Intussusception : Experience in 507 Thai Pediatric Patients
Background Purpose: Intussusception remains an important cause of intestinal obstruction in children under the age of 2 years. Management of this disease has continuously improved with better outcomes. This study aims to review our experience in patients with intussusception at a referral center for children in Thailand.
Methods: Medical records of patients treated from January 1, 1988 to December 31, 1998 for intussusception at the Queen Sirikit National Institute of Child Health were reviewed. Information about clinical manifestations, radiological findings and results of treatment were obtained. The statistical differences were analyzed by the Chi-square and the Z-test.
Results: Five-hundred and seven patients with 549 episodes of intussusception were available for the review. Two-hundred and eighty-eight (56.8%) were male and 219 (43.2%) were female. About 80 percent of patients were under one year of age with the peak incidence at 6 months. The disease was found in every month with the highest incidence between January to March. Vomiting was the most common symptom, being found in 90 percent of the patients. Bloody stool, abdominal pain and palpable abdominal mass were found in 75, 72 and 57 percent respectively. Radiological findings revealed complete intestinal obstruction and soft tissue mass in 65 and 32 percent of the cases.
Hydrostatic barium enema (BE) reduction was attempted in 211 episodes and found to be successful in 135 (64 %) with a colonic perforation in 3 cases. Pneumatic reduction was attempted in 243 episodes and found to be successful in 178 (73 %). Surgical treatment was needed in 234 episodes. Of these, manual reduction was successful in 158, intestinal resection was required in 68. Appendectomy only was done in the remaining 8 patients because complete reduction was noted during exploration. Leading points were recorded in 20 patients (3.9 %). Meckel's diverticulum (8 cases) and intestinal polyp (5 cases) were the most common causes. The overall mortality rate was 0.8 percent (4 cases) and all the deaths occurred after intestinal resection due to bowel necrosis and septicemia.
Conclusion: Treatment outcomes of intussusception have continuously been improved. Non-operative reduction should be the initial management, unless the patients had contraindications for such intervention, because it has the lowest incidences of morbidity and mortality.
2. Stevenson RJ. Non-neonatal intestinal obstruction in children. Surg Clin North Am 1985; 65: 1217-34.
3. Hamby LS, Fowler CL, Pokorny WJ. Intussusception. In: Donnellan WL, Burrington JD, Kimura K, Schafer JC, White JJ (eds). Abdominal surgery of infancy and childhood. Australia: Harwood Academic Publishers; 1996. p. 42/3-19.
4. Swain V. Sir Jonathan Hutchison 1828-1913: his role in the history of intussusception. J Pediatr Surg 1980; 15: 221-3.
5. Bruce J, Huh YS, Cooney DR, Karp MP, Allen JE, Jewett TC. Intussusception: evolution of current management. J Pediatr Gastroenterol Nutr 1987; 6: 663-74.
6. Tangi VT, Bear JW, Reid IS, Wright JE. Intussusception in Newcastele in a 25year period. Aust NZ J Surg 1991;61:608-13.
7. Ravitch MM, McCune RM Jr. Reduction Of intussusception by barium. Ann Surg 1948; 128: 904-17.
8. Fiorito ES, Recalde Cuestas LA. Diagnosis and treatment of acute intestinal intussusception with controlled insufflation of air. Pediatrics 1959; 24:241-4.
9. Guo J, Ma X, Zhou Q. Results of air pressure enema reduction of intussusception: 6396 cases in 13 years. J Pediatr Surg 1986;21:1201-3.
10. Reijnen JM, Festen C, Joosten A. Chronic intussusception in children. Br J Surg 1989; 76: 815-6.
11. Niramis R, Watanatittan S, Havanonda S. Intussusception in infancy and childhood. Bull Dept Med Serv 1984; 9:275-86, (in Thai).
12. Dennison WM, Shaker M. Intussusception in infancy and childhood. Br J Surg 1970; 57: 679-84.
13. Ein SH, Stephens CA. Intussusception: 354 cases in 10 years. J Pediatr Surg 1971; 6: 16-27.
14. Hutchison IF, Olayiwola B, Young DG. Intussusception in infancy and childhood. Br J Surg 1980; 67: 209-12.
15. Sutthiwan P, Darnwiriyagul L, Sritanayaratana s. Intussusception. J Med Assoc Thai 1982; 65: 403-8.
16. Liu KW, MacCarthy J, Guiney EJ, Fitzgerald RJ. Intussusception - current trends in management. Arch Dis Child 1985;61: 75-7.
