Intussusception is considered one of the major causes of children's mortality and morbidity. As per theory, the two main aetiologies that lead to cause for intussusception are either infection or some anatomical variant occluding the lumen, causing invagination of one segment of bowel into another one, leading to obstruction.{3} The majority of children who are affected belong to the age group of less than 3 years of age.{2} Complications varied from abnormal bowel engorgement, bleeding, venous stasis, necrosis, gangrene & perforation. Ileo- colic being the most common variant of intussusception documented, there are various types of intussusceptions like jejuno- jejunal, ileo-ileal, ileo- Colo-colic & Colo- colic. In younger children, they are commonly associated with enlargement of lymphoid tissue due to Rota-virus infection, whereas in older children, there may be a leading point due to an anatomical variant causing either dynamic or adynamic obstruction, like mesenteric adenitis, submucosal lipoma, GI polyps, or growth.

MATERIALS AND METHODS

A retrospective analytical study was done in intussusception cases for the duration of one year. Data includes the type of intussusception, duration of symptoms, attempt of hydrostatic reduction, surgery indication, intraoperative findings, hospital stay, post operative complications.

Statistical analysis was performed using Microsoft Excel 2013 (codenamed Office 15) trialware, and variables were compared with the Chi‑squared test.

RESULTS:

A total of 72 paediatric patients diagnosed with intussusception were included in the study. The Shapiro–Wilk test revealed that the distributions of age, number of reduction attempts, symptom duration before presentation, and length of hospital stay deviated from normality (p < 0.001 for all variables). Therefore, non-parametric statistical methods were employed when appropriate. (Table-1) The median age at presentation was 36 months (interquartile range [IQR]: 11–60 months), with a mean age of 38.38 ± 30.74 months. Most children required only a single reduction attempt, with a median of one episode (IQR: 1–1). The median duration of symptoms prior to hospital presentation was two days (IQR: 1–2), and the median hospital stay was also two days (IQR: 2–4), though the mean duration was 3.96 ± 3.49 days, indicating variability. (Table-2)

Ileocolic intussusception was the most prevalent anatomical variant, accounting for 84.7% of cases. Ileo-Colo-colic types constituted 11.1%, while Colo-colic, ileo-ileal, and jejuno-jejunal forms were rare, each observed in 1.4% of patients. Mesenteric adenitis was identified as the predominant cause (94.4%). Pathological lead points were infrequent and included Peutz–Jeghers syndrome (2.8%), Meckel’s diverticulum (1.4%), and submucosal lipoma (1.4%). (Table-3) Hydrostatic reduction was attempted in most cases, with an overall success rate of 80.6%. Reduction failed in 12.5% of patients, and 6.9% were not eligible for reduction due to sepsis on admission. As a result, 19.4% required surgical intervention. Among surgically treated patients, 85.7% underwent bowel resection with anastomosis, while 14.3% were managed with manual reduction alone. (Table-4)

Treatment outcomes were generally favorable. Post-treatment complications were rare, occurring in only 4.2% of cases, all involving wound dehiscence. Intussusception recurrence was uncommon (2.8%), with 97.2% remaining recurrence-free during follow-up. A statistically significant relationship was found between intussusception type and hydrostatic reduction outcome (p < 0.001). Ileocolic cases showed a high success rate (93.3%), whereas ileo-Colo-colic and ileo-ileal types were more prone to reduction failure. Comparison between successful and unsuccessful reduction groups showed no significant difference in age (p = 0.664). (Table-5)

However, failed reductions were associated with more attempts, longer symptom duration before presentation, and extended hospitalization (p < 0.001 for all). Specifically, failed cases had a mean symptom duration of 3.44 ± 0.88 days and an average hospital stay of 8.44 ± 3.97 days, compared to 1.59 ± 0.56 days and 2.55 ± 0.82 days, respectively, in successful cases.(Table-6) Correlation analysis indicated a moderate positive relationship between symptom duration before presentation and hospital stay length (r = 0.439, p < 0.001), suggesting that delayed presentation contributed to prolonged hospitalization. No significant correlation was found between hospital stay and either age or the number of reduction attempts. (Table-7)

Multivariable linear regression identified duration of presentation as a strong independent predictor of hospital stay (β ≈ 0.71–0.74, p < 0.001). Conversely, a greater number of reduction attempts was independently associated with a shorter hospital stay (β ≈ −0.30, p < 0.001), while age had no significant predictive value. The analysis confirmed delayed presentation as the key determinant of prolonged hospitalization. (Table-8)

Table-1 Shapiro Wilk Normality Test

Table-2: Quantitative description of variables

Fig-1: Gender Distribution

Table-3: Type and Cause of Intussusception

Table-4: Distribution of Procedures

Table-5: Association between Reduction outcome & Type of intussusception

Fig-2: Distribution of Cause of Intussusceptions & Hydrostatic reduction

Table-6: Association between Reduction outcome and variables

Table-7 Correlation Analysis

Table-8: Multivariable linear regression

Discussion:

In our study, the majority of intussusceptions are due to mesenteric adenitis, which occurs due to the enlargement of Payer’s patches taking place in the ileo-cecal segments. Earlier diagnosis and intervention play a major role in managing intussusception by nonsurgical management. According to the literature, pathological lead points are the usual cause of intussusception in all age groups over 6 months {4}. Three methods of non-surgical management are used for intussusception: hydrostatic reduction under USG guidance, pneumatic reduction, & Barium reduction, which uses fluoroscopy. As per a study by Ahmad et al {5} and our study also stated that hydrostatic reduction is safer with no radiation exposure & very low chance of perforation because the pressure is shared out through the entire length of the bowel. Even in the case of perforation chance of Perforative peritonitis is less comparing the other modes of management.

By comparing the success rate of hydrostatic reduction with other studies, our study has 80.6 % success rate, while other documented studies also show success rates between 75% - 96% {5,6,7}. In our study, patients who presented within 48 hours has higher rate of success, which is similar to a study done by Soundharya et al {9}, but another study by Van den Ende et al {8} found no correlation between time of presentation and success rate. Patients presented with complaints of more than 48 hours have a lower chance of success rate and more chances of bowel non-viability. Our study had a failed reduction in 9 cases (12.5%), and 5 cases did not undergo reduction due to the features of sepsis on admission, which agrees with the study done by Gadgade et al {10} & Reijnen et al {11}.  All 14 cases underwent emergency laparotomy, and one had successful manual reduction, while the rest underwent resection and anastomosis due to non-viability of the bowel.

We encountered two cases of Peutz-Jeghers syndrome, one presented as jejuno- jejunal intussusception and another one involving the proximal ileum, causing ileo-Colo-colic intussusception. A polyp causing small bowel intussusception should be kept in mind as one of the differential diagnoses causing small bowel intussusception {12,13}.

Recurrence was noted in only one case due to mesenteric adenitis, which was treated conservatively.

Conclusion:

The mesenteric lymph node is the lead point in most of our cases, leading to intussusception. Hydrostatic reduction is safer and feasible in most of the cases. Earlier intervention has a higher chance of treating it with non-surgical management. All hemodynamically stable, uncomplicated children, irrespective of age, should be given a trial of hydrostatic reduction.

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