3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item An audit of pneumatic reduction in paediatric ileo-colic intussusception cases at Chris Hani Baragwanath and Charlotte Maxeke Johannesburg academic hospitals(2017) Pillay, ParushaINTRODUCTION: Intussusceptions may cause significant morbidity and mortality if not treated timeously. One method of conservative management is pneumatic reduction, the outcome of which is dependent on a number of factors. AIM: To determine the proportion of children with intussusception who have evidence of bowel obstruction on initial abdominal radiograph, and the failure rate of pneumatic reduction in patients with and without bowel obstruction. The study also looked into whether there were any associations between the radiological presence or absence of bowel obstruction and pneumatic reduction outcome, the finding of necrotic bowel at surgery, and CRP and WCC levels. METHOD: A retrospective study was performed using an existent paediatric surgery intussusception database. Three different readers read the baseline abdominal radiographs and subjectively determined whether bowel obstruction was present or not. Treatment choices, outcomes of the pneumatic reduction, and if available, clinical presentation and lab results were captured from the patient’s discharge summary and NHLS portal. RESULTS: A sample size of 45 patients was studied. The median age of presentation was 7 months, with 83% of the patients having had symptoms for 3 days or less. 80% of patients had bowel obstruction on initial X-ray, and of these patients, only 17% had successful pneumatic reduction. No significant association was found between bowel obstruction and the presence/absence of necrotic bowel. 64% had their symptoms documented, and only 26 % and 42 % had CRP and WCC documented respectively, which did not meet sample size requirements. CONCLUSIONS: Even though a strong association was shown between evidence of bowel obstruction and pneumatic reduction outcome, the sample study was too small to make between-group comparisons. Due to this limitation, it is recommended that further investigation be done, possibly by including patients from other South African tertiary hospitals in order to obtain statistically significant results.