Background: Intussusception is a common cause of intestinal obstruction among infants. Delayed diagnosis and treatment worsen the outcome with possible mortality. At present, ultrasonography is the preferred tool for both diagnosis and treatment for select cases. It is also useful in the diagnosis of comorbidities and as a guide to pneumatic and hydrostatic reduction of intussusception. Aim: The aim of this study is to evaluate the ultrasound features of intussusceptions and to correlate its findings with surgical findings at a tertiary health-care facility. Materials and Methods: This is a retrospective study carried out at Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-east Nigeria, between 2014 and 2016. Data were extracted from case notes, theater records, and radiology, and the following domains were explored: sociodemographic data, ultrasound findings, and intraoperative findings. The data obtained were recorded in an Excel Spreadsheet and were analyzed using the SPSS software version 20, and the results were reviewed in tables and charts. Results: A total of 15 patients that met the inclusion criteria were used for this study. There were more males than that of females, and the peak age was between 4 and 6 months. Most of the patients were scanned and operated after 24 h from the onset of symptoms. The most common presenting symptom was vomiting, and most of the masses were in the right hemiabdomen. Conclusion: The sensitivity of ultrasound in our study was 100%, and this correlates with the findings in other studies. The use of ultrasound early in patients with increased clinical suspicion will, therefore, help to reduce the unnecessary delays in intervention and therefore reduce the complications.

Ultrasonographic diagnosis and ultrasonic reduction of intussusception in Nnewi, South-East Nigeria

A meta-analysis study to assess the influence of instant surgery (IS) compared with conservative therapy (CT) on paediatric complicated acute appendicitis (CAA) post-surgery wounds. A comprehensive literature examination until January 2023 was implemented, and 2098 linked studies were appraised. The picked studies contained 66 674 subjects with paediatric CAA post-surgery wounds in the picked studies' baseline; 64 643 of them were using IS, and 2031 were using CT. The odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to calculate the consequence of the IS compared with the CT on paediatric CAA post-surgery wounds using the dichotomous and continuous styles and a fixed or random model. The IS had a significantly higher wound infection (OR, 4.97; 95% CI, 2.35-10.54, P < .001) with moderate heterogeneity (I2  = 57%) compared with the CT in a paediatric CAA post-surgery wound. However, no significant difference was found between IS and CT in total antibiotic duration (MD, -5.34; 95% CI,-12.67 to -1.98, P = .15) with high heterogeneity (I2  = 95%) in paediatric CAA post-surgery wounds. The IS had a significantly higher wound infection; however, no significant difference was found in total antibiotic duration compared with the CT in paediatric CAA post-surgery wounds. Although precautions should be taken when commerce with the consequences because most of the studies picked for this meta-analysis had low sample sizes.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/iwj.14163

Effect of instant surgery compared with traditional management on paediatric complicated acute appendicitis post-surgery wound: A meta-analysis.

Objective: To compare the efficacy of non-surgical conservative management with surgical management in cases of uncomplicated acute appendicitis in children. 
Study design: Prospective comparative study. 
Settings: Pediatric surgery Department, Ghulam Muhammad Mahar Medical College Sukkur. 
Study duration: 1st February 2020 to 31st May 2021. 
Materials and Methods: Ninety patients of either gender with age range from 5-12 years, diagnosed as uncomplicated acute appendicitis, were divided in two groups. Group C patients were managed conservatively with antibiotics (ceftriaxone 100 mg/kg/day, amikacin 10mg/kg/day and metronidazole 22.5 mg/kg/day) and maintenance fluids were started. Patients were observed for improvement or any signs of deterioration. Those who deteriorated within 24 hours were managed with surgical management immediately. Follow-ups were carried out after discharge on the 7th day, 1 month, and six months. Patients reporting a recurrence of symptoms were managed with appendicectomy. Group S patients were managed with appendicectomy with the open technique. Patients were observed for post-operative complications. 
Results: Demographic data of both groups was comparable. In group C, 34 (75.56%) patients were successfully treated with conservative management, whereas in group S, 39 (86.67%) were successfully treated with surgical management. The difference was insignificant with a p-value of 0.114. In group C, 5 (11.11%) patients did not respond to conservative management and they were managed with appendicectomy and recurrence of symptoms was seen in 6 (13.33%) patients in group C, they were also managed with appendicectomy. In group S, 6 (13.33%) patients suffered post-operative complications. Mean length of stay in hospital was 4.31±1.20 and 4.09±1.12 days in group C and S respectively. This difference was statistically insignificant with a p-value of 0.368. 
Conclusion: It is concluded in our study that uncomplicated acute appendicitis in children can be successfully managed with non-surgical conservative management.

https://www.journalrmc.com/index.php/JRMC/article/download/1859/1670

Non-Operative Management of Acute Uncomplicated Appendicitis in Children

Background: Intussusception is an important disease of childhood & has been recognized since ancient time. It commonly involves young infants of 3 ½ months to 10 months of age. Diagnosis is mostly clinical on the basis of classical triad or quarter of pain in abdomen, vomiting palpable abdominal mass and currant red jelly stools. It is confirmed by ultrasound, barium enema which also has a therapeutic potential. The parents in our region lacks awareness regarding the intussusception. They usually bring the child to hospitals after trying various homemade or herbal remedies. The delay in diagnosis always results in severity in symptoms and aggressive mode of treatment.
Objective: The current study was aimed to identify the Frequency, associated symptoms and post-operative complications of intussusception in tertiary care hospital of Province Sindh
Methodology: It was a cross sectional study conducted from July 2017 to June 2020 at department of Pediatric Surgery Ghulam Mohammad Mahar Medical College Teaching Hospital Sukkur. Data regarding symptoms and prognosis was noted on the file of patient and written informed consent was taken from parents. Data was analyzed by using SPSS version 20. Chi square was applied as test of significance at 95%confidance interval and p-value less than 0.05 was considered as significant.
Results: Fourty patients of intussusceptions were reported the mean age was 5.88 ± 1.5 months while 8 (20%) patients were 1to10 years with mean age of 3.88± 3.18 years. Thirteen (32.5%) patients presented within 24 hours of onset of symptoms and 27 (67.5%) presented after 24 hours 19 (47.5%) patients had history of diarrhea while 6 (15%) patients had respiratory tract infection. The most common postoperative complication was gut gangrene.
Conclusion: In three years of study we found only 40 children who came to our hospital with diarrhea and the triad i.e. abdominal pain, abdominal mass and bleeding per rectum. Ultrasound abdomen was found to be best diagnostic modality with impressive accuracy rate at our setup. Gut gangrene was postoperative complication and recurrence was uncommon.

/pdf/frequency-associated-symptoms-and-prognosis-of-4lo3elp0l6.pdf

Nabi Bux Napar

Papers

Non-Operative Management of Acute Uncomplicated Appendicitis in Children

Frequency, Associated Symptoms and Prognosis of Intussusception in Tertiary Care Hospital of Province Sindh