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BEST PRACTICE MANAGEMENT OF INTUSSUSCEPTION IN RURAL CENTRES: HOW TO MINIMISE MORBIDITY AND MORTALITY
Author(s) -
Beasley S. W.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04128_2.x
Subject(s) - medicine , enema , barium enema , intussusception (medical disorder) , sick child , paediatric surgery , general surgery , mortality rate , clinical practice , surgery , pediatrics , intensive care medicine , family medicine , colorectal cancer , colonoscopy , cancer
Purpose In recent years there have been a number of refinements in the management of intussusception (INT) that have led to an increase in the success rate of enema reduction, and reduced morbidity. This study proposes guidelines for the management of children with suspected INT in centres that do not have a specialist paediatric surgeon. Methodology Analysis of clinical indicator data for INT and review of the outcomes of treatment in the South Island of New Zealand have been used to develop an algorithm for use in regional centres. Results INT reduced non‐operatively has a lower morbidity and costs less to treat than those requiring surgery. In the region reviewed, management guidelines appear to have contributed to an overall success rate of enema reduction using Barium improving from 25% to 75%, and with air enemas from 75% to 86%. Discussion of cases between the rural centre and tertiary centre has become the norm. Conclusion In smaller centres, an initial enema (barium or gas) should be performed if the child is in reasonable clinical condition. Sick infants, and those in whom an initial enema has failed, are best transferred to a paediatric surgical institution. Good communication is an essential element in developing and implementing clinical pathways that improve outcomes for children with INT.