The Role of the Multidisciplinary Approach in the Diagnosis and Treatment of Intussusception

Introduction: Intestinal intussusception, the most common cause of intestinal obstruction in children, is an intestinal obstruction that occurs by telescoping one intestinal segment into another, pulling also the mesentery which determine venous congestion phenomena and arterial insufficiency with intestinal wall necrosis. The cause of intussusception in children is frequently attributed to viral infections. Symptoms include abdominal pain, vomiting and hemorrhagic stools. Untreated, it is complicated by intestinal wall perforation and peritonitis. Currently, abdominal ultrasound is the gold standard method for confirming the diagnosis. Treatment should be started as soon as possible after the patient’s diagnosis.

Methods: This is a 15 years retrospective study carried out in the “Sfântul Ioan” Clinical Emergency Hospital for Children in Galati. In this study we included 37 patients aged 0-18 years with the diagnosis of intussusception admitted between 2008 and 2022. We included in the study demographic data (age, sex, rural or urban origin), comorbidities, type of invagination, clinical data, laboratory and imaging examinations, therapeutic management, and complications.

Results: Intestinal intussusception is more common in children between 1 and 12 months of age, predominantly affecting males (2/1). Symptomatic triad was present in 24% of cases and only in patients under 1 year of age, with onset of symptoms greater than 6 hours. The most common symptom was abdominal pain, which was observed in 92% of patients, followed by vomiting which had a frequency of 86%. In 84% of cases, the intussusception was primary, the most common anatomical form being ileocolic in 67.5%. The main operative technique was manual reduction of the intussusception, associated with cecopexy in 63% of cases, and circumstantial appendectomy in 100% of cases. Bowel resection was performed in only 7 (26%) of patients. There were 2 recurrences of intussusception, 1 case of evisceration and 1 case of secondary necrosis of the uninvaginated loop.

Conclusions: Intussusception is a serious surgical pathology and treatment delays are common in our setting. Delayed presentation contribute to considerable morbidity and mortality. Training the family physicians and health staff of the local hospitals and raising awareness of the people to present early after the warning signs, will help to enhance early diagnosis of intussusception. In addition, the accessibility of the ultrasound and the training of specialists in the fields related to the pediatric pathology are also important. This information will contribute to the early diagnosis and non-operative treatment of intussusception.