Routine surgical intervention for childhood intussusception in a developing country

Abstract

Objective/purpose: We aim to determine the basis for the routine surgical treatment of intussusception in southeast Nigeria.

Methods: We analyzed 71 children operated for intussusception between June 1998 and May 2006 at the University of Nigeria Teaching Hospital Enugu, southeastern Nigeria.

Results: The median age at presentation was 6 months (range 3 months to 7 years), and the average duration from onset to presentation 3.2 days (range 4 hours to 7 days). Forty-six (64.8%) had ileocolic intussusception, 7 (9.9%) colocolic, and 5 (7.0%) ileoileal. In 31 (43.7%), there was no identifiable cause, while mesenteric lymphadenopathy and inflamed Peyer's patches were noted in 37 (52.1%), and polyp in 3 (4.2%). Manual reduction was successful in 39 (55%), while 32 (45%) required bowel resection for gangrene, or irreducibility. After average follow up of 9.7 months (range 4-22 months) there was no recurrence, but overall mortality was 6 (8.5%) from septicemia. Late presentation, dearth of facilities and trained manpower, and lack of multidisciplinary collaboration may contribute to the regular surgical treatment.

Conclusion: Intussusception in our setting is characterized by late presentation, high rate of bowel resection, and high mortality. Surgery may remain our main stay of treatment until deficiencies in time to diagnosis, specialized facilities, and personnel improvement.