Management outcomes and factors related to hospital stay for pediatric intussusception in a Tertiary Care Hospital, Northwestern Ethiopia

Résumé

BACKGROUND: Intussusception is the most common cause of intestinal obstruction in infants and young children that requires prompt diagnosis and treatment to prevent complications and death. Nowadays, when cases are presented to hospitals on time and have no significant complications, non-invasive ultrasound-guided hydrostatic reduction is the first-line treatment, resulting in favorable outcomes, including higher recovery, lower complications, and shorter hospital stay compared to open surgery. However, evidence on management modalities, clinical outcomes, and factors related to hospital stay in resource-limited settings remains scarce. This study evaluated management outcomes and identified factors associated with the length of hospital stay among children with intussusception at a comprehensive specialized hospital in Northwestern Ethiopia, Bahir Dar. METHODS: A retrospective study was conducted among pediatric patients diagnosed with intussusception at a comprehensive referral hospital between September 2020 and August 2024. Data were extracted from patient medical records using a structured data collection tool. Descriptive statistics were used to summarize patient characteristics and treatment outcomes. Non-parametric statistical tests, including Spearman's correlation, Mann-Whitney U test, and Kruskal-Wallis test were used to examine the relationship between clinical variables and the length of hospital stay. Statistical significance was considered at p < 0.05. RESULTS: A total of 257 children with intussusception were included in the study. The majority were males (62.6%), and nearly half (47.0) were rural residents. The mean age of participants was 18.8 months, while more than half of the cases (56.4%) were infants. Overall, 255 patients were successfully managed, while two died from complications related to late presentation. The majority (62.3%) were treated using ultrasound-guided hydrostatic reduction, while the rest required open surgical reduction. Most patients (91.8%) presented with ileocolic intussusception. Participants presented after prolonged symptom durations (mean 2.3 days), increasing the risk of complications. The majority had dehydration (67.6%), and over a quarter had fever at admission (28.0%). Longer hospital stay is associated with higher open surgical intervention (r = 0.89; p < 0.001); body temperature (r = 0.55; p < 0.001), elevated white blood cell count (r = 0.39; p < 0.001), longer duration of symptoms before presentation (r = 0.44; p < 0.001), number of hydrostatic reduction attempts (r = 0.54, p < 0.001), dehydration (η2 = 0.49; p < 0.001), and rural residency (r = 0.48; p < 0.001). CONCLUSION: The high burden of intussusception among children can be effectively managed with a non-operative hydrostatic reduction. However, late presentation, particularly from rural areas, remains a critical driver of complications and mortality. Strengthening early referral systems in peripheral health centers is essential to reducing the surgical burden and improving outcomes for children with intussusception.

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