Observational Study

Clinical presentation and Journal of International Medical Research

2024, Vol. 52(3) 1–15
A The Author(s) 2024
management outcome of Article reuse guidelines:
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pediatric intussusception DOI: 10.1177/03000605241233525
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at Wolaita Sodo University

Comprehensive Specialized
Hospital: a retrospective
cross-sectional study

Yohannes Zewde1, Tamrat Bugie1,

Abel Daniel2, Awoke Wodajo2 and
Mengistu Meskele3

Abstract
Objective: To assess the pattern of clinical presentations and factors associated with the man-
agement outcome of pediatric intussusception among children treated at Wolaita Sodo
University Comprehensive Specialized Hospital, Ethiopia.
Methods: This retrospective cross-sectional study included the medical records of 103
children treated for intussusception from 2018 to 2020. The data collected were analyzed using
SPSS 25.0 (IBM Corp., Armonk, NY, USA).
Results: In total, 84 (81.6%) patients were released with a favorable outcome. Ileocolic intus-
susception was a positive predictor, with a nine-fold higher likelihood of a favorable outcome
than other types of intussusception [adjusted odds ratio (AOR), 9.16; 95% confidence interval (CI),
2.39– 21.2]. Additionally, a favorable outcome was three times more likely in patients who did than
did not
undergo manual reduction (AOR, 3.08; 95% CI, 3.05–5.48). Patients aged <1 year were 96% less
likely to have a positive outcome than those aged >4 years (AOR, 0.04; 95% CI, 0.03–0.57).
Conclusion: Most patients were discharged with favorable outcomes. Having ileocolic intussus-
ception and undergoing manual reduction were associated with significantly more favorable out-
comes of pediatric intussusception. Therefore, nonsurgical management such as hydrostatic
3
School of Public Health, Wolaita Sodo
University, Wolaita Sodo, Ethiopia
1
Department of Surgery, School of Medicine, Corresponding author:
Wolaita Sodo University, Wolaita Sodo, Ethiopia Mengistu Meskele, School of Public Health, Wolaita Sodo
2
Department of Pediatrics, School of Medicine, University, PO Box 138, Wolaita Sodo, Ethiopia.
Wolaita Sodo University, Wolaita Sodo, Ethiopia Email: [email protected]

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2 Journal of International Medical Research

enema and pneumatic reduction is recommended to reduce hospital discharge of patients

with unfavorable outcomes.

Keywords
Intussusception, pediatric, clinical presentation, management outcome, Ethiopia, nonsurgical
management
Date received: 30 August 2023; accepted: 29 January 2024

Introduction Studies in Uganda9 and Kenya10 showed

that this duration was 4.5 and 4.4 days,
In the pediatric population, acute intussus-
respectively, and the median duration of
ception is one main cause of abdominal sur-
symptoms in referred and non-referred
gical emergencies such as severe intestinal
patients was 4 days and 2 days,
obstruction and abdominal pain.1,2
respectively. In Ethiopia, 80% of patients
Following appendicitis, acute intussuscep-
visit the hos- pital after 2 days of illness.
tion is the second most common cause of
One study showed that the mean duration of
acute abdomen in children and the most
symp- toms before presentation to the
common cause of small bowel obstruction
hospital was 5.2 days (range, 1–21 days).2
in young infants.3 Acute intussusception
Reports from Nigeria showed that 46.3% of
occurs worldwide with an incidence of
patients required bowel resection and that
approximately 1 to 4 in 2000 infants and
nine (23.1%) patients died, and these
children. It can be seen in children of all
deaths were directly related to
ages, but 75% of cases occur within the
intussusception occurring in patients who
first 2 years of life and 90% occur within
presented after 24 hours.11–13
3 years of life. The occurrence rate is high-
In another study, most patients (89%)
est between 4 and 8 months of age.4
were <2 years old, and 78% presented at
Intussusception was first described by
the age of 3 to 18 months. Only 11% of
Paul Barbette in 1674,5 and the Scottish sur-
patients presented after 2 years of age,
geon James Hunter then coined the term and the age at presentation was significantly
“intussusception” in 1793.6 Intussusception lower
is defined as the movement of a proximal in Black African patients.8 Intussusception
bowel segment into a distal bowel segment. also occurs more commonly in male than in
The associated mesentery is dragged within female patients, with a ratio of 2:1 or 3:2. 9,10
the invaginated part, leading to venous con- In a study in Nigeria, most affected patients
gestion and edema. This results in ischemia were aged 3 to 9 months, with peak incidence
and eventually bowel necrosis, perforation, at 6 months.14–17 In one of the above-
and peritonitis if left untreated. 3 The classic mentioned studies, a radiographic modality
clinical triad of Ombredanne consists of was used to diagnose intussusception in
intermittent abdominal pain, red currant >95% of patients in all regions except
jelly stool, and a sausage-shaped abdominal Africa, where clinical findings or surgery
mass.7 were used in 65% of the patients. 2 In other
Many children with intussusception present research, the diagnosis of intussusception
late for definitive treatment, and this seems was mainly clinical in 71.4% of patients.18
to be the norm in developing countries.8 The suggested treatment modality for
acute intussusception is surgery or
 Zewde et 3

