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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 4  |  Issue : 1  |  Page : 42-44

Retrospective surveillance of intussusception in children aged less than 2 years in a tertiary care institute of Eastern India


Department of Paediatrics and Paediatric Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India

Date of Web Publication10-Dec-2020

Correspondence Address:
Vijayendra Kumar
Professor & HOD, Department of Paediatric Surgery, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Objective : Intussusception is the most common cause of acute intestinal obstruction in infants and young children. Very few studies on the epidemiology of intussusception have been done in India, particularly the eastern part of our country. Government of India recently introduced rotavirus vaccine in national immunisation schedule (NIS). Earlier some licensed rotavirus vaccine had been seen to be associated with occurrence of intussusception. Though newer rotavirus vaccines have not been seen to be associated with intussusception, background data on epidemiology, clinical presentation and outcome of intussusception cases are required to correctly compare and analyse the scenario in pre and post introduction of rotavirus vaccine.
Methods : Retrospective surveillance of intussusception cases of age group 0-2 years admitted during period of 5 years, from March 2012 to February 2017 at IGIMS, Patna was done. For diagnosis of intussusception, Brighton collaboration working group definition was used. The baseline demographic data, clinical signs and symptoms, immunisation history (with particular emphasis on rotavirus vaccine) and diagnostic and treatment procedures were extracted for analysis.
Results : There were 31 confirmed cases of intussusception during study period. The median age of diagnosis was 9 months with male to female ratio of 3.2: 1. The mean time of presentation to hospital from onset of symptoms was 56.4 hours. Vomiting (80%), blood in stool (76%), abdominal pain (72.5%) and diarrhoea (52%) were the most common symptoms. Intussusception case occurred round the year with peak occurrence from January to March. No intussusception associated death was recorded. The commonest type of intussusceptions was ileo-colic (80. 4%) followed by colo-colic (12.6%). Direct surgical intervention was carried out in 66.5% cases where as in 18.2% cases surgery was required after failure of non-surgical measures. Out of 31 cases, immunisation records were found in 22 cases. None of them had been vaccinated with rotavirus Vaccine.
Conclusion : This study provides the baseline data of epidemiology, clinical presentation and outcome of intussusception at a tertiary care hospital. A prospective surveillance study is highly needed to assess impact of rotavirus vaccine on intussusception occurrence in the post rotavirus vaccines introduction scenario.

Keywords: Intussusception, Hospital based surveillance Study


How to cite this article:
Kumar R, Kumar V, Prakash J, Hasan Z, Thakur Vk, Kumar P. Retrospective surveillance of intussusception in children aged less than 2 years in a tertiary care institute of Eastern India. J Indira Gandhi Inst Med Sci 2018;4:42-4

How to cite this URL:
Kumar R, Kumar V, Prakash J, Hasan Z, Thakur Vk, Kumar P. Retrospective surveillance of intussusception in children aged less than 2 years in a tertiary care institute of Eastern India. J Indira Gandhi Inst Med Sci [serial online] 2018 [cited 2022 Jan 20];4:42-4. Available from: http://www.jigims.co.in/text.asp?2018/4/1/42/302983




  Introduction : Top


Intussusception is the most common cause of acute intestinal obstruction in infants and young children. Approximately 2/3 of such cases occur in infancy itself[1],[2]. Failure of timely diagnosis and treatment often results in surgical emergency due to development of intestinal ischemia, perforation and peritonitis leading to fatal outcome.

Intussusception has drawn additional attention from the paediatric fraternity because of the association of intussusception with first licensed rotavirus vaccines (Rotashield)[3]. Rotashield was later withdrawn from the market because its use was found to be associated with 24 fold increase in intussusception risk in vaccinated infants. However the other newer generation rotavirus vaccines namely rotarix and rotateq, and phase 3-trial of the indigenously developed rota-vac vaccine showed no significant difference in incidence of intussusception in the vaccinated infants[4],[5].

