Presentation and management outcome of children with intussusception at Tenwek Hospital, Kenya

East and Central African Journal of Surgery Pub Date : 2016-11-14 DOI:10.4314/ECAJS.V21I2.8

P. B. Ooko, M. Oloo, V. Mwaka, W. Russell

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引用次数: 3

Abstract

Background: Intussusception, a common cause of Intestinal obstruction in infants and young children, occurs when one segment of the bowel invaginates into a distal segment. While non-operative reduction has been well described, surgery remains the predominant mode of therapy in many developing countries due to delayed presentation. This study aimed to describe the presentation, management and outcome of children with intussusception at a single institution. Method: A retrospective review of patients aged 16 years and below with intussusception managed at Tenwek hospital from January 2009 through December 2014 was undertaken. Diagnosis was based on the presenting signs, symptoms, physical findings and plain upright or supine abdominal X-rays, and confirmed via ultrasonography, barium enema or at surgery. Results: A total of 45 cases (24 boys, 21 girls) of intussusception were noted, with a mean age of 2.6 years (range 1 month-15 years). The mean duration between symptom onset and presentation was 4.4 days (range 1-14), and the classic triad (vomiting, bloody mucoid stools and abdominal pain/distension) was noted in 27 (60%) cases. Abdominal ultrasound was diagnostic in 7 of the 11 cases ordered, with the rest diagnosed clinically. Non-operative reduction was undertaken in 4 cases and successful in 3. Surgery was performed in 42 cases with bowel gangrene and perforation noted in 20 (47.6%) and 15 (35.7%) cases respectively. The main types of intussusception were ileocolic (23, 51.1%), colocolonic (10, 22.2%) and ileoceacal (7, 15.6%). Five (11.1%) mortalities and 4 (8.8%) morbidities were noted at discharge, most commonly being surgical site infection in three cases. Conclusion: Intussusception, in this series, was primarily diagnosed clinically and managed surgically, with a majority of the patients having gangrenous or perforated bowel at laparotomy. Keywords: Intussusception, children, management, outcome, Kenya

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肯尼亚tenweek医院儿童肠套叠的表现和治疗结果

背景:肠套叠是婴幼儿肠梗阻的常见原因，当肠的一部分内陷到远端肠段时发生。虽然非手术复位已被很好地描述，但由于延迟表现，手术仍然是许多发展中国家的主要治疗模式。本研究旨在描述在单一机构中肠套叠患儿的表现、处理和结果。方法:回顾性分析tenweek医院2009年1月至2014年12月收治的16岁及以下肠套叠患者。诊断依据表现体征、症状、体格检查和普通直立或仰卧腹部x光片，并通过超声、钡灌肠或手术确诊。结果:本组共收治45例肠套叠患者，其中男24例，女21例，平均年龄2.6岁(范围1个月-15岁)。从症状出现到出现的平均持续时间为4.4天(范围1-14天)，27例(60%)患者出现了典型的三联征(呕吐、带血粘液便和腹痛/腹胀)。11例中腹部超声诊断7例，其余临床诊断。非手术复位4例，成功3例。手术治疗42例，其中肠坏疽20例(47.6%)，穿孔15例(35.7%)。肠套叠的主要类型为回结肠(23例，51.1%)、结肠(10例，22.2%)和回盲肠(7例，15.6%)。出院时死亡5例(11.1%)，发病4例(8.8%)，最常见的是3例手术部位感染。结论:在本病例中，肠套叠主要是临床诊断和手术治疗，大多数患者在剖腹手术时出现坏疽或肠穿孔。关键词:肠套叠，儿童，管理，结果，肯尼亚

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East and Central African Journal of Surgery

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