The study was conducted from November 01 to 30, 2021 in the Hiwot Fana Specialized University Hospital (HFSUH), eastern Ethiopia, among children diagnosed and treated for acute intussusception between January 2014 and December 2020. The hospital is located 526 km east of Addis Ababa, the capital city of Ethiopia, in Harar town, the capital city of Harari Regional State and East Hararghe Zone of Oromia Regional State. Harar town has two public hospitals (Jugol General Hospital and HFSUH), one Federal Police Hospital, one private General hospital, four public health centers, and one Family Guidance Association.

HFSUH is serving as a teaching institution for health science students from different Health Science Colleges and Universities in eastern Ethiopia under the umbrella of Haramaya University. It provides 24-h comprehensive services for more than 5.8 million populations with different demographic and socioeconomic backgrounds from the entire surrounding of the Eastern part of the country including the Harari Regional State, Dire Dawa City Administration, Eastern part of Oromia Regional State (Eastern and Western Hararghe Zones) and the Somali Regional State. The hospital provides emergency medicine, internal medicine, neurology, general surgery, orthopedics, neurosurgery, obstetrics and gynecology, pediatrics, radiology, dermatology, pathology, oncology, anesthesiology, and neonatal care specialty services for the entire population from eastern Ethiopia. The department of Pediatrics has six units including Pediatric Ward, PICU, NRU, NICU, OPD, and Chronic Follow-up Units.

An institutional-based retrospective descriptive cross-sectional study was conducted to determine the clinical profile, treatment outcomes of acute intussusception and its associated factors among children diagnosed and treated for acute intussusception at HFSUH, eastern Ethiopia. All medical records of children admitted and received management for acute intussusception at HFSUH between January 2014 and December 2020 were included in the study. Medical records of children with incomplete data and unknown treatment outcomes were excluded from the study.

All medical records of the pediatric population admitted and treated for acute intussusception between January 2014 and December 2020 at HFSUH that fulfilled the inclusion criteria were included in the study consecutively.

Data were collected using a validated pretested structured data extraction checklist adopted from relevant literature and modified to the study variables. First, the operation theatre and admission records were reviewed to develop lists of cases presenting with acute intussusception between January 2014 and December 2020. Then, data were extracted from the medical registrations of children taken from the examination room at arrival, operating room records, post-surgical evaluation and monitoring sheets, and intensive care and discharge records. Data were collected by trained data collectors and supervisors through a review of the medical records of children. The variables such as socio-demographic characteristics, delay in presentation, clinical signs and symptoms, interventions given for the child, surgical procedures performed, and the duration of hospitalization were collected using the checklists.

The well-understood and proven interventions for children with acute intussusception were pneumatic reduction or hydrostatic enema: once intussusception is suspected and confirmed, the initial management was the pneumatic reduction, which would be attempted under mask anaesthesia or hydrostatic enema using barium enema solutions. If this attempt to a reduction of acute intussusception was unsuccessful after three trials, the reduction was considered a failure and the children would be transferred for surgical interventions.

A pretested validated structured data collection tool prepared in simple English language after a review of related literature was used to ensure data quality. One day training was given to data collectors and supervisors on the purpose of the study, the contents of data collection tools, where to find the records and how to extract the required data from medical records and record data appropriately. A pretest was conducted on 5% of the sample size before the actual data collection period to check for the reliability and validity of data collection tools. The questionnaires were reviewed and checked for completeness, accuracy and consistency by the principal investigator and amended accordingly based on the pretest results. The collected data were carefully checked for incompleteness, accuracy, and inconsistency on daily basis by supervisors, and the principal investigator. Double data entry was done by two individuals to minimize errors.

The collected data were validated for completeness and accuracy, categorized, coded and entered into Epi-data version 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) software version 25.0. Descriptive findings were expressed as frequency percentages, means, and standard deviations. The non-parametric (Chi-square (χ²)) tests were applied to identify the statistical significance of the association between the independent and outcome variables. The statistical significance was considered at a p-value < 0.05 with a 95% confidence interval (CI).