Very few studies on the epidemiology of intussusception have been done in India, particularly the eastern part of our country. It is critically important to generate base line date on clinical presentation, treatment outcomes and epidemiology of intussusception in infants and children so that the data in the post vaccination era can be better compared. This study outlines the clinical presentation, seasonality, management and outcome of intussusception in children admitted at IGIMS Patna.


  Materials and Methods : Top


This retrospective study was based on hospital data analysis of cases of intussusception in age group 0-2 years and was done at an eminent tertiary care institute IGIMS, Patna. The study period was of 5 years, from March 2012 to February 2017. Necessary permission was taken from Institute ethical Committee and patient confidentiality was properly maintained during the analysis of data.

Case definition criteria for diagnosis of intussusception cases were based on Brighton collaboration working group[6]. Detailed information on demography, date of admission and discharge, clinical signs and symptoms, vaccination status and diagnosis and treatment procedure were extracted and analysed. Vaccination status, with particular emphasis on rotavirus vaccine was checked on the basis of immunisation record card of the child.


  Results : Top


A total of 31 cases of intussusception in the group 0-2 years were identified .The median age of subjects was 9 months. The majority (62%) of these cases were infants with a peak between 6 and 12 months of age [Figure 1]. The male to female ratio was 3.2: 1. The cases of intussusception presented round the year but had been found to be clustered during January-April [Figure 2]. Out of 31 cases, immunisation records were found in 22 cases. None of them had been vaccinated with rotavirus Vaccine.
Figure 1: Age distribution of intussusception cases.

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Figure 2: Seasonality of intussusception cases.

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The mean time of presentation to hospital from onset of symptoms was 56.4 hours. Vomiting (84.2%), pain in the abdomen (72.6%), Blood in stool (64%) and diarrhoea (51%) was the most common symptoms observed [Table 1]. The classical triad of abdomen pain, vomiting and blood in stool was present in only 56.4% cases, whereas abdominal lump was found in only 19.6% of cases. The common type of intussusception was ileo-colic (80.4%) followed by colo-colic (12.6%). Ultrasonography of abdomen was used for diagnosis in all cases. Out of 31 confirmed cases, three (9.6%) had spontaneous resolution. Surgical intervention was required in 24 cases (77.4%), hydrostatic reduction in three (9.6%) cases and surgery after failed hydrostatic reduction in 1 case (3.2%). All intussusception cases were treated successfully and no death was recorded.
Table 1: Clinical signs and symptoms reported among 31 intussusception cases.

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  Discussion : Top


This study usefully describes the epidemiological pattern of intussusception cases in the eastern part of the Country. Male preponderance which is observed globally is reaffirmed in this study[7]. The peak age of diagnosis was observed during 9 months of age which is similar to other reports[7],[8],[9]. Vomiting was the most common clinical symptom (84.2%) percent of our cases had its absence makes the diagnosis of intussusception less likely. The classical triad of pain abdomen, vomiting and blood in stool, which was high as compared to some other Indian studies[10]. Ileo-colic intussusception was the comment site in this study, also quite comparable to other studies. Because of late referrals by the treating clinicians, the presentation of intussusceptions from outside to our hospital was quite late. This was the reason of relatively high percentage (80.6%) of the need of surgical intervention in our cases. Similar scenario were found in some of the other Indian study[11], while other who got early referrals, were successful in treating by non-surgical hydrostatic reductions means in most of the cases. Our study highlights the need of early timely referral and urges the treating clinicians for the same.

The current study was limited by the fact that as it is hospital based study, it may not be a true representation of all intussusception cases that may be collected from population surveillance. For this reason the exact incidence was not estimated though it can be treated as a reflection to it. Secondly, our study was limited by the lack of complete immunisation data in all the confirmed cases. Those whose immunisation record was available showed no vaccination with rotavirus vaccine. But with the introduction of rotavirus vaccine in national immunisation schedule, the coverage rate is bound to be high in future. Although the newer generation of licensed rotavirus vaccine show no association with intussusception, this does not negate the need of surveillance in post introduction of vaccines in NIS[11],[12].

