Clinical outcomes of intussusception: The experience in Johannesburg, South Africa

Abstract

Background. A previous study on intussusception from our institution demonstrated a pneumatic reduction (PR) rate of 33%, with a mortality rate of 9.1%. Numerous protocol changes were implemented, and as part of a national prospective observational study, a subsequent cohort of patients was compared with the initial series.

Objectives. To compare our current series of children presenting with intussusception with our previous series. Specifically, we aimed to compare PR rates, resection rates, morbidity and mortality.

Methods. This was a retrospective review of patients aged <3 years who presented with intussusception to Chris Hani Baragwanath Academic Hospital in Johannesburg, South Africa, from 2011 to 2015 (era 2). Clinical outcomes of patients and management modalities were reviewed. These were compared with results reported in the previous article (2007 - 2010, era 1).

Results. A total of 111 patients were included. PR was attempted in 52 patients (46.8%). It was successful in 25 patients (48.1%) and unsuccessful in 27 (51.9%), with an overall success rate of 22.5%. Eighty-six patients (77.5%) underwent surgical intervention. Bowel resection was performed in 54/86 of the surgically managed patients. No deaths were reported during the era 2 study period.

Conclusion. Despite improved protocols, we could not demonstrate an improvement in the proportion of attempted PR cases compared with our previous series, and we did not achieve better PR rates. This failure is thought to be due to the delayed presentation of our patients, as well as an aggressive approach to management. However, this aggressive management strategy has decreased our mortality rate to zero.