nonsurgical therapies such as hydrostatic neonatal intensive care unit, outpatient

and pneumatic reduction under fluoroscopy department, and chronic follow-up unit.
or ultrasound guidance.4 In developing
countries, a higher rate of patients undergo Study design and population
surgical treatment, which has higher com-
plication and mortality rates because late This retrospective cross-sectional study
presentation commonly occurs in these included all medical records of children
regions.9,10,18 admitted and treated for acute intussuscep-
Although pediatric intussusception is a tion at WSUCSH from January 2018 to
standard pediatric surgical emergency with December 2020. Medical records with miss-
ing data and uncertain treatment outcomes
considerable morbidity and mortality,
were excluded from the study. The report-
data in Ethiopia seem to be insufficient.
ing of this study conforms to the STROBE
Therefore, the present study was performed
guidelines.19
to examine the pattern of clinical presenta-
tions, morbidity, and mortality associated
Sample size and sampling techniques
with pediatric intussusception at Wolaita
Sodo University Comprehensive The study sample comprised pediatric
Specialized Hospital (WSUCSH). patients who underwent surgical treatment
of intussusception. The sample size was cal-
culated using a single population propor-
Methodology tion formula based on the findings of the
Study setting and period Jimma University Medical Center study,20
with a p value of 0.157 and calculation of
In this study, children diagnosed and treated the 95% confidence interval (CI). Odds
for acute intussusception from January 2018 ratios (ORs) and Z-scores (Z 1.962) were
¼
to December 2020 were retrospectively ana- also considered, resulting in an initial
lyzed. The study was conducted from 1 to sample size of 203. After applying the
30 November 2021 in WSUCSH, which is finite population correction, the final calcu-
located in Wolaita Zone, 329 km from lated sample size was adjusted to 128. We
Addis Ababa, Ethiopia’s capital. This included all patients who underwent an
hospi- tal serves as a teaching institution for operation for intussusception.
health science students and residents and
provides 24-hour comprehensive services Dependent variable. The dependent variable
for a popu- lation of more than 5.8 million in this study was the surgical management
people with different demographic and outcome of pediatric intussusception
socioeconomic backgrounds from the entire (favorable or unfavorable).
surrounding area of the southern part of the
country. It offers general surgery, internal Measurements/operational definitions
medicine, neurology, orthopedics, Cure: Telescoping of the bowel has been
neurosurgery, obstetrics and gynecology, resolved and the patient is no longer
pediatrics, radiol- ogy, dermatology, experiencing symptoms
pathology, oncology, anesthesiology, and Recurrence: Symptoms reappear after
neonatal care specialty services for the successful treatment
entire population of eastern Ethiopia. The Failure of treatment: Symptoms reappear
Department of Pediatrics has six units: the or worsen after repeated nonsurgical treat-
pediatric ward, pediatric inten- sive care ment attempts
unit, neonatal resuscitation unit,
4 Journal of International Medical Research

