8 Intussusception - A 12 Year Single Centre Experience Defining Clinical Outcomes Versus Nationwide Metrics
Meraj Ondhia1, Yousef Al-Mutawa2, Srikrishna Harave3, Paul Losty2,4
1Institute of Child Health , University of Liverpool, Liverpool, United Kingdom. 2Institute of Child Health, University of Liverpool, Liverpool, United Kingdom. 3Department of Paediatric Radiology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, United Kingdom. 4Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, United Kingdom

Abstract

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 ]

Methods
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.

Results
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.

Conclusion
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.


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