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This paper focuses on one of the few surgical diseases whose cause is still unknown, intussusception.
This is a common disease in infants whose name comes from the Latin word: intus meaning ‘within’ and suscipere meaning ‘to take up’). It occurs when the bowel telescopes into itself purportedly leading to kinking of vessels and ischaemic death of the bowel tissue known as gangrene.
It is common for children in high-income countries with this condition to come to the hospital within hours and be treated with similar urgency using a non-operative technique. However, in many LMICs, there are significant prehospital delays up to days or even weeks for intussusception. It is thought that like many other surgical diseases (where long pre-hospital time leads to a higher risk of gangrene), a long duration of 'kinking' should lead directly to gangrene in intussusception.
In their practice, the researchers noticed that even children who present after days or weeks of symptoms seem counterintuitively to have no gangrene, raising questions about whether kinking of the vessels actually occurs and prompting interesting hypotheses about the cause of intussusception which still eludes the scientific community.
The researchers decided to analyse intussusception patients over two years to describe the patient journey while in hospital, the topography of the time delays, and the geographical spread of origin of cases. They also analysed whether presentation delay had any relation to the intra-operative finding of gangrene.
Interestingly, they found no relationship between preoperative delay and the finding of gangrene which raises questions about why some children have gangrene and others do not.