Abstract:
BACKROUND: Intussusception is a common gastrointestinal emergency in children and appears to have a
somewhat different clinical spectrum in developing countries. Its etiology is still unclear, but a link to infective
agents and viruses has been highlighted. This study aimed to assess the clinical spectrum and prevalence of
intussusception in children from the diverse South African population.
METHODS: Retrospective data were obtained from 9 participating pediatric referral units on the occurrence of
intussusception in South African children (!14 years old) during a 6-year period (1998–2003). Results were
correlated with national population statistics. Intussusception was anatomically classified into ileoileal, ileocolic,
and colocolic types. The clinical features, management, outcome, and possible causes were examined.
RESULTS: We reviewed the occurrence and clinical spectrum of intussusception in 423 children (age, 0–14 years)
presenting with acute intussusception to 9 pediatric surgical centers. The mean duration of symptoms was 1.5
days, but a delayed presentation was common (median delay, 2.3 days). Intussusception occurred throughout the
year, with a peak in the summer months. The majority of patients (89%) were !2 years old, and 78% presented
at age 3–18 months of age. Crude population estimates indicate an occurrence of 1 case per 3123 population !2
years old. Only 11% of patients presented after 2 years of age, and the age at presentation was significantly lower
( ) in black African patients. All ethnic groups P ! .05 were affected. In 84% of patients, intussusception occurred
at the ileocolic region junction, in 7% it was ileoileal, and in 9% it was colocolic. Colocolic intussusception appeared
more common in black African patients, and associated pathologic conditions (polyps and Burkitt’s lymphoma)
occurred mainly in older children. Surgical intervention was required in 81% of patients and involved resection
of gangrenous bowel in 40%.
CONCLUSION: Intussusception appears to be a relatively frequent occurrence in children in South Africa. Although
the clinical spectrum appears to vary, there is an apparent link to intestinal infection, which requires further
investigation. A collaborative approach is required to ascertain the relationship of intussusception to preventable
infections and to improve its diagnosis and management.
