INTUSSUSCEPTION IN CHILDREN - INTERNATIONAL PERSPECTIVE

Fifty consecutive cases of children with intussusception treated at a hospital in a developing country were compared with 50 consecutive cas es treated at an American inner city children's hospital and 50 consec utive cases treated at an American referral children's hospital. The p lan was to recommend ways of improving the treatment of children with intussusception in the developing world. Nonoperative reduction was at tempted in the two American hospitals but was not available in the dev eloping world hospital where all children were treated operatively, Ch ildren in the developing world hospital had a significantly longer dur ation of symptoms, an increased incidence of nonviable bowel, and a mo rtality of 18%. There were no deaths in either American hospital, The poorer outcome for developing world children was related to delay in t reatment, the higher incidence of nonviable bowel, and the lack of ade quate nursing care for acutely ill children. The use of nonoperative r eduction would not have significantly improved the mortality rate amon g the developing world children, The mortality can best be reduced by: (1) earlier recognition and treatment of the intussusception; and (2) improvement in the postanesthetic care with better monitoring leading to prompt recognition and treatment of postoperative complications.