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.