The age criterion when choosing a treatment strategy for intussusception in children 
 

Stakhov V. V., Rusak P. S., Rybalchenko V. F.

Department of Pediatric Surgery of the Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine

Zhytomyr Regional Children’s Clinical Hospital, Ukraine

Purpose: investigation of dependence between the age of patients and the presence of anatomical causes of intussusception.

Materials and methods. The work is based on the results of treatment of 196 children with intussusception in the surgical department of the Zhytomyr regional children’s hospital between 2006 and 2015. The age of patients ranged from 2 months to 17 years. Most of them were children under 12 months — 144 (73.5 ), children older than one year — 52 (26.5%). Among patients, there were: boys — 135 (68.9%), girls — 61 (31.1%). During examination and treatment of patients with intussusception, the following instrumental methods were used: X-ray of the abdominal organs, ultrasound of the abdominal organs and intussusceptum, Doppler study of the blood flow in the intestinal walls, laparoscopy.

Results and discussion. We have determined the frequency of intraoperative detection of anatomical substances in intussusceptum in children under one year and older. Based on the findings, a statistically significant difference was not found between the number of anatomical constituents found intraoperatively in the intussusceptum of children under one year and older. Most often, in the composition of intussusceptum, enlarged mesenteric lymph nodes (60 (49.59%) cases) and the appendix with signs of inflammation (37 (30.58%) cases) were detected. In the group of patients under 2 months of age, anatomical constituents were found in 58 cases out of 75 performed surgeries, representing 77.33%. In patients older than 1 year, we have found 41 anatomical constituents out of 46 operated children, accounting for 89.13%.

Conclusion. Additional anatomical constituents in intussusceptum are found in most cases, but not always they are the cause of intussusception. Their detection rate in patients under 12 months of age and over a year is equally high that is a reason not to consider the age factor (after one year) as indication for surgery by laparotomy.

Key words: intussusception, diagnosis, treatment, children.

References

1. Belyaev MK. 2004. Invaginatsiya kishok u detey: rasshirenie pokazaniy k konservativnomu lecheniyu. Avtoref dis. d-ra med nauk. 14.00.35. Novokuznetskiy GIUV. M: 192.

2. Belyaeva OA, Rozinov VM, Konovalov AK. 2010. Znachenie ehografii v obosnovanii lechebnoy taktiki u detey s kishechnoy invaginatsiey. Detskaya hirurgiya. 1: 10-14.

3. Morozov DA, Gorodkov SYu, Filippov YuV, Staroverova GA. 2012. Invaginatsiya kishechnika: mozhno li provodit konservativnoe lechenie nezavisimo ot dlitelnosti zabolevaniya. Rossiyskiy vestnik detskoy hirurgii, anesteziologii i reanimatologii. 2; 4: 17-20.

4. Demirkan A, Yağmurlu A, Kepenekci I et al. 2009. Intussusception in adult and pediatric patients: two diffe rent entities. Surg Today. 39; 10: 861-865.

5. Bucher BT, Hall BL, Warner BW, Keller MS. 2011. Intussusception in children: cost-effectiveness of ultrasound vs diagnostic contrast enema. J Pediatr Surg. 46; 6: 1099-1105.

6. Lehnert T, Sorge I, Till H, Rolle U. 2009. Intussusception in children-clinical presentation, diag nosis and management. Int J Colorect Dis. 24; 10: 1187-1192.

7. Ho WL, Yang TW, Chi WC et al. 2005. Intussusception in Taiwanece children: analysis of incidence, length of hospitalization and hospital costs in diffe rent age groups. J Formos Med Assoc. 104; 6: 398-401.