Analysis of Clinical Factors and Operative Findings in Childhood Intussusception

소아 장중첩증에서 임상양상과 수술소견과의 관계에 관한 분석

Although nonoperative reduction plays a major role in the management of uncomplicated intussusception in the pediatric age group, surgical treatment is still a necessary alternative when nonoperative reduction is unsuccessful. The author analyzed the clinical features of 68 patients requiring operation in order to identify factors which might influence the type of operative management. A nine-year experience at Ewha Womans University Hospital was reviewed, and the findings compared to previous reports. Barium was used for the initial reduction attempt in 33 cases, saline in 35. Manual reduction by milking at operation achieved success in 41 cases(60.3%). Fifteen cases(22.1%) required resection of bowel, and 12 patients(17.6%) were found to have spontaneous and complete reduction of the intussusception at operation. Two cases had pathologic leading points. There were no perforations due to nonoperative reduction. There were no significant differences in demographic data, clinical findings, laboratory data, and anatomic type of intussusception between barium and saline reduction groups. However, a significant number of cases with spontaneous reduction were in saline reduction group(p<0.05). There was a slight chance of spontaneous reduction in infants under 6 month of age(p<0.001). Age under 6 month. body temperature over $38^{\circ}C$, symptom over 24 hours, and ileo-colic and ileo-ileo-colic intussusception contributed significantly to the necessity for bowel resection(p<0.05-0.001). The author believes that the age, body temperature, duration of illness, and anatomic type of intussusception strongly influence operative management.