17%) patients. The rest were initially treated for other problems. Decision to refer to surgeons, was based on abdominal distension. Plain x-ray was done in four patients and barium enema in one patient. Seventy five percent of the patients required fluid resuscitation before operation. All patients (100%) were managed operatively. Seventy two percent had ileo-colic intussusception, 8% ile-oileal and 22% colo-colic. Perforation was found in 22% and gangrene in 31%. Sixty seven percent were successfully reduced by "milking" while 33% required resection and anastomosis/or stoma creation. Complications included: anastomatic breakdown, bronchopneumonial renal failure, sepsis, recurrent intussusception and death. Mortality was 14% overall. CONCLUSION: Early diagnosis and presentation coupled with improved peri-operative management are essential in improving outcome.
OBJECTIVE: To review the management of childhood intussusception at the Moi Teaching and Referral Hospital, Eldoret and identify factors that require attention for improved outcome. DESIGN: A retrospective descriptive study covering the period January 2000 to December 2003. SETTING: Moi Teaching and Referral Hospital, Eldoret. PATIENTS: Thirty six children. RESULTS: Of the 36 children, 28 (78%) were males and eight (22%) females giving a ratio of 3.5:1. Median age was six months with a range of 2-72 months. The duration of symptoms was a mean of 5 days with a range of 1-14 days. Sixty one percent were referrals. Initial diagnosis of intussusception based on signs and symptoms was made in 6 out of 36 (17%) patients. The rest were initially treated for other problems. Decision to refer to surgeons, was based on abdominal distension. Plain x-ray was done in four patients and barium enema in one patient. Seventy five percent of the patients required fluid resuscitation before operation. All patients (100%) were managed operatively. Seventy two percent had ileo-colic intussusception, 8% ile-oileal and 22% colo-colic. Perforation was found in 22% and gangrene in 31%. Sixty seven percent were successfully reduced by "milking" while 33% required resection and anastomosis/or stoma creation. Complications included: anastomatic breakdown, bronchopneumonial renal failure, sepsis, recurrent intussusception and death. Mortality was 14% overall. CONCLUSION: Early diagnosis and presentation coupled with improved peri-operative management are essential in improving outcome.
Authors: Richard Omore; Francis Osawa; Janet Musia; Brian Rha; Amina Ismail; Nicholas Mukaria Kiulia; Fenny Moke; John Vulule; Anthony Mungai Wainaina; John Tole; Stanley Mugambi Machoki; J Pekka Nuorti; Robert F Breiman; Umesh D Parashar; Joel M Montgomery; Jacqueline E Tate Journal: J Pediatric Infect Dis Soc Date: 2015-08-25 Impact factor: 3.164