Intussusception As Seen At Kenyatta National Hospital A Review Of 54 Cases Seen At The Hospital From January 1970 To August 1974.
Abstract
The aim of this work was to review all cases of 1ntussusception
treated at Kenyatta National Hospital over a period
of ten years. For lack of time, only cases seen over a period
of eight years and eight months have been reviewed ie. from
January 1966 to August 1914. Having noted the monotonous
similarity of clinical and pathological features and also of
slow progress in aetiological aspects of this condition as
reported from many series, both prospective and retrospective,
I have also been encouraged by the lack of local literature,
to tackle a topic in which there seemed little prospects of
coming out with anything new from the outset.
Similarly, because of lack of any definite policy in the
hospital of managing oases of intussusception and an almost
hopeless attitude towards the plight of those affected by it,
it became obvious to me that by stressing certain aspects of
it and by suggesting certain lines of diagnosis and management,
a definite contribution would have been made in the local history of this disease.
The clinical features of intussusception as reported by
many clinicians and investigators are so constant that one may
think that they have been copying each others works word by
word. With this in mind I have reviewed the literature as
extensively as I could in order to find out any local peculiarities
by comparing our findings with what has already been
reported.
Some undisputed and often repeated statements have also
been put to test and in a few instances I have failed to agree
or to confirm them.
The incidence of intussusception as reported from Europe,
united States and the Far East have been reviewed and compared
with what is seen at the Kenyatta National Hospital. As for
the racial incidence I was not in a position to give any contribution
or suggestion as all our patients were Africans.
Regarding the aetiology of the disease the role of weaning
has been regarded as being of less importance than has hitherto
been assumed. This is because intussusception occurs even in
those babies who have not been weaned and the weaning diets
are not the same from place to place and even in the Same
community. The role of diarrhoea in the initiation of intussusception has been emphasized. The majority of the patients
reviewed had diarrhoea and this was the finding of Wambwa
(1964) in a review of Intestinal obstructions in Kenya
and particularly of cases seen at the Kenyatta National Hospital. Very few of our patients had upper respiratory infections
as opposed to what one reads in the standard textbooks of
surgery and paediatrics. There were also other diseases that
the patients with intussusception had which were not thought
to be of any aetiological significance.
Pathology of intussusception Showed no differences when
one compared our cases with what is normally reported in
the literature~ There were some cases associated with heavy
round worm infestations and these were children of 3 to 5 years
of age. The percentage of cases of intussusception in this
age group was higher than is normally reported and this has
been attributed to the irritant effect of these worms on
the bowel. It is therefore thought that worms play a part in
the initiation of intussusception not only in the children
and infants but also in the adults in whom worms have been
found in association with enteric intussusceptions.
The clinical features at the time of admission varied
according to the duration of the symptoms. The majority of
the patients presented with vomiting whether they came early
or not to the hospital, Abdominal distension which was advanced
in many oases tended to obscure abdominal mass yet in
some of such cases a mass was felt rectally. The next most
recorded symptom to vomiting was blood in stool which was
either typical current jelly stool or just blood in stool and
in some cases frank rectal bleeding. Pain was the third commonest
recorded symptom and abdominal mass was the last in the
list for reasons already given.
The prolapse rate was quite high and it was not clear
whether this was due to mobile ileo-caecal region or due to
lateness of the case. Moderate anaemia occured in some
oases and all these oases had had blood per rectum so that
anaemia was attributed to rectal bleeding.
In the differential diagnosis intestinal obstruction due
to collections of roundworms has been stressed. More important
than this is that in all cases of diarrhoea with blood
in the stool intussusception should be ruled out and those
oases that are not clear out should be constantly watched.
The diagnosis of intussusception is purely clinical and
the use of ancilliar,y methods of diagnosis should not be
stressed. Barium enema as a diagnostic tool is only required
in a very few cases.
Late presentation pf patients for surgical treatment has
also been analysed and contrary to what moat people believe
failure of prompt diagnosis by the doctors was the most important
factor. The parents were responsible for late coming of
patients only in a few cases.
There is not much controversy over treatment of intussusception
except that some surgeons favour the use of hydrostatic
pressure for reducing their cases and they only use operative
method once this ha failed. Our circumstances do not favour
the use of the former method and it has not b en recommended
for lack of facilities and in the interests of the patients.
The outcome of this work has shown that the high mortality
can only be reduced if all the ca e8 re diagnosed early and
this has been shown to rest entirely on the hands of the
attending doctors. Once diagnosis was made there was no delay
in starting treatment. Clinicians are therefore urged to be
constantly aware of this condition which after all is not a
rare condition as it is the commonest cause of intestinal
obstruction in children under the age of twelve ie. in the paediatric group.
Citation
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