1. PAPSA / APSON CONFERENCE LAGOS 2016
Childhood intussusception in a semi-urban referral hospital in Southwest Nigeria
Adesanya OA*, Dedeke IOF, Ogundeyi M, Adesanya OO
*Pediatric Surgery Unit, Department of Surgery
Federal Medical Centre, Abeokuta
9/23/2016
PAPSA / APSON CONFERENCE LAGOS 2016

2. PAPSA / APSON CONFERENCE LAGOS 2016
Background
Intussusception is the acquired invagination of a segment of intestine into an adjacent bowel (1)
a common cause of bowel obstruction in infants and children occurring usually between 4-10 months of age (2)
Aetiology is unknown in infants and children < 3 yrs (2), in older children a pathologic lead point such as polyps, meckels diverticulum may be seen.
9/23/2016
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3. PAPSA / APSON CONFERENCE LAGOS 2016
Background (contd)
associated aetiologic factors include
- Recent upper respiratory tract infection
- recent viral gastroenteritis
-recent change in diet from breast milk
-recent immunization with rotavirus vaccine
Previous studies have also shown race and gender predilection as well as good nutritional status in affected infants
9/23/2016
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4. PAPSA / APSON CONFERENCE LAGOS 2016
Background (contd)
Management associated with high morbidity and mortality (2-25%) across Africa but better in most series from HICs
Factors associated with poor outcome (2)
- late presentation/ delayed intervention
- inadequate fluid resuscitation
- associated gangrene/ perforations
-postoperative complications
Changing trend in management from operative to non operative reduction
9/23/2016
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5. PAPSA / APSON CONFERENCE LAGOS 2016
Objectives
-to determine the pattern and management outcomes of childhood intussusception in the centre -to identify determinants of outcome
9/23/2016
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6. PAPSA / APSON CONFERENCE LAGOS 2016
Study setting
- 300 bed referral hospital that serves Abeokuta , SW Nigeria ( est. population 500,000) and adjoining towns -Attends to about 2000 pediatric emergencies annually
9/23/2016
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7. PAPSA / APSON CONFERENCE LAGOS 2016
Methods
Study population:
- children aged years treated for intussusception from April 2013 to March 2016 at the study centre.
Records of patients’ demographics, clinical features, findings at surgery, outcomes and complications of management were retrieved from case folders
Statistical analysis done using SPSS version p < was considered significant
9/23/2016
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8. PAPSA / APSON CONFERENCE LAGOS 2016
RESULTS
Total number of patients – 24
AGE DISTRIBUTION
Range: 4months to 4 years
Majority (83.3 %) of patients were < 1 year old.
The median age was 7 months.
GENDER DISTRIBUTION
M:F = 1.2:1
9/23/2016
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9. SEASONAL DISTRIBUTION
-Peaks observed in March, September and December
-correspond with change over of seasons (dry/ rainy season) accompanied by high incidence of RTIs in children
9/23/2016
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10. PAPSA / APSON CONFERENCE LAGOS 2016
Predisposing factors
Recent respiratory Tract infections %
Recent weaning from breast milk %
Recent anti viral immunization %
* Role of Nutritional status
- >90% of expected body weight for age % %
9/23/2016
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11. PAPSA / APSON CONFERENCE LAGOS 2016
DURATION OF SYMPTOMS
-Mean duration of symptoms before presentation days
-Range 1-14 days
-50% of patients presented after 72hrs of symptoms
9/23/2016
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12. PAPSA / APSON CONFERENCE LAGOS 2016.
CLINICAL FEATURE
( %)
SYMPTOMS
ABDOMINAL PAIN/DISCOMFORT
15(62.5)
MUCO-BLOODY STOOLS
18 (75)
VOMITING
20 (83.3)
DIAGNOSTIC TRIAD
13 ( 54.3)
FEVER
21(87.5)
ABDOMINAL DISTENSION
13 (54.2)
SIGNS
PALPABLE ABDOMINAL MASS
17(70.8)
INVESTIGATIONS
ANEMIA
6 (25)
HYPOKALEMIA
3 (12.5)
POSITIVE ULTRASOUND FINDINGS
20 (83.3)
9/23/2016
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13. PAPSA / APSON CONFERENCE LAGOS 2016
Role of ultrasound
Utilized in 21 (87.5%) patients
True Positive ( 95.2%)
False Positive 1 (4.8%)
9/23/2016
PAPSA / APSON CONFERENCE LAGOS 2016

14. PAPSA / APSON CONFERENCE LAGOS 2016
Treatment
Preoperative resuscitation with intravenous crystalloids
Nasogastric decompression
Intravenous broad spectrum antibiotics
Preoperative transfusion where indicated
Mean Admission operation interval =24hrs
(Range = hrs)
9/23/2016
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15. PAPSA / APSON CONFERENCE LAGOS 2016
Outcome
9/23/2016
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16. Post operative complications
Superficial SSI (16.6%)
Burst abdomen (8.3%)
Severe sepsis (8.3%)
Determinants of morbidity:
-presentation after 24hrs (p- 0.58)
- undernutrition (p=0.21)
-preoperative Anemia (p=0.45)
-bowel resection (p=0.046)
9/23/2016
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17. PAPSA / APSON CONFERENCE LAGOS 2016
CAUSES OF DEATH
severe sepsis (8.3%)
?anesthetic death (4.2%)
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18. Duration of hospitalization
Range : days
Median : 7 days
Mean : 8.1 ± 0.6 days
9/23/2016
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19. PAPSA / APSON CONFERENCE LAGOS 2016
Discussion
Pattern of presentation and outcome in our patients is similar to other centres in LMIC such as ours.
Seasonal distribution as demonstrated in our patients correlates with change over of seasons (dry/rainy) and may provide an opportunity to sensitize pediatricians and general practitioners to facilitate early detection and referrals for prompt intervention
Further studies necessary to evaluate the role of weaning practices. A study in North America (Johnson et al, 1999) suggested lower intussusception in children weaned on soy based formula than those weaned on cow milk formula.
9/23/2016
PAPSA / APSON CONFERENCE LAGOS 2016

20. PAPSA / APSON CONFERENCE LAGOS 2016
Discussion (contd)
Rotavirus immunization is not routinely available in our setting presently but may become important as a possible aetiological factor as there are plans to include it in the NPI schedule.
About 20% (5 patients) presented early and could have been potential candidates for non operative reduction . This may reduce cost of treatment , intervention time and improve overall outcome
9/23/2016
PAPSA / APSON CONFERENCE LAGOS 2016

21. PAPSA / APSON CONFERENCE LAGOS 2016
Conclusion
Outcome of management of intussusception in our centre is comparable to other centres but still unacceptably high
there is need to further educate the public and primary care givers tofacilitate earlier presentation/referral and decrease the morbidity and mortality associated with this disease
9/23/2016
PAPSA / APSON CONFERENCE LAGOS 2016

22. Thanks for your attention
9/23/2016
PAPSA / APSON CONFERENCE LAGOS 2016