Childhood intussusception at the Moi teaching and Referral Hospital Eldoret: management challenges in a rural setting.
OBJECTIVE
To review the management of childhood intussusception at the Moi Teaching and Referral Hospital, Eldoret and identify factors that require attention for improved outcome.


METHODS
A retrospective descriptive study covering the period January 2000 to December 2003.


METHODS
Moi Teaching and Referral Hospital, Eldoret.


METHODS
Thirty six children.


RESULTS
Of the 36 children, 28 (78%) were males and eight (22%) females giving a ratio of 3.5:1. Median age was six months with a range of 2-72 months. The duration of symptoms was a mean of 5 days with a range of 1-14 days. Sixty one percent were referrals. Initial diagnosis of intussusception based on signs and symptoms was made in 6 out of 36 (17%) patients. The rest were initially treated for other problems. Decision to refer to surgeons, was based on abdominal distension. Plain x-ray was done in four patients and barium enema in one patient. Seventy five percent of the patients required fluid resuscitation before operation. All patients (100%) were managed operatively. Seventy two percent had ileo-colic intussusception, 8% ile-oileal and 22% colo-colic. Perforation was found in 22% and gangrene in 31%. Sixty seven percent were successfully reduced by "milking" while 33% required resection and anastomosis/or stoma creation. Complications included: anastomatic breakdown, bronchopneumonial renal failure, sepsis, recurrent intussusception and death. Mortality was 14% overall.


CONCLUSIONS
Early diagnosis and presentation coupled with improved peri-operative management are essential in improving outcome.
Kuremu
R T
RT
Department of Surgery, Faculty of Health Sciences, Moi University, Eldoret, Kenya.
D002675:Child, Preschool; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D007443:Intussusception / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D007630:Kenya / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D019035:Rural Health Services; D012424:Rural Population