INTUSSUSCEPTION: A RETROSPECTIVE THREE
YEAR REVIEW IN SINGAPORE
Lai A.H.M.1, Teo E.L.H.J.2,
Jacobsen A.S.3, Fung F.M.Y.4, Han H.H.4,
Bock H.L.4, De Vos B.4, Hardt K.4, Phua
K.B.1
1Department of Paediatrics, 2Department
of Diagnostic Imaging, 3Department of Paediatric Surgery, KK
Women¡¯s and Children¡¯s Hospital, Singapore, 4GlaxoSmithKline,
Rixensart, Belgium
Background: Intussusception is the commonest cause of
intestinal obstruction in infants and young children. Wild type human
rotavirus is uncommonly detected in cases of intussusception. However, the
administration of a rotavirus vaccine (Rotashield®) has been
associated with a higher rate of intussusception during the week following
vaccination and was subsequently withdrawn. In preparation for a new
rotavirus vaccine efficacy trial in Singapore, a retrospective
epidemiological surveillance was undertaken.
Objective: To describe the epidemiology of
intussusception-related hospitalizations in children 5 years old and below
over a period of 3 years.
Method: Case definition applied: each child between 0-5
years admitted at KK Women's and Children's Hospital between 1 Jan 1998 and
31 Dec 2000 and discharged with a code for IS (ICDC 560.0) was included. Demographic,
clinical and imaging data were recorded on a standard data sheet.
Results: This retrospective study comprised 169
hospitalized patients treated for intussusception over a three-year period.
The male to female ratio for intussusception was 1.6:1. Considering a
yearly birth cohort of 45,000 and the fact that about 75 % of children of
Singapore are treated at KK Women's and Children's Hospital, the overall
incidence of intussusception-related hospitalisation in 0-5 years old was
around 33/100,000 infants per year. Below 3 months and above 3 years of
age, intussusception rate was very low. The peak of intussusception was
observed between 3 to 9 months, with an incidence of 100/100,000 infants
per year. The reported annual rate of intussusception associated
hospitalisation in US varies from 18-56/100,000 infants per year (below one
year of age), while in Singapore, the annual rate for infants below one
year is 80/100,000 infants per year. Rotavirus infections are seasonal in
Singapore, with a peak during monsoon between December and March. In contrast,
the number of case reports of intussusception was independent of this
seasonality. The four classical features of
intussusception, namely vomiting, abdominal pain, abdominal mass and rectal
bleeding were presented together in only 7.3 % of the patients, and hence a
high index of suspicion is necessary when any of the signs and symptoms are
present in the infants or young children. Air
enema reduction successfully reduced intussusception in 80 % of the
patients. No lethal case was recorded.
Conclusion: The incidence of intussusception associated
hospitalisations in babies below one year of age in Singapore was found to
be 80/100,000 infants per year, higher than the incidence of reported
intussusception hospitalisations in US. Intussusception is not affected by
seasonality, in contrast to rotavirus infections. Abdominal ultrasonography
was confirmed as the most accurate method to diagnose intussusception.