The study was conducted following the principles of the Helsinki Declaration. Ethical clearance was obtained from the Institutional Health Research and Ethics Review Committee (IHRERC) of the College of Health and Medical Sciences, Haramaya University. A written official letter of cooperation was submitted to the HFSUH before the commencement of data collection to obtain administrative permission. Informed voluntary consent was obtained from the heads of the hospital and the department after they were informed of the aim, purpose and benefits of the study. The confidentiality of the information was maintained throughout the data collection and information dissemination process.

In this medical records review, 86 children were admitted with the diagnoses of acute intussusception and treated at Hiwot Fana Specialized University Hospital over the seven years period, of which 75 medical records of children were included in the analysis, yielding a retrieval rate of 87.2%. Among the study participants, the majority, (72%) of children were male, giving a male to female ratio of 2.6:1. The median age of the study participant was 13 months. Regarding the age group of children, 31(44%) were in the age group of less than 12 months and 24(32%) were in the age group between 12 and 24 months, and the majority, 44(56%) of children were in the age group above one year old. The majority, 56(74.7%) of cases seen came from outside Harar (Table 1).

According to the findings of this study, 32(42.7%) cases were presented between July and September, with a second peak of 10(13.3%) occurring in August (Figure 1).

According to this study, only 7(9.3%) patients were identified to have signs of malnutrition, and the majority, 68(90.7%) did not have any underlying medical illness. Approximately, 40(53.3%) and 15(20%) of the children had upper respiratory tract infections and gastroenteritis within 1–2 weeks of the diagnosis of intussusception, respectively.

The majority of children, 45(60%) were presented to the hospital after 48-h of the onset of symptoms, and the remaining 30(40%) were presented within 48-h of the onset of illness. Abdominal pain 71(94.7%), vomiting 70(93.3%), bloody mucoid diarrhea 53(70.7%), abdominal distention 57(76.0%), and palpable abdominal mass 24(32.0%) were the most common presenting clinical findings. The classic triads of signs and symptoms such as abdominal pain, bloody mucoid diarrhea, and abdominal mass were identified on physical examination in 32(42.7%) of cases (Table 2).

Regarding the diagnostic modality, abdominal ultrasound was the most frequently used in 50(66.7%) cases followed by plain abdominal radiography in 10(13.3%), and the remaining were diagnosed clinically. Regarding the perioperative treatment, 31(41.3%) of children were treated with antibiotics and only 7(9.3%) took prophylactic antibiotics. The majority, 45(60%) of the intussusception was an ileocolic type (Figure 2). Among the total cases, 54(72%) and 4(5.3%) had non-specific lymphadenitis and Meckel's diverticulum, respectively. The remaining 17(22.7%) had no identified leading point.

In this study, all children received surgical intervention; we observed that non-surgical management options such as pneumatic reduction or hydrostatic enema services were not available in this facility. Among the surgical interventions, reduction without resection was possible in 47(62.7%) cases, resection and anastomosis were performed in 19(25.3%) cases, stoma in 2(2.7%) cases, and nothing was done for the remaining 7(9.3%) following laparotomy. Post-operative antibiotics were administered to all children who underwent surgery for acute intussusception.

In this study finding, the overall mortality in children with acute intussusception was 13.3% (95% CL: 11.8–14.8). Among the complications, post-operative infections and septic shock were identified as the causes of death. The majority, 65(86.7%) of children were improved and discharged with good recovery. Post-operative complications occurred in 27(36%) of patients; surgical site infection 16(21.3%), pneumonia 7(9.3%) and anastomotic leak 4(5.3%) were common complications occurring after surgical intervention. The Chi-square (χ²) test showed that there was a statistically significant association between age less than 24 months and treatment outcome of acute intussusception [X²= 8.13(df = 1); p = 0.004]. Moreover, preoperative vital signs [X²= 19.21(df = 2); p = 0.000], intraoperative findings [X²= 18.89 (df = 1); p = 0.000], and postoperative complications [X²= 14.60 (df = 1); p = 0.000] were significantly associated with treatment outcome of acute intussusception (Table 3).

This study had some limitations: First, a retrospective document review was used, which may miss some variables and lacks explanations for why delayed presentation and timing of interventions, and due to the nature of the cross-sectional study design used, it was difficult to establish the cause-effect relationship between the study variables. Second, the study sample size was very small which may make it difficult to represent a larger population. In addition, the effect of rotavirus vaccination was not considered in this study.