Nigerian Journal of Clinical Medicine

Hydrostatic reduction of intussusception with normal saline using the gravity aided
method in a Nigerian teaching hospital
M.A. Abdulsalam, B.O. Balogun, R.I. Osuoji, O.O. Olofinlade, O.M. Faboya, M.A. Bankole

Abstract

Background: The non-operative treatment of intussusception has evolved over the years.
One of such treatment modalities is ultrasound guided hydrostatic reduction using barium,
saline and other water soluble agents. Despite the benefits of this method, surgery remains the
mainstay of treatment in our hospital as well as in many other Nigerian hospitals.

Aim: To evaluate the success rate of ultrasound guided hydrostatic reduction of

intussusception using the gravity aided saline reduction method.

Method: This is a prospective study of hydrostatic reduction of intussusception using the

gravity aided saline reduction method. Patients were seen between January and December
2015.

Results: Thirty five cases who were confirmed to have intussusception by ultrasonography
were seen but only 12 were suitable for the procedure. Seven patients (58.3%) had successful
hydrostatic gravity aided saline reductions while five (41.7%) had failed reductions. One
patient had a recurrence. Bowel perforation complicated the procedure in one patient, who
required a laparotomy for further management.

Conclusion: Ultrasound guided hydrostatic reduction with normal saline by gravity method
is a reliable and safe method of reducing intussusceptions in carefully selected cases. Thus, it
should be recommended as the primary mode of treatment provided there are no features of
peritonitis.

Keywords: Intussusception; ultrasound guided gravity and saline reduction

Open Access Subscription or Fee Access

A comparison of manual versus hydrostatic reduction in children with intussusception:

Single-center experience
S Ocal, M Cevik, ME Boleken, E Karakas
Abstract

Objective: In recent years several techniques have been recommended for intussusception
treatment. In this study, an evaluation was made of intussusception cases that presented at our
clinic and had reduction applied together with saline under ultrasonography (USG) and cases,
which were surgically treated.

Patients and Methods: A retrospective evaluation was made of the records of 72 cases
treated for a diagnosis of intussusception between January 2010 and July 2012. Patients were
evaluated demographics, clinical presentation, management strategy, during the
hospitalisation and outcome.

Results: A total of 72 cases which consists of 44 male and 28 female with age range between
5 and 132 months were treated with a diagnosis of intussusception. USG was applied to all
cases on initial presentation. As
treatment, hydrostatic reduction (HR) together with USG was applied to 47 cases. Of these,
the HR was unsuccessful in 13 cases. Surgical treatment
was applied to 38 cases. Of these cases, ileocolic intussusception was observed in 30 cases,
ileoileal in seven cases and colocolic in one case. Meckel diverticulum was determined in
five of these cases, polyps in two cases, lymphoma in two cases, lymph nodule in one case
and 28 cases were observed to be idiopathic. There was no mortality in any case.

Conclusion: HR together with USG is a safe technique in the treatment of intussusception,

which also shortens the duration of hospitalisation and
significantly reduces the treatment costs.

Key words: Hydrostatic reduction, intussusception, treatment, ultrasonography

Prolapsed intussusception in children: a report of 4 cases

G Ngom, I Fall, AA Sankale, A Sagna, M Ndoye

Abstract

Background: Prolapsed intussusception is defined the invagination of an intestinal segment into the
adjacent segment to it, with exteriorization of the head intussusception through the anus.

Patients and Methods: Four children were diagnosed in the Emergency Unit of Hpital Aristide Le
Dantec of Dakar.

Results: The average time of presentation to hospital was 45 days (21 days - 95 days). On digital
rectal examination, a sulcus was felt between the rectal wall and the protruding mass. The diagnosis
of intussusception was made on clinical basis. All children had surgery through a large abdominal
incision. Findings were that of ileo-anal intussusception, the presence of a long mesentery and a
failure of fixation of the right colon. A wide bowel resection plus enterostomy in two patients and a
simple reduction with appendectomy also in two patients were performed. One patient died 2 days
following a wide bowel resection.

Conclusion: Prolapsed intussusception should not be confused with, but should always be
considered as a differential diagnosis of, rectal prolapse.

Keywords: prolapsed intussusception, children

African Journal of Paediatric Surgery Vol. 2(1) 2005: 17-19

Open Access Subscription or Fee Access

Paediatric Intussusception in Dar es Salaam, Tanzania

PMR Carneiro, HL Wella

Abstract

Background: Intussusception is a common cause of intestinal obstruction in children below

5 years of age. Prompt diagnosis and treatment reduce its morbidity and mortality in Sub-
Saharan Africa.

Broad objective: To describe the socio-demographic and clinical characteristics of

intussusception in infants and children in local settings during a nine-year period and
determine the incidence in infants up to 12 months of age.

Methodology: This is a retrospective study whereby the medical records of all infants and
children up to the age of 5 years diagnosed to have intussusception and admitted at the
paediatric surgical ward at Muhimbili National Hospital (MNH) from January 2000 to
December 2008 were reviewed. Demographic factors evaluated included age, sex, month of
presentation to assess any seasonal variation, etiology, clinical features, duration of
symptoms, methods of diagnosis and management, outcome including mortality.