17. West KW, Stephens B, Vane DW, Grosfeld JL. Intussusception: current management in infants and children. Surgery 1987;102:704-10.
18. Kim YS, Rhu JH. Intussusception in infancy and childhood: analysis of 385 cases. Int Surg 1989; 74: 114-8
19. Ravitch MM. Intussusception. In: Welch KJ, Randolph JG, Ravitch MM, Rowe MI (eds.). Pediatric Surgery. 4th ed. Chicago: Year Book Medical Publishers; 1986. p. 868-82.
20. Gardener PS, Knox EG, Court SDM, Green CA. Virus infection and intussusception in childhood. Br Med J 1962;2:697-700.
21. Bell TM, Steyn JH. Viruses in lymph nodes of children with mesenteric lymphadenitis and intussusception. Br Med J 1962; 2ะ700-2.
22. Ross JG, Potter CW, Zachary RW. Adenovirus infection in association with intussusception in infancy. Lancet 1962; 2:221-3.
23. Stringer MD, Pablot SM, Brereton RJ. Paediatric intussusception. Br J Surg 1992; 79: 867-76.
24. Ein SH. Recurrent intussusception in children. J Pediatr Surg 1975;10:751-4.
25. Cox JA, Martin LW. Postoperative intussusception. Arch Surg 1973; 106: 263-6.
26. Mollitt DL, Ballantine TVN, Grosfeld JL. Postoperative intussusception in infancy and childhood: analysis of 119 cases. Surgery 1979: 86: 402-8.
27. Ein SH, Ferguson JM. Intussusception-the forgotten postoperative obstruction. Arch Dis Child 1982; 57 :788-90.
28. West KW, Stephens B, Rescorla FJ, Vane DW, Grosfeld JL. Postoperative intussusception: experience with 36 cases in children. Surgery 1988; 104: 781-7.
29. Niramis R, Watanatittan S, Witta J. Postoperative intussusception in infancy and childhood. Bull Dept Med Serv 1994;19: 14-9 (in Thai).
30. Beasley SW, Auldist AW, Strokes KB. Recurrent intussusception: barium or surgery? Aust NZ J Surg 1987; 57: 11-4.
31. Paes RA, Hyde I, Griffiths DM. The management of intussusception. Br J Radiol 1988; 61: 187-9.
32. Mackay AJ, MacKellar A, Sprague P. Intussusception in children: a review of 91 cases. Aust NZ J Surg 1987; 57: 15-7.
33. Winstanley JHR, Doig CM, Brydon H. Intussusception: the case for barium reduction. J R Coll Surg Edinb 1987;32:285-7.
34. Eklof OA, Johanson L, Lohr G. Childhood intussusception: hydrostatic reducibility and incidence of leading points in different age group. Pediatr Radiol 1980; 10: 83-6.
35. Rattanasuwan T, Pattanawin P, Watanatittan S, Suwatanaviroj A. Hydrostatic reduction of intussusception. Bull Dept Med Serv 1986; 11: 459-65 (in Thai).
36. Shiels WE II, Maves CK, Hedlund GL, Kirks DR. Air enema for diagnosis and reduction of intussusception: clinical experience and pressure correlates. Radiology 1991; 181:169-72.
37. Palder SB, Ein SH, Stringer DA, Alton D. Intussusception: barium or air? J Pediatr Surg 1991; 26: 271-5.
38. Gu L, Alton DJ, Daneman A, Stringer DA, Liu P, Wilmot OM, et al. Intussusception reduction by rectal insufflation of air. AJR 1988;150: 1345-8.
39. Jinzhe Z, Yenxia W, Linchi W. Rectal inflation reduction intussusception in infants. J Pediatr Surg 1986; 21: 30-2.
40. Stringer DA, Ein SH. Pneumatic reduction: advantages, risks and indications. Pediatr Radiol 1990; 20: 475-7.
41. Glover JM, Beasley SW, Phelan E. Intussusception: effectiveness of gas enema. Pediatr Surg Int 1991; 6: 195-7.
42. Kruatrachue A. Air enema reduction of intussusception. Proceedings of the 36th annual scientific meeting of the Radiological Society of Thailand and the Royal College of Radiologists of Thailand, 1999: 34
43. Renwick AA, Beasley SW, Phelan E. Intussusception: recurrence following gas (oxygen) enema reduction. Pediatr Surg Int 1992; 7: 361-3.
How to Cite
Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.