Pediatric intussusception in Uganda: differences in management and outcomes with high-income countries
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In brief
In brief
Prospective study of 40 pediatric intussusception cases in Uganda reveals stark contrasts with high-income settings: 100% required surgery (vs. radiographic reduction), average 4.5-day symptom duration, and 32% mortality. Fever at admission predicted 20-fold mortality increase, highlighting critical need for earlier referral and intervention in resource-limited environments.
Written by the GCMD Library team from the article.
Purpose
In high-income countries the presentation and treatment of intussusception is relatively rapid, and most cases are correctable with radiographically-guided reduction. In low-income countries, many delays affect outcomes and surgical intervention is required. This study characterizes the burden and outcome of pediatric intussusception in Uganda.
Methods
Prospective case series of intussusception cases from May 2015 to July 2016 at a tertiary referral hospital in Uganda.
Results
Forty patients were included in the study. Male to female ratio was 3:2. Average duration of symptoms before presentation was 4.5 days. Median duration of symptoms in referred patients was 4 days and 2 days in non-referred patients (P value 0.0009). All 40 patients underwent surgical treatment: 25% had resection and enterostomy, 15% had resection and primary anastomosis, 2.5% had resection, primary anastomosis and enterostomy and 57.5% underwent manual reduction. Mortality was 32% and febrile patients on admission were 20 times more likely to die (P value 0.040).
Conclusion
Intussusception carries a high operative and mortality rate in Uganda. Referred patients presented later than non-referred patients to health facilities. Fever on examination at admission was positively associated with mortality. This disease remains a target for quality metrics in global pediatric surgery.
Type of study
Diagnostic study.
Level of Evidence
III