POOR PROGNOSTIC FACTORS OF INTUSSUSCEPTION IN CHILDHOOD AS SEEN IN ILORIN, NIGERIA

Abstract

This was a prospect~ve study of24 children with intussusception seen over a 3year period of the university of Ilorin Teaching Hospital. Males were more affected than females at a ratio of 3: l, with 70% of the cases occurring in children between 6months and 2years of age. The common presenting symptoms were vomiting in 83.3%, bloody stool in 75%, abdominal distension in 58.3%, diarrhoea in 58.6% and constipation in 37.5% of the cases. An abdominal mass was palpable in 58.3%. Majority of the patients presented late with 70.8% presenting beyond 24 hours from the onset of the symptoms. Ileocolic intussusception accounted for 72.9% of the cases whilst ileo-ileal occurred in 12.5%. Mesenteric lymphadenopathy was the pre-dorminant detectable predisposing factor at surgery in 25% of the cases. Fifty percent had gangrenous bowel requiring resection at surgery. The mortality rate was 29.2%. Mortality was high in those with delayed presentation beyond 48 hours from onset of symptoms (38.5%, odds ratio "OR" = 2.8/, relative risk "RR" = 1.33), severe acidosis (75%, OR=12.0, RR=3.2), temperature> 38.5° centigrade at admission (80%, OR=21.33, RR=4.2), severe dehydration, andrespiratory distress (62.5% and 66.6%, respectively RR=2.3), and a delay in surgical intervention beyond 48hours from admission (66.6%, OR =6.4, RR=2.29). I The poor prognostic factors observed in this study included delayed presentation beyond 48 hours from the onset of symptoms, severe respiratory distress at presentation, temperature> 38.5° centigrade at admission, severe, acidosis, severe dehydration and delay in surgical intervention beyond 48 hours. Children with intussusception still present lale to our facility with the resultant development of the above stated bad prognostic factors and its attendant high mortality.