Seasonal Variations and Different Treatment Protocols OF Intussusception In Children:
Condition: Intussusception
MeSH terms: Intussusception
Study type: Interventional

Summary: 
      Background: Intussusception remains a common cause of bowel obstruction in children and
      results in significant morbidity and mortality if not promptly treated. There is a paucity of
      prospective studies regarding childhood intussusception. This study describes the seasonal
      variation and management outcomes of childhood intussusception.

      METHODS: This was A prospective study of all patients admitted and treated for childhood
      intussusception aged < 12 year intussusception from January 2014 to December 2018 was
      conducted in El-Minia University Pediatric surgery unit. Data about the ages of the patients,
      sex, clinical presentation, duration of symptoms before presentation, mode of treatment,
      outcome of treatment, and incidence of recurrence were recorded and analyzed.
    

Detailed description: 
      A prospective study from January 2014 to December 2018 was conducted in 470 cases in El-Minia
      University Pediatric surgery unit. All pediatric patients (up to 14 years old) hospitalized
      with diagnosis of bowel intussusception were included in the study. The clinical records
      included: age, gender, signs, symptoms, and number of any previous episodes of
      intussusception and their treatment, concomitant pathologies and intolerance, ultrasound
      data, laboratory parameters and performed treatment.

      An ultrasonography was performed when patients presented suspicion symptoms and signs of
      intussusception, in order to confirm the diagnosis and exclude other causes. Diagnosis was
      based on the presence of the "target sign" on vertical section on ultrasound images.
      Collected data included location and diameter of the intussusception, free fluid in abdomen
      and presence of visible pathological lead point. If diagnosis was confirmed, the management
      and treatment depended on the patients' situation, in patients complaining of severe
      dehydration, high grade fever and other signs of septicemia the conservative treatment was
      contraindicated and direct surgical treatment was performed. For children in good general
      conditions initial Pneumatic reduction under continuous imaging monitoring using a C-arm
      device was attempted; if reduction failed or unstable vital signs were observed, enema was
      discontinued and surgical management was proposed. If intussusception recurrence was observed
      in the next hours, Pneumatic reduction was performed again whenever possible.

      Treatment After fluid and electrolyte correction, Pneumatic reduction was performed by using
      air through an 18 F urinary catheter applied to the rectum under continuous imaging guidance
      by C-arm. With child in a supine position, a Foley catheter was introduced in the rectum and
      maintained by inflating its balloon with 40 ml saline; the buttocks were joined with a band
      aid in order to avoid leaks. The rectal cannula was connected to Sphygmomanometer inflatable
      cuff initially about 80 mmHg increasing up to a maximum of 120. The passage of air into the
      ileum through the ileocecal valve ensures successful reduction. No time limit was imposed on
      the duration of the procedure; however, cessation of retrograde movement of the
      intussusception for more than 15 minutes was regarded as a failed attempt. The procedure was
      repeated 20 minutes later, with a maximum of 3 attempts.

      All children were kept under medical supervision, no oral intake was permitted for the
      following 24 hours and intravenously fluids and antibiotics were given. After 12 to 24 hours
      ultrasonography was repeated to exclude early recurrence.
    

Intervention name(s): Pneumatic reduction and Laparotomy
Intervention type(s): Procedure
Intervention description(s): Pneumatic reduction is the main intervention for suitable cases and If failed a laparotomy exploration and surgical reduction is done to save life
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Intussusception, Pediatric surgery, Pneumoreduction