In spite of the many recent advances in the management of intussusception further improvements may only be possible through earlier recognition at the onset of the diease and earlier contact with pediatric surgeon.
To identify the factors leading to deliberate surgical intervention, author reviewed and analysed 84 consecutive cases of intussusception of pediatric age group surgically treated from 1980 to 1989 at Ewha Woman University Hospital.
1) Demographic data show that sex incidence was a strong male preponderance of 2.5:1, that age incidence was a peak under 1 year old(81%), that the higher incidence was associated with cow's milk-fed, and that significant number of the cases were moderately nourished to undernourished.
2) The clinical symptoms and signs were abdominal pain or irritability(83%), vomiting(82%), currant-jelly stool(61%) and palpable abdominal mass(58%), And only 40% of the cases had the clasic triad of symptoms.
3) Simple abdominal x-ray revealed diagnostic findings in 35% of cases.
4) The most common anatomic type of intussusception was ileo-colic with 45% of the cases.
5) The only 4 cases(5%) had the pathologic lead point such as duplication of cecum, lymphoma of ileum and hematoma of ileum in Henoch-Schonlein purpura.
6) The manual reduction by milking archieved success with 61 cases (73%), 13 cases(16%) needed resection of bowel and 10 cases(12%) showed spontaneous ans complete reduction of intussusception between the time of diagnosis and the time of laparotomy.
7) The average postoperative hospital stay was 8.8 days. Only 7 patients(8.3%) had significant postoperative complications.
This study points out that the duration of illness and unusual anatomic type strongly influence necessity for bowel resection, and that also hydrostatic reduction by well-trainded pediatric radiologist plays a rols in the reducing the unnecessary laparotomy.