Positive/favorable outcome: Patient has Data quality management

been cured of intussusception and is dis-
charged from the hospital We used a pretested, validated, structured
Negative/unfavorable outcome: Patients data collection tool prepared in simple
discontinue treatment against medical English after a review of the related litera-
advice, develop in-hospital recurrence or ture to ensure data quality. The data
failure of treatment, or die after discharge collec- tors and supervisors received 1
day of training on the purpose of the
Diagnosis of intussusception study, the contents of the data collection
tools, where to find the records, how to
The initial diagnostic criterion was the clin- extract the required data from the medical
ical triad of abdominal pain, bloody diar- records, and how to appropriately record
rhea/stool, and a palpable abdominal mass. the data. A pretest was conducted on 5%
However, abdominal ultrasonography find- of the sample before the actual data
ings such as a target sign, pseudo kidney, or collection period to assess the reliability
doughnut sign were used for patients who and validity of the data collection tools.
did not exhibit the classic triad and did not The question- naires were reviewed and
require urgent surgical intervention, such as checked for com- pleteness, accuracy, and
patients with peritonitis. The findings of the consistency by the principal investigator
clinical triad and/or ultrasonography were and amended accord- ingly based on the
confirmed by intraoperative identification pretest results. The supervisors and the
of the intussusception. principal investigator carefully checked
the collected data for completeness,
Data collection tools and methods accuracy, and consistency daily. Two
Data were collected using a validated pre- individuals performed double data entry
tested structured data extraction checklist to minimize errors.
adopted from relevant literature and modi-
fied to the study variables. First, the Data processing and analysis
surgical and admission records were The collected data were validated for com-
reviewed to develop a list of patients pleteness and accuracy. They were then cat-
presenting with acute intussusception from egorized, coded, and entered into EpiData
January 2018 to December 2020. Next, data version 3.1 (EpiData Association, Odense,
were extracted from the medical records of Denmark) and analyzed using SPSS version
children taken from the examination room 25.0 (IBM Corp., Armonk, NY, USA).
upon arrival, operating room records, Descriptive statistics were used for the
postsurgical evalu- ation and monitoring fre- quency, mean and median, standard
sheets, intensive care records, and discharge devia- tion, and percentage. The results
records. Data were collected by trained data were summarized using graphs, charts,
collectors and supervisors. Additional data and tables, and data interpretations were
collected included sociodemographic based on the main objectives of the
characteristics, delay in presentation, study.
clinical signs and symptoms, interventions, Variables with a p-value of <0.25 at a
surgical proce- dures, and the duration of 95% CI were candidates for the final mul-
hospitalization. tivariate logistic regression. The features
To avoid selection bias, we included all included in the final model were the length
patients who underwent surgical operations of hospital stay, age, sex, residence, abdom-
for intussusception. inal distension, eagerness to drink, type of
intussusception, sunken eyes, and the
 Zewde et 5

