Aim of the study
Intussusception is the commonest cause of bowel obstruction in infancy. Management involves non-operative reduction by air enema as a first line modality with operation in cases of unsuccessful reduction. This study evaluated success rate(s) of non-operative reduction at a single centre compared to national reduction rates [ UK intussusception audit: A national survey of practice and audit of reduction rates - 2014 Clinical Radiology ]
All patients diagnosed with intussusception (ICD 10 Code K56.1) at a single centre from 2004 - 2016 were analysed. Data evaluated included patient demographics, clinical presentation, treatment modality, complications and outcome. Data were analysed with Chi-squared and Fisher’s exact test.
236 confirmed cases (69% male) of intussusception were identified. Median age at presentation was 9.7 months (range 4 days – 15 years). Abdominal pain (57%) was the commonest presenting symptom, followed by vomiting (56%) and rectal bleeding (35%). 163 cases (69%) proceeded directly to air enema reduction and successful reduction was achieved in 102 cases (63%). A single case (0.6%) of attempted air enema reduction was complicated by perforation. The risk(s) of air enema being unsuccessful was significantly increased by presence of rectal bleeding (risk ratio 1.5; p< 0.05) and a pathological lead point (risk ratio 3.0; p< 0.001). A pathological lead point was identified in 44 cases (19%); Meckel’s diverticulum being the most frequent anomaly (27%). Operation was performed in 119 cases (50%) with 57 patients (24%) having bowel resection. There were no deaths.
This is the largest single centre study defining practice outcomes for intussusception in the UK. Success rate(s) of non-operative reduction nationwide have been variably reported as 61%-71%. Clinical outcomes from this centre with air enema reduction
(63% success) compare favourably with national metrics. A low complication rate (0.6%) with enema reduction was also evident.