Intussusception in children: not only surgical treatment

Abstract

Introduction: Intussusception is the commonest cause of acute in­testinal obstruction in children. Failure of timely diagnosis and treatment results in a surgical emergency leading to fatal outcome. The classic triad of symptoms is seen in less than one-third of the children affected. Aim of this study was to evaluate the comprehensive management of intussusception in children, evaluating the outcome of conservative treatment with hydrostatic ultrasound reduction and surgery.

Material and methods: A retrospective analysis was conducted including pediatric patients (up to 14 years old) with diagnosis of bowel intussusception. The management and treatment depended on the patients’ situation: for children in good general conditions initial hydrostatic reduction under continuous ultrasonographic monitoring was attempted; if severe dehydration and/or septic shock was observed, the conservative treatment was contraindicated and direct surgical treatment was performed.

Result: A total of 44 pediatric patients were included in the study. The most frequent symptoms observed were paroxysmal abdominal pain (100% of cases) and vomiting (72%); only 29% of patients presented with the classic triad of symptoms (abdominal pain, palpable mass and blood stained stools). 28 patients (64%) were managed conservatively with ultrasound hydrostatic reduction. 10 patients (23%) required primary surgical intervention because of clinical conditions; 6 patients (14%) were operated after failure of conservative approach. The total percentage of operated patients was 36%, with lead points identified in 12 cases.

Conclusion: Our data confirm that hydrostatic reduction is a simple, real time procedure, free of radiations, non invasive and safe. Age had no impact on the reducibility whereas bloody stool, a prolonged duration of symptoms and the presence of lead point were risk factors of failure.