Comparative Analysis of Clinical Indices in Manual Reduction and Bowel Resection for Childhood Intussusception

Abstract

Background: Contrary to reports from developed countries, operative treatment of pediatric intussusceptions by either manual reduction or bowel resection still constitute the major treatment modality in our environment. Comparative analysis of pre-operative and post-operative indices of the patients treated by the two methods may help decision making in some critical clinical situations.

Objective: To compare clinical indices between children who had manual reduction and bowel resection for intussusception.

Materials and Methods: Retrospective analysis of all children who had operative treatment for intussusceptions at the University of Nigeria Teaching Hospital, Enugu from January 2008 to December 2015. The patients were divided into two groups: manual reduction (MR) and bowel resection (BR). Data including patient demographics, weight, duration of symptoms, presence of fever, need for re-laparotomy, and duration of hospital stay, post-operative complications and mortality rates were compared between the two groups.

Results: Sixty-four patients were analyzed. Twenty-six patients (41%) had manual reduction (MR) and 38 patients (59%) had bowel resection (BR). Mean duration of symptoms for manual reduction was 4.0±3.16 days and 4.8±3.04 days for bowel resection (p=0.28). All patients had fever. Palpation of intussusceptum per rectum in manual reduction was 42% and 36% in bowel resection (p=0.80). Average length of hospital stay for manual reduction was 9.1±4.20days and 14.3±8.24 days in bowel resection (P < 0.01). Duration of hospital stay in 26% of manual reduction and 75% of bowel resection was up to 10 days (P < 0.001). Two patients died after bowel resection and one after manual reduction. There were no recurrences.

Conclusions: Average length of hospital stay is significantly higher in bowel resection manual reduction. Those with bowel resection are more likely to spend beyond 10 days in hospital. There were more post-operative complications and reoperation in bowel resection. There was no significant difference in sex, age, duration of symptoms and mortality between the two groups.