University of Stellenbosch, Tygerberg, South Africa.
J Infect Dis. 2010 Sep 1;202 Suppl:S156-61. doi: 10.1086/653563.
Intussusception is a common gastrointestinal emergency in children and appears to have a somewhat different clinical spectrum in developing countries. Its etiology is still unclear, but a link to infective agents and viruses has been highlighted. This study aimed to assess the clinical spectrum and prevalence of intussusception in children from the diverse South African population.
Retrospective data were obtained from 9 participating pediatric referral units on the occurrence of intussusception in South African children (<14 years old) during a 6-year period (1998-2003). Results were correlated with national population statistics. Intussusception was anatomically classified into ileoileal, ileocolic, and colocolic types. The clinical features, management, outcome, and possible causes were examined.
We reviewed the occurrence and clinical spectrum of intussusception in 423 children (age, 0-14 years) presenting with acute intussusception to 9 pediatric surgical centers. The mean duration of symptoms was 1.5 days, but a delayed presentation was common (median delay, 2.3 days). Intussusception occurred throughout the year, with a peak in the summer months. The majority of patients (89%) were <2 years old, and 78% presented at age 3-18 months of age. Crude population estimates indicate an occurrence of 1 case per 3123 population <2 years old. Only 11% of patients presented after 2 years of age, and the age at presentation was significantly lower (P < .05) in black African patients. All ethnic groups were affected. In 84% of patients, intussusception occurred at the ileocolic region junction, in 7% it was ileoileal, and in 9% it was colocolic. Colocolic intussusception appeared more common in black African patients, and associated pathologic conditions (polyps and Burkitt's lymphoma) occurred mainly in older children. Surgical intervention was required in 81% of patients and involved resection of gangrenous bowel in 40%.
Intussusception appears to be a relatively frequent occurrence in children in South Africa. Although the clinical spectrum appears to vary, there is an apparent link to intestinal infection, which requires further investigation. A collaborative approach is required to ascertain the relationship of intussusception to preventable infections and to improve its diagnosis and management.
肠套叠是儿童常见的胃肠道急症，在发展中国家似乎具有不同的临床特征。其病因尚不清楚，但已强调与感染因子和病毒有关。本研究旨在评估来自南非多样化人群的儿童肠套叠的临床特征和流行情况。
对 9 家儿科转诊单位在 6 年期间（1998-2003 年）发生的南非儿童肠套叠的回顾性数据进行了研究。结果与国家人口统计数据相关联。肠套叠解剖学分为回盲型、回结型和结肠型。检查了临床特征、治疗、结果和可能的病因。
我们回顾了 423 例（年龄 0-14 岁）急性肠套叠患儿在 9 家小儿外科中心的发生情况和临床特征。症状的平均持续时间为 1.5 天，但延迟就诊很常见（中位延迟时间为 2.3 天）。肠套叠全年均可发生，夏季发病率较高。大多数患者（89%）年龄<2 岁，78%的患者年龄在 3-18 个月。粗略的人口估计表明，每 3123 名<2 岁的人群中就有 1 例发生肠套叠。仅 11%的患者在 2 岁以后就诊，而且黑种人患者的就诊年龄明显较低（P<.05）。所有种族都受到影响。84%的患者肠套叠发生在回盲部交界处，7%的患者肠套叠发生在回结部，9%的患者肠套叠发生在结肠型。黑种人患者中更常见结肠型肠套叠，并且相关的病理情况（息肉和伯基特淋巴瘤）主要发生在较大的儿童中。81%的患者需要手术干预，其中 40%的患者需要切除坏死的肠段。
肠套叠在南非儿童中似乎是一种相对常见的疾病。尽管临床特征似乎有所不同，但与肠道感染明显相关，这需要进一步研究。需要采取协作方法来确定肠套叠与可预防感染的关系，以改善其诊断和治疗。
