P3.096: Intussusception Presentation, Management, and Outcomes at a Tertiary Hospital in Rural Kenya: A 5-year Retrospective Review

Background: In the pediatric population, intestinal obstruction caused by ileocolic intussusception is a frequent cause of abdominal surgical emergencies. Acute intussusception is the second most common cause of acute abdomen in children and the most common cause of small bowel obstruction in infants. In low- and middle-income countries (LMICs), lack of knowledge of the disease, limited access to imaging, and a lack of timely medical intervention often contribute to worse outcomes compared to high-income countries. Only a few hospitals in Kenya have the technology to offer nonsurgical therapy like the pneumatic reductions offered at this tertiary center. In facilities without the capacity for pneumatic reduction, all patients with intussusception undergo laparotomy. We aim to understand the unique management and outcomes of this condition at this tertiary hospital to inform strategies to reduce morbidity and mortality related to intussusception.

Methods: A retrospective review was performed on pediatric patients who presented to this rural Kenyan tertiary hospital between January 2020 through December 2024. Twenty-two patients were identified with intussusception and eighteen with ileocolic intussusception. Patients were categorized into groups: successful pneumatic reduction (sPR), attempted pneumatic reduction (aPR), and no pneumatic reduction (nPR) to compare demographics, presentation, and outcome data using descriptive statistics, Mann-Whitney U Test, and Fisher’s Exact Test.

Results: When comparing sPR and aPR, significant differences were noted in presenting days of symptoms (3 vs 6, p=0.03), days in HDU/PICU (1 vs 4, p=0.03) and days in hospital (2 vs 5, p< 0.01). The patients whose intussusceptions were successfully reduced pneumatically tended to be younger (8 vs 24 months, P=0.16). No difference was seen in sex or z-score. Greater than sixty percent of patients in all groups were referred from outside hospitals. When comparing rates of management and outcome, a significant difference was seen in rate of bowel resection with 1 in sPR and 4 in aPR (p=0.01). Remaining rates are displayed in the table and geographic homes of the patients according to treatment arm can be found on the map provided. Descriptive results of nPR seen in the table were excluded from comparative analysis due to small group size.

Conclusion: Successful pneumatic reduction of intussusception was performed in patients with symptoms up to 6 days and in patients less than 2 years of age. If pneumatic reduction failed, patients were likely to need a bowel resection. Performing a pneumatic reduction requires specialized equipment and trained personnel but can be performed safely and successfully on children even with multiple days of symptoms prior to presentation. Continued education and skills training can help avoid laparotomies and improve outcomes in pediatric patients with intussusception in LMICs.