Background/purpose: Many children with intussusception are reported to present late for definitive therapy. Attempted nonsurgical reduction of intussusceptions after 48 hours is controversial because of the low probability of reduction and an increased risk of perforation. This study was conducted to determine the effect of delayed presentation on clinical parameters, management, and the outcome of childhood intussusceptions. The author also studied the diagnostic investigations that can give criteria that may help to predict bowel viability and to choose the most suitable management.
Methods: Comparative analysis of 44 children with intussusception managed from 2007 to 2011 at Tanta university and Saudi Arabia was done.
Results: The mean time from onset of presentation was 3 days (range from 4 hours to 7 days). Thirty seven patients presented within 48 hours of symptoms (group 1) and 7patients presented after 48 hours (group 2). Clinical presentations were similar in the children with the exception ofbilious vomiting, rectal bleeding, and abdominal distension that were significantly commoner in group 2 children (p < O.05).The type ofintussusceptionsfound at operation did not differ in the groups, but bowel complications and the incidence offailed reduction and bowel resection were higher in group 2 patients (p < 0.05). Though the postoperative complications did not differ significantly between the two groups, mortality directly related to intussusceptions occurred only in patients who presented after 48 hours.
Conclusion: Significant number of children with intussusceptions present late for definitive treatment. These cases have a high risk of bowel complications and intestinal resection. The outcome of these patients can be improved through good perioperative care and reducing delays in seeking health care. Also, cases of delayed presentation can safely undergo contrast enema reduction ifno bowel-wall edema ofthe intussuscipiens or obstruction or ischemia is demonstrated.