Predictors of Surgery and Gangrenous bowel in pediatric intussusception

Abstract

Background: Intussusception is a surgical emergency and the leading cause of intestinal obstruction in children aged 3 months to 3 years. Delays in presentation, diagnosis, or treatment may result in intestinal necrosis, necessitating bowel resection. Aim: To explore clinical presentations in children with intussusception requiring surgery or bowel resection and evaluate predictors of intestinal necrosis to facilitate timely management and improved outcomes. Methods: A prospective study was conducted on 100 patients under 14 years of age diagnosed with intussusception at the Pediatric Surgery Department of Children Welfare Teaching Hospital, Baghdad, from October 2022 to November 2023. Diagnosis was confirmed via ultrasound (U/S). Data collection included medical history, physical examination, laboratory findings, U.S measurements of intussusception mass, and intraoperative findings (mass type, bowel status, and pathological lead points). Cases with alternative diagnoses (e.g., lymphoma, ovarian cyst, renal tumor) were excluded. Results: Of the 100 patients, 46% underwent operative reduction, 24% required bowel resection, and gangrenous bowel was observed in 14%. Predictors for operative reduction included prolonged abdominal pain (P=0.004), bleeding per rectum (P=0.004), vomiting (P=0.003), bilious vomiting (P=0.013), tachycardia and tachypnea (both p