Childhood intussusception at the Moi teaching and Referral Hospital Eldoret: management challenges in a rural setting.

Objective: To review the management of childhood intussusception at the Moi Teaching and Referral Hospital, Eldoret and identify factors that require attention for improved outcome.
Design: A retrospective descriptive study covering the period January 2000 to December 2003.
Setting: Moi Teaching and Referral Hospital, Eldoret.
Patients: Thirty six children.
Results: Of the 36 children, 28 (78%) were males and eight (22%) females giving a ratio of 3.5:1. Median age was six months with a range of 2-72 months. The duration of symptoms was a mean of 5 days with a range of 1-14 days. Sixty one percent were referrals. Initial diagnosis of intussusception based on signs and symptoms was made in 6 out of 36 (17%) patients. The rest were initially treated for other problems. Decision to refer to surgeons, was based on abdominal distension. Plain x-ray was done in four patients and barium enema in one patient. Seventy five percent of the patients required fluid resuscitation before operation. All patients (100%) were managed operatively. Seventy two percent had ileo-colic intussusception, 8% ile-oileal and 22% colo-colic. Perforation was found in 22% and gangrene in 31%. Sixty seven percent were successfully reduced by "milking" while 33% required resection and anastomosis/or stoma creation. Complications included: anastomatic breakdown, bronchopneumonial renal failure, sepsis, recurrent intussusception and death. Mortality was 14% overall.
Conclusion: Early diagnosis and presentation coupled with improved peri-operative management are essential in improving outcome.