The evaluation of invagination case WHO applied to emergency department between 2011-2021

Introduction: Invagination is the distally telescopic engagement of the proximal intestinal segment. It is the most common cause of obstruction in childhood. It is commonly seen between the ages of 3 months and 2 years. 90% of treated cases are idiopathic. It often progresses with symptoms such as abdominal pain, vomiting, and strawberry jelly defecation. Diagnosed cases can be treated with surgical and non-surgical methods. Aim: In our study, we aimed to evaluate the cases diagnosed as invagination, to determine the atypical symptoms as well as the typical symptoms, and to determine the differences between the cases in which surgical and non-surgical treatment methods were applied. Patients and Methods: Sociodemographic, clinical, imaging, treatment and follow-up data of the cases diagnosed with intussusception between 01.01.2011 and 31.12.2022 in Dokuz Eylul University Faculty of Medicine, Department of Pediatric Emergency Department, are available retrospectively from the information system used in our hospital. obtained by inspection. Findings: A total of 229 cases were reached in our study. Fifty of the cases were under 1 year old, 121 were between 1-3 years old, 42 of them were between 4-6 years old, 13 of them were above 6 years old. The minimum age of the patients was 1 month, and the maximum age was 13. The mean age was 2.6 years. (±2.1 ss) Of the cases, 132 were boys and 87 were girls. The male/female ratio was found to be 1.5. It was determined that 69 of 229 cases applied in summer, 59% in winter, 55 in spring and 45 in autumn. Of the 229 cases, 23 had a history of previous intussusception. Abdominal pain was the most common complaint with 148 cases. Abdominal pain was followed by vomiting in 134 patients, restlessness in 73 patients, and bloody stool in 42 patients, respectively. While bloody stools were observed in 29 of 132 male cases, bloody stools were observed in only 10 of 87 female cases. Fatigue was seen in 7 of 50 cases under the age of 1, and was most common in this age group. Abdominal pain was seen in 96 of 121 1-3 years old cases and was most common in this age group. Invagination triad was seen in 12 cases among all cases. A palpable mass in the abdomen was observed in 9 of 142 ileocolic invaginations and was most frequently detected in this localization. It was observed that 56 of 229 cases underwent spontaneous reduction. It was determined that 26 of 121 1-3 years old patients and 15 of 42 4-6 years old patients underwent spontaneous reduction and spontaneous reduction was more common in these age groups. Spontaneous reduction was observed in 29 of 74 ileoileal invagination cases, and the rate of spontaneous reduction was found for this localization with the highest rate. In our study, it was found that hydrostatic reduction was applied to 165 cases, and 142 cases were successfully treated with hydrostatic reduction. In 23 cases, treatment with hydrostatic reduction was unsuccessful and surgical treatment was performed. It was determined that 82 of 121 cases aged between 1 and 3 years were treated with hydrostatic reduction only, and hydrostatic reduction was found to be most successful in this age group. It was determined that 97 of 142 ileocolic invaginations were treated with only hydrostatic reduction and hydrostatic reduction was more successful in these ileocolic invaginations than ileoileal invaginations. It was determined that all 7 cases of colocolic invagination were successfully treated with hydrostatic induction. Due to the indication, 2 out of 50 cases under 1 year old, 1 out of 121 cases 1-3 years old, and 2 of 13 cases over 6 years old were first treated with surgery. It was found that there was an indication for surgery. No perforation was detected in any of the cases in our study. No case was lost in our study. Result: Invagination is a common cause of acute abdomen in emergency departments. It should be kept in mind that cases can only be diagnosed with atypical findings such as restlessness. Non-surgical treatment methods are used more frequently nowadays. Treatment success of non-surgical methods seems to be higher in cases with early diagnosis. Key words: Invagination, physical examination, treatment