versão On-line ISSN 2078-5151
S. Afr. j. surg. vol.50 no.2 Cape Town Mai. 2012
Kaan Sonmez; Zafer Turkyilmaz; Billur Demirogullari; Ramazan Karabulut; Nuri Kale; A. Can Basaklar
M.D.; Department of Pediatric Surgery, Gazi University Medical Faculty, Ankara, Turkey
AIM: The aim of this study was to present our experience in patients with intussusception (IN).
MATERIALS AND METHODS: One hundred and five cases of IN treated between 1991 and 2007 were analysed. Age, gender, symptoms, signs, diagnostic and treatment methods, types of IN including leading point, and postoperative complications were evaluated.
RESULTS: The mean age of the patients was 2.5 years (range 1 month - 15 years). Fifty-nine per cent (62/105) were under 1 year of age, and of these 28% were receiving therapy for upper respiratory tract infection. The most common symptom was colicky abdominal pain. Rectal bleeding was present in all patients under 2 years of age. In 23 children (21.9%) leading points were detected. Thirty per cent of the patients were older than 4 years, and 76.6% of these had leading points. Ultrasonography demonstrated the invaginated segment in 93 patients. Hydrostatic reduction was attempted in 71.4% (75) of the patients and was successful in 48% (36), 70% of whom were under 1 year of age. Of the patients with unsuccessful hydrostatic reduction, 11 required intestinal resection and primary anastomosis and 35 manual reduction. Twenty-four patients were diagnosed by means of ultrasonography and were operated on immediately. Ten of these patients had signs of peritonitis on admission and were treated by resection-primary anastomosis.
CONCLUSION: In patients with IN under 2 years of age, hydrostatic or pneumatic reduction may be successful. Considering the high incidence of leading points in older children, one should not persist with reduction but should rather design a treatment plan accordingly, i.e. laparotomy with manual reduction or resection.
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1. Ein SH, Alton D, Palder SB, Shandling B, Stringer D. Intussusception in the 1990s: has 25 years made a difference? Pediatr Surg Int 1997;12:374-376. [ Links ]
2. Slam KD, Teitelbaum DH. Multiple sequential intussusceptions causing bowel obstruction in a preterm neonate. J Pediatr Surg 2007;42(7):1279-1281. [ Links ]
3. Kaiser AD, Applegate KE, Ladd AP. Current success in the treatment of intussusception in children. Surgery 2007;142(4):469-475. [ Links ]
4. Le Masne A, Lortat-Jacob S, Sayegh N, Sannier N, Brunelle F, Cheron G. Intussusception in infants and children: feasibility of ambulatory management. Eur J Pediatr 1999;158:707-710. [ Links ]
5. Vestergaard H, Westergaard T, Wohlfahrt J, Pipper C, Melbye M. Association between intussusception and tonsil disease in childhood. Epidemiology 2008;19(1):71-74. [ Links ]
6. Fischer TK, Bihrmann K, Perch M, et al. Intussusception in early childhood: a cohort study of 1.7 million children. Pediatrics 2004;114(3):782-785. [ Links ]
7. Reijnen HA, Joosten HJ, de Boer HH. Diagnosis and treatment of adult intussusception. Am J Surg 1989;158:25-28. [ Links ]
8. Grant HW, Buccimazza I, Hadley GP. A comprarison of colo-colic and ileo-colic intussusception. J Pediatr Surg 1996;31(12):1607-1610. [ Links ]
9. Yoo RP, Touloukian RJ. Intussusception in the newborn: a unique clinical entity. J Pediatr Surg 1974;9:495-498. [ Links ]
10. Saxena AK, Seebacher U, Bernhardt C, Höllwarth ME. Small bowel intussusceptions: issues and controversies related to pneumatic reduction and surgical approach. Acta Paediatr 2007;96(11):1651-1654. [ Links ]
11. Sargent MA, Babyn P, Alton DJ. Plain abdominal radiography in suspected intussusception: a reassessment. Pediatr Radiol 1994;24:17-20. [ Links ]
12. Shanbhogue RL, Hussain SM, Meradji M, Robben SG, Vernooij JE, Molenaar JC. Ultrasonography is accurate enough for diagnosis of intussusception. J Pediatr Surg 1994;29(2):324-328. [ Links ]
13. Meyer JS, Dangman BC, Buonomo C, Berlin JA. Air and liquid contrast agents in the management of intussusception: a controlled, randomized trial. Radiology 1993;188(2):507-511. [ Links ]
14. Moore SW, Kirsten M, Müller EW, et al. Retrospective surveillance of intussusception in South Africa, 1998-2003. J Infect Dis 2010;202:S156-161. [ Links ]