operative procedure performed. Logistic abdominal tenderness in 36 (35.0%),

regression analyses were utilized, and a p-
bloody stool in 53 (51.5%), a rectal mass
value of <0.05 was considered statistical-
in 61 (59.2%), and a gangrenous bowel con-
ly significant.
dition in 30 (29.1%). In terms of the diag-
nostic method, 64 (62.1%) of the patients
Ethical considerations were diagnosed clinically, and 39 (37.9%)
This study was approved by the Institutional were diagnosed by ultrasound. Most
Research Review Committee of the College patients [60 (58.3%)] had a >3-day history
of Health Sciences and Medicine, Wolaita of symptoms at presentation. The key clin-
Sodo University, Ethiopia (Certificate Ref. ical manifestations and findings are shown
No: CHSM/ERC/02/2014). A written offi- in detail in Table 1.
cial letter of cooperation was submitted to
WSUCSH before the commencement of Intraoperative findings and management
data collection. Informed consent was vol-
outcomes
untarily provided by the heads of the hospi-
tal and the department after they had been Table 2 presents the intraoperative findings
informed of the aim, purpose, and benefits and management outcomes. A pathological
of the study. The confidentiality of the lead point was found in 16 (15.5%)
infor- mation was maintained throughout patients. Among these 16 patients, the
the data collection and information lead points were a lymph node in
dissemination process. We also de- 7 (43.75%), Meckel’s diverticulum in
identified all patient details in the chart 2 (12.5%), duplication cyst in 3 (18.75%),
review. Because of the anonymous nature and other sites in 4 (25.0%) (Figure 1).
of the data analysis, the requirement for The most common operative procedure
informed consent from the patients’ was manual reduction, which was
guardians was waived by the ethics performed in 54.4% of the patients.
committee. Resection and anastomosis were also
common, performed in 47 (45.6%) patients.
Results Resection and anastomosis were performed
because of gangrenous bowel attributable
Patients’ sociodemographic characteristics to delayed presentation in most cases, and
bowel perforation occurred during manual
Among 128 eligible patients, we excluded
25 (19.5%) because of incomplete records. reduction in some patients. Many patients
Therefore, the study included the remaining [31 (30.1%)] were transferred to the inten-
103 (80.5%) patients. Of these 103 patients, sive care unit (ICU) either at Wolaita Sodo
68 (66%) were male and 43 (42%) were Teaching and Referral Hospital or at the
aged <1 year (minimum age, 2 months; study site. The length of hospital stay was
mean age, 3.55 3.62 months). Ninety- >11 days in 25% of patients, ranging from
two (89%) patients resided in rural areas. 1 to 25 days (mean, 8.01 5.39 days).
Surgical site infection occurred in
Clinical presentations and findings 13 (12.6%) patients, and hospital-acquired
infection occurred in 15 (14.6%). Upon dis-
Seventy-six (74%) patients visited our hos- charge, 84 (81.6%) patients showed
pital through a referral from another health improvement, 6 (5.8%) left against medical
institution. The clinical presentations advice, and 13 (12.6%) died. The cause of
included abdominal pain in 75 (72.8%)
death in most of these patients was sepsis
patients, vomiting in 83 (80.6%),
6 Journal of International Medical Research

Table 1. Clinical presentations and findings according to the patterns of clinical presentations and
management outcomes of pediatric intussusception at Wolaita Sodo University Comprehensive Specialized
Hospital (n ¼ 103).
Variables Categories n %

Means of visit to the hospital Referred from health institution 76 73.8

Self-referred 27 26.2
Abdominal pain Yes 75 72.8
No 28 27.2
Bloody stool Yes 53 51.5
No 50 48.5
Vomiting Yes 83 80.6
No 20 19.4
Abdominal distension Yes 18 17.5
No 85 82.5
Duration of symptoms 24 hours 10 9.7
≤
25–48 hours 16 15.5
48–72 hours 17 16.5
>72 hours 60 58.3
Tachycardia Yes 93 90.3
No 10 9.7
Fever Yes 19 18.4
No 84 81.6
Tachypnea Yes 20 19.4
No 83 80.6
Delayed capillary refill time Yes 26 25.2
No 77 74.8
Eager to drink Yes 24 23.3
No 79 76.7
Irritable Yes 36 35.0
No 67 65.0
Lethargy Yes 16 15.5
No 87 84.5
Sunken eyes Yes 51 49.5
No 52 50.5
Rectal mass Yes 61 59.2
No 42 40.8
Abdominal tenderness Yes 36 35.0
No 67 65.0
Diagnosis Clinical 64 62.1
Imaging (ultrasonography) 39 37.9
Blood transfusion Yes 13 12.6
No 90 87.4
Bowel condition Viable 62 60.2
Gangrenous 30 29.1
Perforated 4 3.9
Gangrenous and perforated 7 6.8
 Zewde et 7

Table 2. Intraoperative findings and management outcomes according to patterns of clinical presentations
and management outcomes of pediatric intussusception at Wolaita Sodo University Comprehensive
Specialized Hospital (n ¼ 103).

