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Background: At a time when pressure is being applied to healthcare systems to reduce costs and improve efficiency, both the medical and financial implications of changing practices need to be documented., Methods: A review was undertaken of 703 patients with intussusception, treated during a 10-year period from 1983., Results: This review showed that changes to the protocol for the management of intussusception have not only benefited the patient by reducing the morbidity and the operative rate, but also have led to a reduction in the length of hospital stay, providing significant cost savings to the health system. The reduction in the operative rate accounts for an estimated annual saving at the Royal Children's Hospital of $139,000., Conclusions: Improvements in the management of intussusception have resulted in significant reductions in the costs of treatments. The recent diagnosis-related group casemix funding arrangements mean, however, that the Royal Children's Hospital benefits more financially from inappropriate operative management of intussusception, than from non-operative management. Funding arrangements should not discourage optimal treatment.

This study reviews all childhood intussusceptions treated over a 6 year period in a regional centre with six visiting general surgeons and two paediatricians. Clinical presentation, management, complications and outcomes were noted and an attempt was made to follow up all cases. There were 20 patients, with a median age of 6 months (range 10 weeks to 17 months). Only one patient had all four classical features of intussusception (pain, vomiting, 'red currant jelly' stools and abdominal mass). Seven patients were managed successfully by barium enema reduction, but 14 required operation, four following failed radiological reduction. There was one intestinal perforation due to attempted barium enema reduction and one patient required a reoperation for ileal gangrene following operative reduction. There were no deaths and there have been no subsequent recurrent intussusceptions although three cases were lost to follow up. There was a delay in diagnosis in some cases (average duration from onset to diagnosis was 34 h). Although delay was incurred by parents in some cases and in peripheral hospitals in others, there is a need for greater awareness by surgeons of the significance of subtle features such as pallor and lethargy in a child with persistent vomiting. Delay in diagnosis is likely to lead to an increased need for primary surgical intervention. Adverse features (age > 3 months or < 2 years; symptoms > 24 h; small bowel obstruction; dehydration > 5%) were predictive of an increased likelihood of surgical resection, and may help avoid inappropriate attempts at radiological reduction.(ABSTRACT TRUNCATED AT 250 WORDS)

A review was conducted of children with intussusception admitted to the Royal Children's Hospital over a 16 year period: of 630 episodes of intussusception, 28 represented recurrences (4.4%): 10 of these occurred in children aged 2 years or over. Duration of symptoms and the incidence of an incorrect initial diagnosis were markedly reduced with recurrence. The clinical presentation was similar to the first episode apart from rectal bleeding which was less common, reflecting the shorter history. Sixteen barium enemas were performed, of which 10 were successful. There were 18 operations with eight resections; seven for localized lesions and one for failure of manual reduction in a patient with an inverted Meckel's diverticulum. Barium reduction for recurrence should not be attempted in children over 2 years of age in whom no laparotomy was performed for their first episode, for most second recurrences, or in multiple polyposis.

Patients with intussusception who have necrotic bowel requiring bowel resection or who are at major risk of perforation from attempted hydrostatic reduction may be better managed without barium reduction. Ideally, the clinician would like to identify such patients at presentation. Two groups of patients, representing the extreme ends of the intussusception treatment spectrum were investigated in order to highlight the clinical features of patients in whom an attempted barium reduction is not justified. A group of 200 patients who had successful and safe hydrostatic reduction was compared with 104 patients who ultimately required bowel resection. Four features were found to be indicators of an increased likelihood of resection: age 3 months or less, or greater than 2 years, duration of symptoms greater than 24 h, presence of small bowel obstruction on plain radiology, and clinical assessment of dehydration greater than 5%. The validity of these features as prognostic indicators was assessed by applying them to all patients who had attempted barium reduction to see how they predicted patient outcome. In isolation, each feature was found to be compatible with a safe and successful hydrostatic reduction. The rate of resection was increased in patients with multiple adverse features and in these patients the enema technique may require modification. Patients with three or four adverse features had an unacceptably high incidence of gangrenous bowel requiring resection and a low likelihood of successful hydrostatic reduction. It is believed that attempts at reduction are not appropriate in these patients.

This is a retrospective study of 91 patients treated for intussusception between 1982 and 1984. Criteria for inclusion in the study were the finding of a classical radiological appearance on Barium enema examination or the presence of an intussusception at operation. The clinical features are described. A protocol of management first reported in 1983 was followed with 90 of 91 patients submitted to a diagnostic and/or therapeutic Barium enema. As a result of recent experience, the protocol has been modified in selected patients at the discretion of the surgeon and the radiologist. A success rate of Barium enema reduction of 78% was achieved, which is higher than in previous Princess Margaret Hospital studies; there was recurrence of the intussusception in 12 patients following hydrostatic reduction. Further Barium enema reduction was successful in 11 and operation in one. There was no mortality and minimal morbidity.