The strength of this study is that it analysed data from a tertiary care hospital with complete investigation and reliable documentation, and thereby give insight of epidemiology of intussusception in this part of the country. With introduction of rotavirus vaccine in the NIS and knowing that probably no previous studies were found during pre-introduction era of these vaccines from this part of the country, this index study may be useful to serve as the baseline data to facilitate further prospective surveillance after introduction of the vaccine.



 
  References Top

1.
WHO vaccines and biologicals. Geneva: World Health Organization; 2002. Acute intussusception in infants and children. Incidence, clinical presentation and management: a global perspective; pp. 1-98.  Back to cited text no. 1
    
2.
Parashar UD, Holman RC, Cummings KC, Staggs NW, Curns AT, Zimmerman CM, et al. Trends in intussusception-associated hospitalizations and deaths among US infants. Pediatrics. 2000;106:1413-21.  Back to cited text no. 2
    
3.
Centers for Disease Control and Prevention. Intussusception among recipients of rotavirus vaccine-United States, 1998-1999. MMWR. 1999;48:577-81.  Back to cited text no. 3
    
4.
Glass RI, Parashar UD. The promise of new rotavirus vaccines. N Engl J Med. 2006;354:75-7.  Back to cited text no. 4
    
5.
Bhandari N, Rongsten-Chandola T, Bhavdekar A, et al. Efficacy of a monovalent human-bovine (116E) rotavirus vaccine in Indian children in the second year of life. Vaccine 2014; 32; a110-6.  Back to cited text no. 5
    
6.
Bines JE, Kohl KS, Forster J, Zanardi LR, Davis RL, Hansen J, et al. Brighton Collaboration Intussusception Working Group. Acute intussusception in infants and children as an adverse event following immunization: case definition and guidelines of data collection, analysis, and presentation. Vaccine. 2004;22:569-574.  Back to cited text no. 6
    
7.
O’Ryan Ryan, Lucero Y, Pena A, Valenzuela MT. Two year review of intestinal intussusception in six large public hospitals of Santiago, Chile. Pediatr Infect Dis J. 2003;22:717-21.  Back to cited text no. 7
    
8.
Nakagomi T, Takahashi Y, Arisawa K, Nakagomi O. A high incidence of intussusception in Japan as studied in a sentinel hospital over a 25-year period (1978-2002) Epidemiol Infect. 2006;134:57-61.  Back to cited text no. 8
    
9.
Eshel G, Barr J, Heyman E, Tauber T, Klin B, Vinograd I, et al. Intussusception: a 9-year survey (1986-1995) J Pediatr Gastroenterol Nutr. 1997;24:253-6.  Back to cited text no. 9
    
10.
Singh JV, Kamath V, Shetty R, Kumar V, Prasad R, Saluja T, Dhingra S. Retrospective surveillance for intussusception in children aged less than five years at two tertiary care centres in India. Vaccine 2014; 32:95-98.  Back to cited text no. 10
    
11.
Kaushik B, Kangg, Bose A, Chacko J, Boydville I, Datta SK, et al. Retrospective surveillance for intussusception in children aged less than five years in a south Indian tertiary care hospital. J Health Popul Nutr 2009; 27: 660-5.  Back to cited text no. 11
    
12.
Patel MM, Haber P, Bags J, Zuber P, Bines JE, Parashar UD. Intussusception and rotavirus vaccination: a review of the available evidence. Expert Rev Vaccine 2009;8: 1555-64.  Back to cited text no. 12
    
13.
Glass RI, Bresee JS, Parashar UD, Jiang B, Gentsch J. The future of rotavirus vaccines: A major setback leads to new opportunities. Lancet. 2004;363:1547-50.  Back to cited text no. 13
    


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