Variables Categories n %
Pathological lead point Yes 16 15.5
No 87 84.5
Operative procedure performed Manual reduction 56 54.4
Resection and anastomosis 47 45.6
Patient transferred to PACU 72 69.9
ICU 31 30.1
Patient condition at discharge Discharged improved 84 81.6
Left against medical advice 6 5.8
Died 13 12.6
Surgical site infection Yes 13 12.6
No 90 87.4
Wound dehiscence Yes 6 5.8
No 97 94.2
Postoperative complication Yes 5 4.9
No 98 95.1
Hospital-acquired infection Yes 15 14.6
No 88 85.4
Length of hospital stay ≤4 days 26 25.2
4.1–6 days 20 19.4
6.1–11 days 31 30.1
>11 days 26 25.2
PACU, post-anesthesia care unit; ICU, intensive care unit

Figure 1. Exploration of the type of lead point among patients according to the patterns of clinical
presentations and management outcomes of pediatric intussusception.

related to gangrenous bowel, bowel perfo- ileocolocolic in 40 (38.83%) patients, ileocolic

ration, and late presentation. in 27 (26.26%), ileoileal in 26 (25.24%),
The most common types of intussusception and colocolic in 10 (9.71%). These findings
based on the intraoperative findings were are diagrammatically depicted in Figure 2.
8 Journal of International Medical Research

Figure 2. Anatomic classification of intussusception according to the patterns of clinical presentations and
management outcomes of pediatric intussusception at Wolaita Sodo University Comprehensive Specialized
Hospital.

Predictors of pediatric intussusception Of the variables included in the final

management outcomes model, the following were identified as pre-
dictors of the outcome after controlling for
To conduct an appropriate logistic regres-
likely confounders: patient age, type of
sion analysis, the outcome variable was
intussusception, and operative procedure.
dichotomized into two groups: patients Patients aged <1 year were 96% less likely
discharged with improvement (positive out-
to have positive outcomes than those aged
come), constituting 81.6% of all patients,
>4 years [adjusted AOR (AOR), 0.04; 95%
and patients who left against medical
CI, 0.03–0.57]. The type of intussusception
advice or died (merged and categorized as was also a predictor, and the ileocolic
patients with an unfavorable outcome) type was associated with a nine-times
(negative outcome), constituting 18.4% of higher likelihood of having favorable out-
all patients. This indicates that most of the comes (AOR, 9.16; 95% CI, 2.39–21.2).
patients were discharged with favorable Compared with other operative procedures,
outcomes following management of pediat- manual reduction was associated with a
ric intussusception at WSUCSH. However, three-times higher likelihood of a positive
a substantial number of patients were dis- outcome (AOR, 3.08; 95% CI, 3.05–5.48)
charged with negative outcomes. (Table 3).
 Zewde et 9

Table 3. Factors associated with management outcomes of pediatric intussusception at Wolaita

Sodo University Comprehensive Specialized Hospital.

Outcome

Variables Categories Positive Negative COR (95% CI) AOR (95% CI)

