8th Baltic Congress of Radiology

Pediatric Radiology

poster abstract

Intussusception is the most common cause of bowel obstruction in small children and 90% of cases occur before the age of 3. The aim of this study was to analyse the clinical data related to the childhood intussusception and the outcome of different management strategies in Tartu University Hospital over a 22-year period (2000-2021). This is the first greater scale scientific research in Tartu University Hospital about the pathology.

Retrospective descriptive study was carried out at Tartu University Hospital. The medical records of pediatric patients (<=18 years) presented with intussusception (K56.1 according to International Classification of Diseases) during January 2000 until December 2021 were analysed. Patient inclusion criteria were set according to the Brighton Collaboration Intussusception Working Group case definition for Level 1 diagnostic certainty (intussusception demonstrated at surgery, during radiologic investigation or on autopsy). Cases were evaluated in terms of patient demographic data (sex, age), symptoms (vomiting, abdominal pain, rectal bleeding, diarrhea, distention, constipation) and duration of symptoms, clinical signs (palpable mass, melaena) upon presentation, imaging findings (sonography, x-ray), treatment methods (fluoroscopic air reduction, surgery) and their outcome (success of fluoroscopic air reduction, bowel resection, complications after surgery, the length of hospital stay). Data (2000-2008 31 paper charts and 2009-2021 38 electronic charts) was collected and analysed using Excel (MS Office Standard 2019, version 1808). Data is presented in the format of absolute numbers with percentages, frequencies, ratios, mean and standard deviation (SD), median, interquartile range (IQR). The level of significance was set to p ≤ 0.05 (for comparing means of different treatment groups). The research was conducted under the permission of the Univeristy of Tartu Research Ethics Committee.

69 patients met the Brighton Level 1 inclusion criteria (47 males, 22 females). Male to female ratio 2,13:1. Mean age at presentation was 37,1 months (SD 46,4 months) and median 13 months (range: 10 days - 219 months, IQR 43 months); by age groups: 0-12 months 34 patients (49,3%), 13-36 months 12 patients (17,4%) and >36 months 23 patients (33,3%). The mean time for the symptom duration before presenting to the hospital was 25,9 hours (SD 32,9 hours) and median 10 hours (range: 1-120 hours, IQR 19 hours); by time intervals : <12 hours in 38 cases (55%), 12-24 hours in 12 cases (17,4%), 24-48 hours in 5 cases (7,2%) and >48 hours in 14 cases (20,3%). The main complaints were vomiting (72,5%), abdominal pain (65,2%), and irritability (34,8%). On physical examination abdominal distension/sensitivity was observed in 53 cases (78,3%), abdominal mass was palpated in 48 cases (69,6%), and melaena per rectum in 10 cases (14,5%). The main diagnostic method was abdominal sonography (97,1%), followed by abdominal x-ray (34,8%). Sonography identified intussusception in 61 patients (sensitivity 88,4%). The commonest type was ileocolic intussusception (91,3%). 34 patients were initially treated by fluoroscopic AR (success rate 55,9%). The overall intussusception recurrence rate was 4,3%. In total there were 51 operative reductions – as a first-line method for 35 patients (50,7%), the second-line method after the failed AR for 15 patients (29,4%), and for one recurrence after successful AR. Bowel resection was required by 10 patients. The mean length of hospital stay was 4,9 days (SD 3,3 days) and median 4,5 days (range: 1-16 days, IQR 3 days). There was a significant difference in the length of hospital days between children who had successful AR (mean 2,1 days) and children who had OR (mean 6,02 days). There was a significant difference in the duration of symptoms between children who had successful AR (mean 13,8 hours) and children who had OR (mean 30,7 hours).

This research is the first larger scale overview on childhood intussusception treatment and outcomes in Tartu University Hospital over a longer period of 22 years. In the study group there is a male predominance. About half of the patients were 1 years old or less. The main complaints were vomiting and abdominal pain. On physical examination abdominal distension/sensitivity was observed in 78,3% of cases, followed by abdominal mass palpation. Abdominal sonography is a good diagnostical method, with sensitivity 88,4%. In our study group the air reduction had a moderate success rate, but it should be still considered as in the case of success it decreases the length of hospital days. The majority of patients were treated by operative reduction. The mean hospital stay was 4,9 days. The length of the hospital stay differed significantly between the successful air reduction group and operative reduction group as did the duration of symptoms before hospital admission.

Intussusception is the most common cause of bowel obstruction in small children. The study aimed at presenting an epidemiological overview of childhood intussusception, analysing clinical data and the outcome of different management strategies in Tartu University Hospital over a period of 22 years (2000-2021). This is the first greater scale scientific research in Tartu University Hospital about this pathology.

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