CHILDHOOD INTUSSUSCEPTION IN A REGIONAL-HOSPITAL

This study reviews all childhood intussusceptions treated over a 6 yea r period in a regional centre with six visiting general surgeons and t wo paediatricians. Clinical presentation, management, complications an d outcomes were noted and an attempt was made to follow up all cases. There were 20 patients, with a median age of 6 months (range 10 weeks to 17 months). Only one patient had all four classical features of int ussusception (pain, vomiting, 'red currant jelly' stools and abdominal mass). Seven patients were managed successfully by barium enema reduc tion, but 14 required operation, four following failed radiological re duction. There was one intestinal perforation due to attempted barium enema reduction and one patient required a reoperation for ileal gangr ene following operative reduction. There were no deaths and there have been no subsequent recurrent intussusceptions although three cases we re lost to follow up. There was a delay in diagnosis in some cases (av erage duration from onset to diagnosis was 34 h). Although delay was i ncurred by parents in some cases and in peripheral hospitals in others , there is a need for greater awareness by surgeons of the significanc e of subtle features such as pallor and lethargy in a child with persi stent vomiting. Delay in diagnosis is likely to lead to an increased n eed for primary surgical intervention. Adverse features (age > 3 month s or < 2 years; symptoms > 24 h; small bowel obstruction; dehydration > 5%) were predictive of an increased likelihood of surgical resection , and may help avoid inappropriate attempts at radiological reduction. A protocol for the management of suspected childhood intussusceptions may improve results in regional centres that treat small numbers of c ases.