Length of hospital stay ≤4 days 17 (20.2%) 9 (47.4%) 1.26 (0.88–3.42) 0.16 (0.08–2.12)
4.1–6 days 17 (20.2%) 3 (15.8%) 4.21 (0.99–8.98) 3.2 (0.19–7.68)
6.1–11 days 28 (33.3%) 3 (15.8%) 4.22 (0.89–5.77) 3.72 (0.39–8.56)
>11 days 22 (26.2%) 4 (21.1%) 1 1
Age ≤1 year 31 (36.9%) 12 (63.2%) 0.34 (0.13–0.79) 0.04 (0.03–0.57)*
1–4 years 18 (21.4%) 3 (15.8%) 0.46 (0.043–6.42) 0.56 (0.03–8.22)
≥4 years 35 (41.7%) 4 (21.1%) 1 1
Sex Male 54 (64.3%) 14 (73.7%) 0.19 (0.18–2.22) 0.11 (0.08–1.32)
Female 30 (35.7%) 5 (26.3%) 1 1
Residence Rural 74 (88.1%) 18 (94.7%) 0.50 (0.12–6.01) 0.41 (0.02–9.02)
Urban 10 (11.9%) 1 (5.3%) 1 1
Abdominal distension Yes 62 (73.8%) 13 (68.4%) 0.33 (0.11–11.21) 1.93 (0.29–13.41)
No 22 (26.2%) 6 (31.6%) 1 1
Eager to drink Yes 22 (26.2%) 2 (10.5%) 3.09 (1.66–6.11) 3.14 (1.76–8.51)
No 62 (73.8%) 17 (89.5%) 1 1
Type of intussusception Ileoileal 23 (27.4%) 3 (15.8%) 2.12 (1.22–9.07) 3.91 (1.11–11.17)
Ileocolic 26 (31.0%) 1 (5.3%) 8.26 (1.19–11.01) 9.16 (2.39–21.2)*
Colocolic 8 (9.5%) 2 (10.5%) 5.12 (0.14–11.22) 4.72 (0.54–10.18)
Ileocolocolic 27 (32.1%) 13 (68.4%) 1 1
Sunken eyes Yes 37 (44.0%) 14 (73.7%) 1.17 (0.51–2.19) 0.07 (0.05–1.15)
No 47 (56.0%) 5 (26.3%) 1 1
Operative procedure Manual reduction 54 (64.3%) 2 (10.5%) 2.11 (1.09–5.98) 3.08 (3.05–5.48)*
Resection and 30 (35.7%) 17 (89.5%) 1 1
anastomosis
COR, crude odds ratio; AOR, adjusted odds ratio; CI, confidence interval.
*
Statistically significant association.

Discussion 10% of intussusceptions occur in children

aged >5 years, 3% to 4% occur in
Pediatric abdominal surgery emergencies
children aged >10 years, and 1% occur in
occur worldwide, necessitating prompt
infants aged <3 months. In one case
diagnosis and treatment.2 Acute intussus-
series,30 children aged >3 and >5 years
ception is considered more prevalent in
accounted for 36.1% and 9.5% of the
chil-
patients with intussusception, respectively,
dren aged <2 years, particularly in infants supporting our findings of a higher inci-
aged 4 to 9 months.21–23 Nevertheless, dence among children aged >4 years.
43 (41.7%) patients in our study were
Male patients were more commonly affect-
infants aged <1 year, 39 (37.9%) were ed than female patients in this study, with
>4 years old, and 21 (20.4%) were 1 to a male:female ratio of 1.94:1.00; this is
4 years old. This suggests that attention also comparable to the results reported
should also be paid to the occurrence of by other researchers.3,25,26,31 However, the
intussusception in older children. The high- spe- cific cause of these age and sex
est incidence among infants in our study is variances remain unknown. In our study,
in agreement with many studies both more than 89% of the patients came from
worldwide and in Africa.24–28 Shiyi and rural areas located a considerable
Ganapathy29 found that approximately distance from the
10 Journal of International Medical Research

