Ghulam Nabi Nasar.
Presentation and management outcome delayed presentation of intussusception in children.
Pak Paed J Jan ;37(3):163-7.

Objectives: To document the presentation management and treatment outcome of Intussusception, when presenting late. Introduction: Intussusception classically affects infants. Usually is diagnosed very early in the developed world and offered non invasive treatment for reduction with a high rate of success. In our society patients generally reach the appropriate Medical facility rather late. This understandably leads to a difficult management with high morbidity and mortality. The present study was planned as a prospective study to look at the delay and its consequences in the management of the disease. Patients and methods: This study was conducted at the Children Hospital Quetta. All the 48 consecutive cases of Intussusception, seen presenting at the Children Hospital over a 3 years, period from June 2009 to May 2012 were prospectively studied. No patients were excluded from the study. Details of symptoms and signs, pre hospital care, treatment and outcome were documented. A standard treatment protocol was adopted in all cases. Results: Forty eight patients were admitted with Intussusception in these three years. There were 30 (62.5%) male and 18 (37.5%) female patients, with the age of 8 (16.6%) patients below one year, 20 (41.6%) patients less than 2 years, whereas 20 (41.6%)were older than 2 years. The most common presenting features were vomiting, abdominal pain, blood in stool in 30 (62.2%) patients, abdominal mass in 8 (16.6%) patients and prolapsed Intussusception in 10 (20.8%) patients. Ultrasonography was performed in 38 patients; there was a positive doughnut and pseudo kidney sign in all these patients. The other Sonographic findings included dilated fluid filled small bowel loops and the presence of free intraperitoneal fluid. The diagnosis was confirmed per operatively. All the patients underwent one of the three procedures. In 28 patients the Intussusception was manually reduced. (58%), In 16 (33.3%) patients a resection of the gangrenous part with restoration of intestinal continuity was performed. In 4 (8.3%) patients, a resection with a proximal ileostomy had to be fashioned, due to severe soilage of the peritoneal cavity and possible ischemia of the bowel. Conclusions: The early symptoms of intussusceptions seem to be overlooked or misinterpreted by the primary health care workers in Quetta with consequently high morbidity and mortality. Early diagnosis referral and treatment can play a key role in reducing the morbidity and mortality.

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