A Comparative Study of Non-operative Management in Childhood Intussusception

PURPOSE: Intussusception is one of the most common causes of intestinal obstruction in children under the age of 2 years, especially in male. In this study, we compared the results of pressure reductions for various treatment methods and identified the factors related to reduction failure. METHODS: From Jan. 1996 to Dec. 1997, 87 barium reductions and 127 air reductions were performed for childhood in tussusception. Success rates of these non-operative managements and factors affecting those rates were analyzed. RESULTS: 1) When only ileocolic intussusceptions were considered in order to exclude the effect of different type of intussusceptions, the success rate for air reduction (AR) was 83.5%, which was significantly higher than 71.8% in barium reduction (BR). 2) Factors affecting reduction failure were history of preceding upper respiratory infection, fever (> or =38oC) and symptom duration in BR, and abdominal distension, leukocytosis (> or =10,000/mm3), and symptom duration in AR. 3) Bowel perforations were occurred in 3 cases of AR, but all of these cases showed bowel wall infarction requiring bowel resection, and complications due to perforations were minimal. There were no BR-related complications in BR. 4) Intussuception recurred in 7.4% of all cases; 4.9% after BR, 9.3% after AR. The mean intervals between previous reduction and recurrence were 37.0 (range 1-88) days in BR and 64.3 (range 2-283) days in AR. Recurrences occurred within 48 hours after reduction in 2 cases of BR and in 3 cases of AR. CONCLUSION: Compared with conventional barium reduction, air reduction had a relatively higher success rate in managing childhood intussusception, in spite of a slightly higher risk of bowel perforation. However, perforation did not significantly affect the clinical course. Therefore, air reduction is one of the good alternative of conventional barium reduction for managing childhood intussusception.

Clinical Review of Treatment of Acute Appendicitis in Children

Acute appendicitis in children under the age of 12 has remained the surgical emergency condition with the highest percentage of misdiagnosis leading to removal of a normal appendix. From January 1994 to April 1997, 312 children (176 boys, 136 girls) were admitted to Jun-ang Gil Hospital with the impression of acute appendicitis. The average age was 8.6 years (2 to 12 years). We reviewed medical records retrospectively for demographics, presenting signs, symptoms, findings of abdominal ultrasonography (USG) and barium enemas, and surgical results. The patients were divided in 2 groups as follows: group I (n=144) received immediate operations without further evaluation, group II (n=168) was treated after a delay for observation and/or special studies (USG and/or barium enema). Group II was subdivided into Group IIa (n=119) (treatment after study) and Group IIb (n=49)(treatment by clinical observations only). In group I, 124 patients were confirmed intraoperatively as having acute appendicitis, and 20 cases were not. In IIa, 36 patients underwent exploratory surgery and 30 cases revealed acute appendicitis. The remaining 83 patients were discharged because of symptomatic relief. In group IIb, 43 patients underwent exploratory surgery and acute appendicitis was revealed in 35. The diagnostic accuracies of groups were 86%, 95% and 84%. The sensitivity, specificity and diagnostic accuracy of an abdominal ultrasonography (n=105) were 96.1%, 82.1% and 92.4%, respectively. Those of a barium enema (n=63) were 94.7%, 100%, and 95.2% respectively. When both modalities were used (n=49), the results were 95.6%, 100% and 95.9%, respectively. The frequencies of a perforated appendicitis had no difference among the groups. In conclusion, in a child suspected of having acute appendicitis, if there are no apparent toxic signs or panperitonitis, surgical observation, USG, and/or a barium enema can decrease the number of unnecessary appendectomy without increasing the risk of perforation.