Paediatric intussusception: epidemiology and outcome.

OBJECTIVES: (i) To describe the clinical presentation of intussusception and determine features associated with earlier diagnosis; (ii) to describe outcomes of children diagnosed with intussusception; and (iii) to determine whether time to diagnosis is associated with poorer prognosis. METHODS: A retrospective review was performed of all patients presenting to a tertiary paediatric hospital with a diagnosis of intussusception during a 10 year study period. RESULTS: One hundred and forty-one confirmed cases met the inclusion criteria, giving an incidence of one case per 1450 ED presentations. The median age of presentation was 9 months, with a ratio of male to female of 2:1. Three or more of the four 'classic' features of intussusception (vomiting, abdominal pain, bloody/red currant jelly stool, or abdominal mass) were reported in only 46% of presentations. Median time to confirmation of diagnosis was 19 h from onset of symptoms. Ultrasound was the most commonly employed method used to confirm the diagnosis. Air enema had a success rate of 80%, with a reduced success rate beyond the first attempt. Early diagnosis was associated with decreased frequency of surgical intervention and need for bowel resection. CONCLUSION: The 'classic' picture of intussusception might frequently not be present in children with intussusception. Reliance on 'classic' features alone might delay diagnosis. Delayed diagnosis is associated with poorer patient outcomes. Air enema has a high success rate for reduction of intussusception.

Laparoscopic adjustable gastric banding prior to renal transplantation.

End-stage renal failure is most commonly caused by the obesity-related diseases, diabetes mellitus and essential hypertension, and is best treated with renal transplantation. Obesity may contribute to poor patient and graft survival, and is an exclusion criterion in some renal transplant programs. Diet and exercise programs have not proven to be effective for weight loss before transplantation, and bariatric surgery in any form has not been used in this setting before. We report three morbidly obese patients who underwent laparoscopic adjustable gastric banding to meet the criteria for renal transplantation and subsequently were successfully transplanted.