Intussusception in children aged under two years in India: Retrospective surveillance at nineteen tertiary care hospitals.

OBJECTIVE: Intussusception has been linked with rotavirus vaccine (RVV) as a rare adverse reaction. In view of limited background data on intussusception in India and in preparation for RVV introduction, a surveillance network was established to document the epidemiology of intussusception cases in Indian children. METHODS: Intussusception in children 2-23 months were documented at 19 nationally representative sentinel hospitals through a retrospective surveillance for 69 months (July 2010 to March 2016). For each case clinical, hospital course, treatment and outcome data were collected. RESULTS: Among the 1588 intussusception cases, 54.5% were from South India and 66.3% were boys. The median age was 8 months (IQR 6, 12) with 34.6% aged 2-6 months. Seasonal variation with higher cases were documented during March-June period. The most common symptoms and signs were vomiting (63.4%), bloody stool (49.1%), abdominal pain (46.9%) and excessive crying (42.8%). The classical triad (vomiting, abdominal pain, and blood in stools) was observed in 25.6% cases. 96.4% cases were diagnosed by ultrasound with ileocolic location as the commonest (85.3%). Management was done by reduction (50.8%) and surgery (41.1%) and only 1% of the patients' died. 91.1% cases met Brighton criteria level 1 and 3.3% Level 2. Between 2010 and 2015, the case load and case ratio increased across all regions. CONCLUSION: Intussusception cases have occurred in children across all parts of the country, with low case fatality in the settings studied. The progressive rise cases could indicate an increasing awareness and availability of diagnostic facilities.

Thoracic ectopia cordis.

Ectopia cordis is defined as complete or partial displacement of the heart outside the thoracic cavity. It is a rare congenital defect in fusion of the anterior chest wall resulting in extra thoracic location of the heart. Its estimated prevalence is 5.5-7.9 per million live births. The authors had one such case of a 15-h-old full-term male neonate weighing 2.25 kg with an externally visible, beating heart over the chest wall. The neonate had difficulty in respiration with peripheral cyanosis. Patient died of cardiorespiratory arrest before any surgical intervention could be undertaken inspite of best possible resuscitative measures.

An infant with caudal appendage.

There are several human atavisms that reflect our common genetic heritage with other mammals. One of the most striking is the existence of the rare 'true human tail'. It is a rare event with fewer than 40 cases reported in the literature. The authors report a case of an infant born with the true tail. A 3-month-old baby girl, presented with an 11 cm long tail, which was successfully surgically removed. Human embryos normally have a prenatal tail, which disappears in the course of embryogenesis by programmed cell death. Recent advances in genetic research reveal that 'of those organs lost, in evolution, most species carry 'genetic blue prints'. Thus, rarely the appearance of ancient organs like tail may be the result of re-expression of these switched off gene.

Ileo-colic intussusception in premature neonate.

Intussusception in neonatal age is very rare. A 12-day-old child was referred from peripheral hospital with history of intolerance to feed, absolute constipation, abdominal distension and significant bilious aspirate. Per-rectal examination revealed necrotic haemorrhagic fluid. The patient was treated on the lines of necrotising enterocolitis in the referring hospital. On further investigation and exploration, the patient turned out to be ileo-colic intussusception which is exceedingly less common in premature neonates. Hence, other causes of intestinal obstruction should also be considered along with vigilant clinical outlook in neonates.