Results: During the nine-year period, 73 children were diagnosed to have intussusception. 48
were males and 25 females (M: F=1.9:1). The infant group (up to the age of one year) was 58
(79.5%), 34 were boys and 24 girls (M: F=1.4:1). Most cases presented in January-March
(31. 5%) and July to September (39.7%) which were the dry seasons. All patients presented
with vomiting and abdominal distention. History of preceding gastro- enteritis was seen in the
infant group. The majority, 59 cases (80.8%) presented with the classic triad of vomiting,
passing red currant jelly stools and abdominal distention. Abdominal mass was palpated in
only 11 cases (15.1%) as patients presented late with very distended and tense abdomen.7
cases (12.1%) presented with anal protrusion of the intussusceptum, which was associated
with poor prognosis. Diagnosis was mainly made clinically and all children were managed by
emergency laparotomy. Majority were found to be ileo-colic type. Twenty nine (39.7%)
underwent bowel resection due to perforation with or without gangrene of the intussuscepted
bowel. Twenty-three patients died postoperatively, a mortality of 31.5%.

Conclusion: The intussusception rate in babies up to one year old was calculated to be
approximately 1:7500 but this is an underestimate as records were missing and some die
before getting to hospital.

Key words: Infants, children, Intussusception,

Open Access Subscription or Fee Access

Acute Intussusception in childhood: Aspects of epidemiologic, Clinical Features and

Management at Children's Hospital, Donka, Guinea Conakry
M Keita, O T Barry, N Doumbouya, A F Diallo, B M Toure, I Balde

Abstract

Background: Intussusception is a common cause of acute intestinal obstruction in children. This

study reports our experience in the management of childhood intussusception at children's hospital,
Donka, in Conakary.
Patients and Methods: This was a retrospective study of children treated for intussusception at
children's hospital, Donka, in Conakary from January 1993 to June 2003.
Results: There were 37 children in this study (M:F= 1.3: 1). Intussusception accounted for 4.60% of
all abdominal emergencies in the paediatric surgery arm of the children hospital Donka in Conakry
within the period. There was 56.76% male preponderance. Majority (86.48%) presented late,
resulting in delayed intervention. Fifteen out of the 37 children presented after one week of onset of
illness. All the patients presented with abdominal pain. Abdominal mass was palpable in 12 (32.4%)
patients while four (10.8%) patients presented with prolapsed intussusception through the rectum.
Majority of the intussusceptions in this study were of idiopathic origin. Seventy three percent (27) of
the intussusceptions were of ileo-cco-colic type. The average length of the intussuscepiens was
estimated at 20 cm. The mortality rate was high (35.13%); the mortality was higher before the age of
one year.
Conclusion: Children with intussusception presented late in our hospital, with a high mortality rate
especially in infants. Ignorance and poverty may be contributory factors.

Keywords: Intussusception, children, classification, mortality

African Journal of Paediatric Surgery Vol. 3 (1) 2006: pp. 1-3

Intussusception in Infants, Experience from Lagos, Nigeria

B Olayiwola, IO Fadeyibi, PF Jewo, N Sanyaolu, MA Bankole

Abstract

Worlwide, intussusception is a fairly common surgical emergency in infants. They often present in
ways that mimmick dysenteric diarrheoa, and accurate diagnosis requires both an awareness of its
modes of presentation and a healthy index of suspicion. We reviewed and analysed several
epidemiologic and clinical parameters as well as management options in cases of intussusception in
infants and children treated at the Lagos State University Teaching Hospital between January 2006
and December 2006. There were 33 cases in all. All of them had operative
management. The commonest type was ileo-colic intussusception (91%). There was no definite
pathologic lead point but enlarged Peyers patches were noticed in 5 cases. Delay in diagnosis and
referral from various centers was apparent as 23 cases (69.7%) presented beyond three days of
onset of symptoms. Manual operative reduction was possible in 50% of cases who presented
beyond 5 days of onset of symptoms. There was one unusual case of post operative jejuno-jejunal
intussusception after an initial operative manual reduction of ileo-colic intussusception. 36% of the
patients that presented more than 72hours after the onset of symptoms required bowel resections,
on account of vascular compromise of the intussusception. Yet there was no mortality in this series.
Late presentation
of patients with intussusception is still quite common in our environment, increasing complications
in these cases. However by a combination of aggressive fluid resuscitation and close monitoring
prior to surgery, we have been able to manage these cases and achieve good results.
Presentation and management outcome of childhood intussusception in Lagos: A
prospective study
CO Bode

Abstract

Background: Intussusception is the commonest cause of bowel obstruction in infancy and childhood.
Early diagnosis and effective management have reduced its morbidity and mortality in developed
countries. Aim: To document the presentation, management and treatment outcome of
intussusceptions at the Lagos University Teaching Hospital (LUTH). Patients and Methods: One
hundred seventy-four consecutive cases of this condition seen in children presenting at LUTH over a
5-year period were prospectively studied. Details of symptoms and signs, pre-hospital care,
treatment, and outcome in LUTH were documented. Results: The triad of abdominal pain, bloody
mucoid stools and palpable abdominal mass was seen in 106 (61%) of the cases. One hundred thirty-
five (77.6%) had been admitted and treated with antibiotics and intravenous fluids in primary
healthcare centers for an average of 3 days before referral to the LUTH. Prolonged mean duration of
recognizable symptoms of 3 days accounted for a 70.4% bowel resection rate. Wound infection
occurred in 61 (36.1%), whereas fecal fistulae developed in six (3.6%), and burst abdomen in five
(3%) of cases. Seven (4.1%) patients developed incisional herniae. Overall, mortality rate was 12.1%.
Conclusion: The early symptoms of intussusception would seem to be missed by primary healthcare
workers in Lagos, with consequently high morbidity and mortality. There is an urgent need to re-
emphasize these symptoms to first-line healthcare providers and parents through public
enlightenment campaigns.

African Journal of Paediatric Surgery Vol. 5 (1) 2008: pp. 24-28

https://www.ajol.info/index.php/index/search/google?q=intusscuception