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in presentation ,25 cases (60.97%) presenting with bloody diarrhea,12 cases(29.26%) with red current jelly stool ,4cases (9.75%) with abdominal distention.

Kufa Med.Journal 2009.VOL.12.No2.

Epidemiological and clinical study of Intussusceptions in a group of children below 6 years old in Najaf Governorate DR .Jasim M. Hashim. Assistant professor of pediatrics MBChB,DCH,FICMS,CABP. DR.Salih M. Ali. MBChB, DCH DR .kussay M. Zwain. Assistant professor of surgery MBChB,FICMS

: ‫أﻟﺨﻼﺻ‬ ‫ﺮاء اﻟﺘﻌﻠ ﻤﻲ ﻟﻠﻨﺴﺎﺋ ﺔ واﻷطﻔ ﺎل وﻣﺴﺘﺸ ﻔﻰ اﻟﺼ ﺪر اﻟﺘﻌﻠ ﻤ ﻲ‬ª‫ﺎ ﻓﻲ ﻣﺴﺘﺸﻔﻰ اﻟﺰ‬ª‫ﺬه اﻟﺪراﺳﺔ ﺗﻢ أﺟﺮاؤ‬ª ♦ ‫ﻓﻲ اﻟﻨﺠﻒ اﻷﺷﺮاف ﻟﺒﺤﺚ ﻣﺨﺘﻠﻒ اﻷﻋ ﺮاض اﻟﺒ ﺌ ﺔ واﻟﺴ ﺮ ﺮ ﻟﺘ ﺪاﺧﻞ اﻷﻣﻌ ﺎء ﻷطﻔ ﺎل دون ﺳ ﻦ اﻟﺴﺎدﺳ ﺔ ﻣ ﻦ‬ ‫وﺟﺪ ﻓ ﻲ‬، ٢٠٠٧ ‫ ﻟﺸ ﺮ آب‬٢٠٠٦ ‫ﺬه اﻟﺪراﺳﺔ ﻣﻦ ﺷ ﺮ ﻛﺎﻧﻮن اﻟﺜﺎﻧﻲ‬ª ‫ واﺣﺪ وأرﺑﻌﻮن ﺣﺎﻟ أﺧﺘ ﺮت ﻓﻲ‬.‫اﻟﻌﻤﺮ‬ ‫ أﺷ ﺮ_ﺳ ﻨﺘﺎن‬٦ ، (%٥١،١٩) ‫ اﺷ ﺮ‬٦ ‫ﺬه اﻟﺪراﺳ ان ﻧﺴﺒﺔ اﻷطﻔﺎل اﻟﺬ ﻦ ﺷﺨﺼﻮا ﺑﺘﺪاﺧﻞ اﻷﻣﻌﺎء دون ﺳ ﻦ‬ª ) ‫ ﺬه اﻟﺪراﺳ ﺔ أن‬ª ‫وﺟ ﺪ ﻓ ﻲ‬.(%٣٢،٧) ‫ ﺳ ﻨﻮات‬٦ -٤ ، (%٧٦،٩) ‫ ﺳ ﻨﻮات‬٤_‫ ﺳ ﻨﺘﺎن‬، (%٤١،٦٣) ‫وﺟﺪ أ ﻀ ﺎ أن ﺗ ﺪاﺧﻞ‬.(١، ٢: ٤) ‫اﻹﻧﺎث‬: ‫( ﻛﺎﻧﻮا إﻧﺎﺛﺎ ً وﻛﺎﻧﺖ ﻧﺴﺒﺔ اﻟﺬﻛﻮر‬%٩٥،٢١)‫( ﻛﺎﻧﻮا ذﻛﻮرا و‬%٠٤،٧٨ ‫ﺬه اﻟﺪراﺳ أن ﺗ ﺪاﺧﻞ اﻷﻣﻌ ﺎء ﺤ ﺪث ﺑﻨﺴ ﺒ ﻛﺒ ﺮه ﻓ ﻲ‬ª ‫أﻛﺪت‬. ‫أﻷﻣﻌﺎء ﺤﺪث ﻓﻲ اﻟﻤﻨﺎطﻖ اﻟﺮ ﻔ وﻣﻨﺎطﻖ اﻟﻤﺪ ﻨ‬ .(%٠٧،٣١) ‫( واﻟﺮﺑ ﻊ ﺑﻨﺴﺒﺔ‬%٢١،٥١) ‫ﻓﺼﻠﻲ اﻟﺼ ﻒ ﺑﻨﺴﺒﺔ‬ ‫( ﺧ ﺮوج دﻣ ﻮي ﺷ ﺒ‬%٩٧،٦٠)‫ ﺬه اﻟﺪراﺳ أن ﻧﺴ ﺒﺔ اﻟ ﺬ ﻦ ﻋ ﺎﻧﻮا ﻣ ﻦ اﺳ ﺎل دﻣ ﻮي ﻛﺎﻧ ﺖ‬ª ‫أظ ﺮت‬ ♦ ‫ﺬه اﻟﺪراﺳ ان ﻋﺪد اﻟﻤﺮﺿﻰ اﻟﺬ ﻦ أﺟﺮي ﻟ ﻢ ﻓﺤﺺ‬ª ‫ وﺟﺪ ﻓﻲ‬.(%٧٥،٩) ‫ وأﻧﺘﻔﺎخ اﻟﺒﻄﻦ‬،(%٢٦،٢٩) ‫ﺑﺎﻟﺠﻠﻲ‬ ‫( ﻻ ﻌﺎﻧﻮن ﻣﻦ ورم داﺧ ﻞ‬%٠٢،٣٩) ‫ﻟﻠﺒﻄﻦ ﺑﺠ ﺎز اﻟﻤﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗ ﻛﺎﻧﻮا واﺣﺪ وﺛﻼﺛﻮن ﻣﺮ ﻀﺎ وﺑﻨﺴﺒﺔ‬ ‫ﺑﺎﻟﻨﺴﺒﺔ ﻟﻤﺨﺘﻠﻒ أﻧ ﻮاع اﻟﺮﺿ ﺎﻋ‬.‫( ﻌﺎﻧﻮن ﻣﻦ ورم ﻓﻲ اﻟﺠ اﻟ ﻤﻨﻰ أواﻟ ﺴﺮى داﺧﻞ اﻟﺒﻄﻦ‬%٥٨،٣٦)‫اﻟﺒﻄﻦ و‬ ‫ﻢ اﻟﺮﺋ ﺴ ﻲ ﻛ ﺎن ﺣﻠ ﺐ اﻷم و‬ª‫( ﻣ ﻦ اﻟﻤﺮﺿ ﻰ ﻏ ﺬاؤ‬%٥٨،٣٦) ‫ ﺬه اﻟﺪراﺳ أن‬ª ‫واﻟﻐ ﺬاء ﻟﻠﻄﻔ ﻞ وﺟ ﺪت‬ ‫وﺟ ﺪت‬.‫( ﻣﺨﺘﻠﻂ ﻣﺎﺑ ﻦ ﺣﻠ ﺐ اﻷم واﻟﺤﻠ ﺐ اﻟﻤﺼﻨﻊ واﻟﻐ ﺬاء اﻟﻤﻨﺰﻟ ﻲ‬%٠٢،٣٩) ‫( اﻟﺤﻠ ﺐ اﻟﻤﺼﻨﻊ و‬%٣٩،٢٤) .