EFFECT OF DELAYED PRESENTTION ON SURGICAL MANAGEMENT IN CHILDREN WITH INTUSSUSCEPTION

Objective: To evaluate the effect of delayed presentation on surgical management of intussusception in children. Material and Methods: This study was conducted at the Department of Paediatric Surgery Post Graduate Medical Institute, Lady Reading Hospital, Peshawar from 1st January 2006 to 31st June, 2007 and spanned over a period of 18 months. All children with surgically diagnosed intussusception were included in the study. A total of 71 children were studied. The relevant information was collected in a predesigned standardized proforma, for the purpose of the study. Results: Eight (11.26%) children presented in 24 hours, six (75%) were successfully manually reduced, and two (25%) required resection of bowel and end to end anastomosis, four (5.63%) presented in 24-48 hours, two (50%) were manually reduced and two (50%) required resection and end to end anastomosis, sixteen (22.53%) presented between 48-72 hours, eight (50%) were manually reduced and eight (50%) required resection and end to end anastomosis of the bowel twelve (16.90%) presented in 72-96 hours, two (16.66%) were manually reduced and ten (83.33%) required resection of the bowel and end to end anastomosis. five (7.04%) presented in 96-120 hours, three (60%) were manually reduced and two (40%) required resection of bowel and end to end anastomosis. seven (9.85%) presented in 120-144 hours, four (57.14%) were manually reduced and three (42.85%) required resection of bowel and end to end anastomosis. nineteen (26.76%) presented in 1 or more than 1 week, nine (47.36%) were manually reduced and ten (52.63%) required resection of bowel and end to end anastomosis. Eleven (15.49%) required ileo-sigmoid, eighteen (25.35%) ileo-transverse, five (7.04%) ileo-ileal one(1.40%) jejuno-jejunal, one (1.40%) ileo-(ascending)colic and one (1.40%) colo-colic anastomosis, after resection of the gangrenous bowel. Conclusion: Delay in presentation and consequent delay in management does not consistently affect the surgical treatment of intussusception in terms of per-operative manual reducibility and the need to resect non-viable, gangrenous gut in case of manually irreducible intussusception.