대한대장항문학회

To assess the clinical differences between the group of barium reduction and of<br>surgical treatment for intussusception in childhood, we analysed the various clinical<br>informations of 325 cases of pediatric intussusception treated at Chonbuk National<br>University Hospital from January 1979 to December 1989.<br>The ratio of rate to female was 1.75'1 and 75.1% of the patients was under the age<br>of 12 month. The main clinical manifestations were irritability and/or abdominal<br>pain(98.5%), vomiting(91.4%), currant-jelly stool (86.2%) and palpable abdominal<br>mass(52.0%). The most common anatomical type of intussusception was<br>ileo-colic(78.5%). In etiological analysis, 84.6% was idiopathic in cause and remained had<br>causative lesions, i. e. mobile cecum(10.8%), hypertrophy of Peyer's<br>patches(3.7%),<br>Meckel's diverticulum(0.6%) and ascariasis(0.3%). The associated diseases or anomalies<br>were observed in 59.7% and the most frequent one was upper<br>respiratory<br>infection(40.0% ).<br>The success rate of barium reduction was 75.5% among 318 cases. According to age<br>group, the success rate of barium reduction was 91.7% in 2 years of age, 68.5% in over<br>3 years of age and 59.5% in below 4 months of age, but there was no significant<br>difference statistically. The success rate of barium reduction according to duration of<br>illness was 87.1% in the group within 24 hours, but below 50% in over 24 hours and<br>the difference was significant statistically(p<0.05).<br>The incidences of non-specific physical findings, soft mass density with or without<br>irregular gas distribution on plain abdominal X-ray and ileo-colic intussusception were<br>high in the group of barium reduction compared with them of the group of surgical<br>treatment. The incidences of increased Peristalsis, abdominal distention, tenderness,<br>rebound tenderness, dehydration, lethargy, muscle guarding, fever over 37.5。C and<br>respiratory rate below 20 and over 60/min. On physical examination, neutrophils over<br>80% in differential leukocyte count, air-fluid levels only in plain abdominal X-ray and<br>ileo-ileal and ileo-ileo-cecal types were statistically higher the group of<br>surgical<br>treatment than the group of barium enema(p<0.05). But there was no statistically<br>significant difference in the seasonal distribution, degree of pulse rate, decree of<br>leukocytosis and associated diseases or anomalies between the group of barium reduction<br>and of surgical treatment.<br>Operation was done in 26.2% (85 cases). Among the surgical Procedures, manual<br>reduction was done in 67.1% and segmental intestinal resection in 23.5%. Remained 8<br>cases(9.4%) were reduced state at the time of laparotomy. As the additional procedures,<br>appendectomy was done in 71.8% and cecopexy in 38.7% among 31 cases with mobile<br>cecum. In conducting frequency of the operative methods according to duration of<br>illness, manual reduction was successed in 81.5% among the group within 24 hours, but<br>segmental bowel resection was needed in 60.0% among the group over 72 hours(p<0.05).<br>The postoperative complications were developed in 28.2% and the group of segmental<br>bowel resection was shown the highest incidence (60%)(p<0.05).<br>The rate of recurrence was 10.2% and 84.2% of them were developed within 6 months<br>after the treatment.7he difference of recurrence rate between the group of barium<br>reduction (12.9%) and of surgical treatment(2.4%) was statistically significant(p<0.05).<br>