‫ﺬه اﻟﺪراﺳﺔ اﻧ ﺗﻢ أﺟﺮاء اﻟﻌﻤﻠ اﻟﺠﺮاﺣ ﻷﻋﺎدة اﻷﻣﻌﺎء ﻟﻮﺿﻌ ﺎ اﻟﻄﺒ ﻌﻲ ﻟﺠﻤ ﻊ اﻟﻤﺮﺿﻰ‬ª Abstract This retrospective study was conducted in Al-Zahraa M.C.H. and AL-Sader teaching hospital to assess the various epidemiological and clinical features of intussusception. Forty one cases included in this study selected from January-2006-till Augest -2007. Below 6 months 8cases (19.51%) ,6 months-2 years 26 cases(63.41%), 2 years-4 years 4cases (9.76%) ,4-6 years 3 cases (7.32%). Thirty-two cases (78.04%) were male, 9 cases (21.95%) were female.This study showed sex preponderance (male:female ratio)(4:1.2). Thirty-six cases (87.80%) were from urban area while 5cases (12.2%) were from rural area.Regarding seasonal variation appear 21 cases (51.21%) in summer,13 cases (31.7% ) in spring,7cases(17.07)in winter.This study showed variation in presentation ,25 cases (60.97%) presenting with bloody diarrhea,12 cases(29.26%) with red current jelly stool ,4cases (9.75%) with abdominal distention.In ultrasound study of 31cases (75.60%),16 cases (51.6%) showed no mass,15 cases (48.4%) showed right side mass or left side mass.According to type of feeding 16 cases (39.02%) (mixed feeding) ,15cases (36.58%) (breast feeding),10cases(24.39%)(bottle feeding).In all cases surgical reduction performed. Introduction Intussusception is the most common cause of intestinal obstruction between 3months-6years of age.Sixty percent younger than 1 years,80% of cases befor 24 month.Seasonal incidence peak in spring and autumn and correlate with adenovirus infection .Male:Female 4:1. Few intussusception reduce spontaneously but if left 12

Kufa Med.Journal 2009.VOL.12.No2. untreated leadto peritonitis and perforation.GIT infection or introduction of new food protein lead to swollen peyers patches in terminal ileum may form the lead piont of intussusception.(1) Intussusception occurs when one segment of bowel telescopes into distal segment.Idiopathic intussusception usually occurs between 6months and 18 months of age.Lead piont is seen in 5% ofcases(Mekel diverticulum,lymphosarcoma,&polyp).Ileocolic form is most frequent followed by ileoilieal and colocolic.