study area, which is consistent with other clinical diagnoses [64 (62.1%)] than
studies.3,27,32 ultrasound-based diagnoses [39 (37.9%)]
Intussusception manifests as paroxysmal in our study.
stomach pain/crying, an abdominal sausage- The suggested treatment modality for
shaped mass, and bloody stool. In the acute intussusception is surgery or nonsur-
present study, the clinical presentations gical therapies such as hydrostatic and
included bloody stool in 53 (51.5%) pneumatic reduction under fluoroscopy or
patients, abdominal pain in 75 (72.8%), ultrasound guidance.4 The most common
vomiting in 83 (80.6%), and a rectal mass operative procedure in our study was
in 61 (59.2%). This is consistent with manual reduction, performed in 54.4% of
research conducted in South Africa show- the patients; resection and anastomosis
ing that >90% of patients presented with were also commonly performed [47
vomiting and bloody stool, 60% with a pal- (45.6%) patients]. This finding suggests a
pable mass, and >30% with a mass palpa- growing diagnostic and interventional shift
ble on rectal examination or presenting at in intussusception management from
the anus.33,34 Notably, the incidence of surgical to nonsurgical reduction.33 Non-
bloody stool was lower in our study than operative reduction using hydrostatic or
in these studies from South Africa.33,34 pneumatic pressure by enema is the treat-
Justice et al.35 reported that 78% of the ment of choice for an infant or child who is
children in their study presented with clinically stable and has no evidence of
abdominal pain, lethargy, and vomiting, bowel perforation or shock when appropri-
which is in agreement with our study. ate radiologic facilities are available.
However, other studies have suggested Because of the increased availability of
that the patterns of symptoms may vary diagnostic modalities among many institu-
depending on the age and sex of the tions and the advancements in medical spe-
child36 and the duration of signs upon pre- cialties, non-operative reduction currently
sentation to the hospital. A significant predominates globally. This is also aug-
number of children with intussusception mented by increased health-seeking
present for definitive treatment late in the behavior and early presentation to health
clinical course, and this seems to be the facilities, which reduces the complications
norm in many developing countries.18 Our associated with resection and anastomosis.
study showed that most of the patients [60 Our findings are consistent with this expla-
(58.3%)] had a >3-day history of symptoms nation because most of our patients were
at presentation, which is consistent with the managed by surgical means.
literature from developing countries.2,9,10 It should be noted that the current find-
The reason for late presentation may be ings contradict data from Tikur Anbesa
the need to travel long distances, potentially Specialized Hospital in Ethiopia,37,38
from rural areas. Ninety-two (89.3%) of Jimma University Medical Centre in
our patients were from a rural area, and Ethiopia,19 and Tanzania,3 where surgery
most such patients seeking public health is used for management of most patients.
care have limited access to transport. The These differences may be due to patients’
presentation of intussusception is similar to early health-seeking behavior, considerable
many common abdominal and respiratory immediate and late surgical complications,
tract infections in children. Intussusception and higher proportion of viable bowel [62
is clinically or surgically diagnosed in most (60.2%) patients in the present study].
patients in developing countries, which is Surgical intervention is indicated when
consistent with the higher percentage of there is evidence of bowel necrosis, bowel
 Zewde et 1

perforation, or peritonitis; when safe facili- than in studies performed in Ethiopia

