Journal of pediatric surgery · 2019
Pediatric intussusception in Uganda: differences in management and outcomes with high-income countries.
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Akello Vivian Valin, Cheung Maija, Kurigamba Gideon, Semakula Daniel, Healy James M, Grabski David, Kakembo Nasser, Ozgediz Doruk, Sekabira John
Аннотация
PURPOSE: In high-income countries the presentation and treatment of intussusception is relatively rapid, and most cases are correctable with radiographically-guided reduction. In low-income countries, many delays affect outcomes and surgical intervention is required. This study characterizes the burden and outcome of pediatric intussusception in Uganda.
METHODS: Prospective case series of intussusception cases from May 2015 to July 2016 at a tertiary referral hospital in Uganda.
RESULTS: Forty patients were included in the study. Male to female ratio was 3:2. Average duration of symptoms before presentation was 4.5 days. Median duration of symptoms in referred patients was 4 days and 2 days in non-referred patients (P value 0.0009). All 40 patients underwent surgical treatment: 25% had resection and enterostomy, 15% had resection and primary anastomosis, 2.5% had resection, primary anastomosis and enterostomy and 57.5% underwent manual reduction. Mortality was 32% and febrile patients on admission were 20 times more likely to die (P value 0.040).
CONCLUSION: Intussusception carries a high operative and mortality rate in Uganda. Referred patients presented later than non-referred patients to health facilities. Fever on examination at admission was positively associated with mortality. This disease remains a target for quality metrics in global pediatric surgery.
TYPE OF STUDY: Diagnostic study.
LEVEL OF EVIDENCE: III.
METHODS: Prospective case series of intussusception cases from May 2015 to July 2016 at a tertiary referral hospital in Uganda.
RESULTS: Forty patients were included in the study. Male to female ratio was 3:2. Average duration of symptoms before presentation was 4.5 days. Median duration of symptoms in referred patients was 4 days and 2 days in non-referred patients (P value 0.0009). All 40 patients underwent surgical treatment: 25% had resection and enterostomy, 15% had resection and primary anastomosis, 2.5% had resection, primary anastomosis and enterostomy and 57.5% underwent manual reduction. Mortality was 32% and febrile patients on admission were 20 times more likely to die (P value 0.040).
CONCLUSION: Intussusception carries a high operative and mortality rate in Uganda. Referred patients presented later than non-referred patients to health facilities. Fever on examination at admission was positively associated with mortality. This disease remains a target for quality metrics in global pediatric surgery.
TYPE OF STUDY: Diagnostic study.
LEVEL OF EVIDENCE: III.