(2) Seventy to ninty five percent( 70%-95% )of cases are classed as idiopathic,associated illness like gastroenteritis or UTI is found in 30%.It is found that hyperplasia of terminal ileum(peyers patches)may be initially event may occur secondary to weaning.(3) Intussusception describes the invagination of proximal bowel into adistal segment.Commonly involves ileum passing into the caecum and colon through the ileocaecal valve.Usually occurs between 2 months and 2 years of age and resuscitation and reduction are urgent.(4). The illness starts suddenly with sever paroxysmal colicky abdominal pain that recurs at frequent intervals and is accompanied with loud crying.Initially the infant looks well and plays normally between the attacks.(5) Diagnosis of intussusception depend on clinical hisatory and physical finding,plain abdominal x-ray that show density in area intussusception.,barium enema that show filling defect with abdominal U/S which is sensitive mathod.(1) During episodes of pain,child becoms pale espcially around the mouh ,and draw up his legs.Asausage-shaped mass,often palpable in the abdomen,passage of acharacteristic red current jelly stool comprising blood stained mucous-tend to occur later in the illness and may be first seen after rectal examination.Intravenous volume expansion is likely to required immediately as there is pooling of fluid in the gut, which lead to hypovolemic shock which is an important complication of intussusception.(4) The presence of bloody mucous on the finger as it is withdrawn after rectal examination supports the diagnosis of intussusception.If the condition is not diagnosed early(during the first day or two) the infant will pass into ashock like state with bile stained vomiting,abdominal distention and high fever secondary to intestinal isckaemia and gangren.(5) Reduction is emergency.Success rate of radiological reduction under U/S is 50% if symptoms > first 48 hr. and 70-90% if