ties to perform an enema reduction are (21.3% and 33.9%)45,46 and Tanzania
unavailable; or when repeated relapse (42.9%).3 The ICU admission rate in our
occurs despite appropriate management. study was 30.1%. Another study showed
Most studies have shown that late presen- that bowel resection was also associated
tation in developing countries is closely with ICU admission (p < 0.001) and
associated with surgical treatment and pro- longed hospitalization (p < 0.001).3
complications.33,39,40 This helps to explain the reasons for the
Intraoperative findings revealed patho- ICU
logical lead points in 16 (15.5%) patients admissions in our setting. Critically ill
in our study. The lead points were a patients with conditions such as intestinal
lymph node in 7 (6.8%) patients, gangrene, respiratory failure requiring
Meckel’s diverticulum in 2 (1.9%), a mechanical ventilation, and multiple organ
duplication cyst in 3 (2.9%), and other dysfunction are more likely to be admitted
sites in 4 (3.9%). This incidence of to the ICU.43 Our mortality rate was
15.5% is higher than in a study from 12.6%, which is consistent with the mortal-
South Africa, which showed a 2% ity rate of 14.3% in the study from
incidence of lead points,4 as well as Tanzania.3 The mortality rate in Africa
another study showing lead points in (9%) was higher than that in other regions
1.5% to 12.0% of cases.41 Open surgery (˂1%),2,3,7 which is in agreement with
was per- formed in our study, and 47 our findings and can be explained by late
(45.6%) patients underwent resection and pre- sentations, open surgical procedures,
anasto- mosis procedures. This proportion post- operative complications, and poor
of patients is less than that in a Tanzanian infrastructure in the developing world,
study, in which 55% of patients unlike more developed countries with
underwent intestinal resection,42 but lower mortality rates. Patients aged <1
higher than the proportions of 33% and year were 96% less likely to have positive
39% reported in Kenya and Tanzania,43 outcomes than those aged >4 years (AOR,
respectively. The higher rate of bowel 0.04; 95% CI, 0.03–0.57). This is because
resection in our study is attributed to the younger patients have a higher probability
patients’ late presenta- tion, which of requiring bowel resection than older
reflects the low level of health awareness patients. This is consistent with other stud-
in our community; infrastructur- al ies showing that an age of <1 year was
problems associated with the high pro- more strongly associated with bowel resec-
portion of patients in rural areas; and tion and associated complications. An age
similarity of symptoms with other of <1 year was shown to have a 2.7-times
common pediatric conditions. higher risk of bowel obstruction than older
Postoperative complications are associ- ages.47 A study in in Nigeria showed that
ated with poor treatment results in patients children aged <1 year were three times
with acute intussusception.44 The most more likely than those aged >1 year to
common postoperative complication is require bowel resection. This might be
hospital-acquired infection, which occurred explained by the fact that infants are more
in 15 (14.6%) patients in our study. prone to developing shock, which may fur-
Hospital-acquired infection is associated ther compromise the already precarious
with the length of hospital stay, which was blood supply to the intussusception.48 The
>11 days in 25% of our patients (range, 1– type of intussusception was also a predic-
25 days; mean, 8.01 5.39 days). tor, and the ileocolic type had a nine-times
Surgical site infection occurred in 13 higher likelihood of favorable outcomes in
(12.6%) patients, which is a lower
incidence
12 Journal of International Medical Research

our study (AOR, 9.16; 95% CI, 2.39–21.2). Acknowledgement

The most common form of intussusception
We would like to express our gratitude to the
in our study was ileocolic, which is in data collectors who extracted the data from the
agree- ment with other studies.45,48 The chart review and to the study supervisors. We
more favor- able outcomes of this type are would also like to thank WSUCSH and Wolaita
indicated by its clinical and ultrasound Sodo University for providing permission to use
presentations.49,50 Additionally, manual all pro- vided documents in this research.
reduction had a three- times higher
likelihood of a positive outcome than other Author contributions
procedures (AOR, 3.08; 95% CI, 3.05– YZ: Conceived the study and drafted the manu-
5.48). This is also in agreement with many script. TB, AD, AW, and MM: Study design and
other studies.23,51,52 methodology, data analysis, writing of manu-
script, and critical evaluation of manuscript.
All authors approved the manuscript for submis-
Limitations sion to the journal.
This study involved a retrospective record
review, which has inherent limitations. The Data availability statement
secondary data in this study might not have The article contains all necessary data within the
specifically addressed the research ques- manuscript. The authors will provide the data
upon request.
tions or contained the information required
for analysis. Another limitation was the
Declaration of conflicting interests
small sample size. Moreover, the retrospec-
tive cross-sectional study design did not All the authors declare that they have no conflict
of interest.
allow for easy establishment of the cause–
effect relationship between the study varia-
Funding
bles or other statistical inferences. The find-
ings of this institutional study are difficult The authors received no funding for this
to generalize to other populations. research.

ORCID iD
Conclusion Mengistu Meskele https://orcid.org/0000-
This study revealed a higher prevalence of 0001-6157-4591
patients with favorable than unfavorable
outcomes. An ileocolic intussusception and References
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