عنوان
پدید آورنده
موضوع
رده
کتابخانه
محل استقرار
98999P
انگلیسی
Assessment of Clinical, Laboratory and Radiological Characteristics and Treatment Methods of Patients Referring with Intussusception to Bahrami Hospital During 1400-1401
بررسی ویژگیهای بالینی، آزمایشگاهی، رادیولوژیکی و روشهای درمانی بیماران مراجعه کننده با انواژیناسیون به بیمارستان بهرامی طی سالهای 1400-1401
[Dissertation]
Irfan Bashir
عرفان بشیر
Tehran University of Medical Sciences, Medicine school
1401
40p
Doctor of Medicine (MD)
دکتری پزشکی عمومی
2023/02/22
1401/12/03
18
18
Introduction: Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment (1). It is the most common cause of acute intestinal obstruction in children between 3 months and 6 years (2). 75% of invaginations occur in first two years of life and more than 40% occur between the ages of 3-9 months. The relative peak is 5-10 months and is rare below the age of 3 months. Intussusception is seen throughout the world with China topping the list with 500 cases every year and in Iran a study in Amir Kabir Hospital in Tehran in 1992 showed the incidence of 28 cases in that particular year. It's has a slight male predilection with the boy to girl ratio being 2:1 and is mostly seen in white people (4). Intussusception is often idiopathic/Primary (95%), without an obvious pathologic lead point, although more than 90% occur due to the hyperplasia of Payers patches, and only 4% percent cases are secondary, with most common focal pathologic lead points as Meckel's diverticulum, duplication cyst, polyp and lymphoma. About 1-6-%cases involve postoperative intussusception, with 0.08-0.5% cases occurring due to prolonged laparotomy. In terms of anatomic classification, 85% of invaginations are ileo-colic, 10% are ilio-ilio-colic, 2.5% are appendico-colic, ceco-colic, and colo-colic, 2.5% are jejuno-jejunal and ileo-ileal.These patients often present with a wide range of non-specific symptoms, with less than one quarter presenting with the classic triad of abdominal pain, vomiting, and bloody stools (2). The most common classical symptom is abdominal pain, which occurs as episodes of sudden, colicky pain lasting only a few minutes and then returns to normal condition, but 15% cases lack this symptom. Initially vomiting contains undigested food and then progresses to biliary emesis and like abdominal pain, absence of vomiting does not rule out the intussusception. The classical signs of intussusception include Sausage-like abdominal mass, haematochezia and passage of Red currant Jelly stools.The initial radiologic evaluation includes a plain abdominal x-ray and a USG. USG may demonstrate a Donut/target sign or a pseudo-kidney appearance, although these findings are suggestive of intussusception but are not pathognomic (3). The gold standard technique for ruling out or diagnosing intussusception is CT-scan, MRI and Barium enema.For the treatment of intussusception, non-operative management is indicated in hemodynamically and clinically stable children and involves Enema reduction techniques, with Air enema showing highest reduction rates. When the patient is hemodynamically unstable, when there is evidence of bowel necrosis, bowel perforation or peritonitis, or when safe facilities to perform an enema reduction are not available and in cases of failure of the conservative therapy and also when a pathological lead point is the cause of intussusception, primary surgical interventions are indicated.A review of literature shows that only a few scattered studies have been carried out to investigate the profile of Iranian children diagnosed with intussusception. In this study, we want to evaluate the clinical, laboratory and radiological characteristics and treatment methods of patients referring with intussusception to Bahrami Hospital during 1400-1401.Method: In this Cross sectional, descriptive study we assessed the clinical, laboratory and radiological characteristics and treatment methods of patients referring with intussusception to Bahrami Hospital during 1400-1401. For this purpose, we collected the data of all the patients admitted in Bahrami Children’s Hospital, during 1400-1401 with a diagnosis of intussusception, based on clinical presentation, laboratory and radiological findings and then treated for the same. The medical records contained at least 70% of the data regarding the clinical manifestations, laboratory findings and imaging findings. The patients who presented with the similar symptoms but the diagnosis of intussusception was ruled out based on history or laboratory or radiological evaluation, and also the patients whose medical records lacked more than 30% of the data relevant to clinical manifestations were excluded. Variables were categorized as independent (age, gender) and dependent (clinical manifestations, laboratory data, radiological findings and treatment methods).Due to the retrospective, descriptive nature of the study, predictor and outcome variables and confounders are not applicable. The instrument used for data collection is a researcher-made checklist including demographics (age and gender), clinical manifestations, laboratory data, and radiological data and treatment methods. After implementation of exclusion and inclusion criteria, all data of medical records including Demographic, clinical, paraclinical and treatment data was recorded in the researcher-made checklist. Finally, data was analyzed using the SPSS® software version 24 (SPSS Inc., Chicago, IL, USA).Results: In this study, the information of 40 intussusception pediatric patients was considered. The data comes from Registry of unit summary of patients admitted to the surgical ward of Bahrami Children’s hospital affiliated with Tehran University of Medical Sciences. We choose 14 different variables to collect the data. Our findings showed that among the 40 patients, there were 30 (75%) male and 10 (25%) female participants. The age distribution of the study population ranged from 3 days to 10 years, with a mean age of 29.27 months. 50% of patients were 19 months old or younger, median (IQR) =19 (37.25) months. The weight of the study population ranged from 3.56-30 kg (mean weight 13.02±7.56 kg). 50% of patients weighted 10.75 kg or less. Furthermore the type of nutrition was also evaluated and it was found that the total of 22 infants were breastfed; 7 (17.5% of total population) were exclusively breastfed, while 15 (37.5%) were fed by both breast milk and solid food. Only 2 infants (5% of total population) were formula-fed. In our study, all patients presented with the classical clinical symptoms of intussusception. On physical exam, classical clinical signs of intussusception were detected in 13 patients (32.5%). The number of episodes of pain/agitation till hospital admission ranged from 1 to 30. We found that the WBC mean was 9465, with a standard deviation (SD) of 4054.35. We also found that the 25% of the total patients had Leukocytosis and the 20% of patients had Anemia. It was found that in 4 patients (10%), X-ray was diagnostic and in 24 patients (60%) ultrasound was diagnostic. We found that the most commonly used treatment modality was radiological reduction (47.5%), followed by surgical resection (15%) and laparotomy (7.5%) , and also the spontaneous reduction was seen in (30%). 3 patients (7.5%) didn't respond to treatment and 3 patients (7.5%) experienced recurrence during the same hospital admission.CONCLUSIONS: The aim of the study was to evaluate the clinical, laboratory and radiological characteristics and treatment methods of patients referring with intussusception. In our study we concluded that the frequency of male was higher than female patients. The age of the study population ranged from 3 days to 10 years, with a mean age of 29.27 months. The classical clinical symptoms of intussusception were present in all the patients and among all the patients in our study, less than half (32.5%) had classical clinical signs. A quarter of the patients had Leukocytosis and the 20% of patients had Anemia. Majority of the patients had positive radiological findings with USG being the more sensitive diagnostic modality. Among the treatment methods used for intussusception, Radiologic reduction was the preferred treatment method over Laparotomy and Surgical resection, and the Spontaneous Reduction was seen in 30% of the patients. Furthermore our study findings indicated that the failure to respond to the treatment and also the recurrence during the same hospital admission was seen among the patients treated with Radiologic reduction.
