During our study period,
there were 85 intussusceptions diagnosed in children in Northern Ireland.
These children all underwent attempted radiological reduction.
As expected,
the majority of these children were male,
with 60 boys,
compared to 25 girls (71%/29% split).
We achieved a success rate of 78.8% (n=67),
with a negative outcome in n=1 (1.2%).
The age profile of our patients is,
unsurprisingly,
in keeping with international data,
the median age 8months (mean 1yr 4months,
range 1 day- 14.5 yrs).
64% (n=53) of the patients were infants less than a year old,
and 82% (n=70) were less than 2 years old at presentation (Figure 9).
Fig. 9: Age of patients at presentation with intussusception to our institution during our study period.
As the regional specialist paediatric centre, all patients in Northern Ireland with confirmed or suspected intussusception are transferred to our institution for treatment.
The maximum distance from our hospital to a patient's home is 108km.
Only 13% (n=11) of our patients had to travel distances greater than 53km.
Fig. 10: The geographic distribution of our patients is shown on this map. Belfast is on the east coast, and the vast majority of our patients' homes are within 1 hour travel. The furthest that any patient with an intussusception has had to travel to receive treatment is 68miles (108km).
Only one of our patients presented with the classic triad (vomiting,
rectal bleeding and abdominal pain),
which highlights the diagnostic challenges facing our clincal colleagues in primary care medicine with these young children. The most frequent presenting symptoms were these 3 symptoms, though evidently not simultaneously.
Fig. 11: The numbers of patients presenting with a given clinical symptom is outlined here, with the success and failure at radiological intussusception reduction.
As expected,
there was a significantly reduced rate of successful radiological reduction in patients who presented with symptoms of duration greater than 24hours (p = 0.011).
There was also a tendency towards reduced success of radiological reduction in children who presented with shock/lethargy but unfortunately (for our statistics),
the numbers of these patients were small (n=5),
and so significance was not reached.
There was also a trend towards lower success rates in those children who had interloop fluid demonstrated on ultrasound (see Table 1).
Table 1: Patient factors associated with more difficult radiological reduction were identified but only those patients presenting with a symptom duration of greater than 24hours had a significantly reduced success rate.
The only negative outcome during our study period was a pneumoperitoneum,
and this occured in one of our patients who presented with lethargy and had a delayed presentation.