ASSESSMENT OF INTRAOPERATIVE MANUAL REDUCTION OF INTUSSUSCEPTION IN CHILDREN
Basrah Journal of Surgery,
Volume 22, Issue 2, Pages 69-76
AbstractAbstract Intussusception is the commonest cause of bowel obstruction in children and is the second most common cause of acute abdominal emergency in this age group, mostly it is idiopathic (primary) and of ileocolic type. Typically, colicky abdominal pain, "currant jelly stool" and a palpable abdominal mass are the triad of presentation. The best mean for early diagnosis is abdominal ultrasound scan. Unless contraindicated, non-operative approach (using either pneumostatic or hydrostatic reduction) is the best way for management with a success rate up to 95%, otherwise, surgical intervention is indicated. Unfortunately, non-operative approaches, were not ever safe options in our health institutes because of the lack of the required hospital facilities and trained staff, so all cases of intussusceptions were managed surgically by laparotomy and manual reduction. This study enrolled 70 children with Intussusception who were managed in two main children's hospital in Basrah city between April 2008 and December 2015 by one pediatric surgeon. The mean age of study population was 11.6 months and male to female ratio was 3.6:1. Primary intussusception was found in 91.4% of the patients and the most common anatomical pattern was ileocolic type (62.9%). Intra-operatively, manual reduction was reported to be easy in about half of the patients, those were presented early in the course of the illness (79.4% were presented within the first 24 hours) that made them very good candidates for non-operative management. Both postoperative complications and hospital stay were significantly related to the intraoperative procedure used for reduction, an easy manual reduction was associated with a less incidence of complications and a shorter hospital stay although generally longer hospital stay when compared with other studies in which intussusception is usually managed nonoperatively.
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