Justification of the conservative treatment of intestinal intussusception in children without age and disease duration considerations

Abstract

Introduction. Since the middle of the last century, the conservative treatment of ileocecal intussusception (ICI) has dominated in children. However, questions on choosing a technique for conservative treatment and indications for surgical treatment remain open.
 Purpose. To assess the effectiveness of hydroechocolonoscopy (HEC) for ICI in children regardless of their age and disease duration.
 Material and methods. 160 children with confirmed ICI were enrolled in the study. All children, who had developed uncomplicated ICI for the first time, had HEC regardless of their age and disease duration. Failed hydrostatic disinvagination and disease relapse after HEC were indications for surgical management (laparoscopy, colonoscopy, laparotomy). To evaluate the effectiveness of conservative treatment at different age groups and at different terms of disease duration, two comparable trials were performed: 1 – stratification of patients by age: main group (n=130) - children older than one year, comparison group (n=30) – children younger than one year; 2 – stratification of patients by disease duration: main group (n=107) – more than 12 hours, comparison group (n=53) – up to 12 hours. To assess outcomes, the following parameters were analyzed: HEC effectiveness and complications, incidence of early relapses after HEC, causes of HEC failure and relapses after HEC, frequency and surgical techniques applied for treating ICI.
 Results. In the groups stratified by age, HEC effectiveness was 95.4% in the main group and 93.3% in the comparison group, p=0.216. Early relapses occurred in 10.3% in the main group and in 3.3% in the comparison group, p=0.128. In the groups stratified by the disease duration, HEC effectiveness was 93.5% in the main group and 98.1% in the comparison group, p=0.204. Early relapses occurred in 10.3% (11) in the main group and in 11.3% (6) of cases in the comparison group, p=0.841. There were no any complications during HEC procedure. Basic reasons for the conservative treatment failure were anatomical ones; for relapses – lymphoid hyperplasia of the abdominal cavity and anatomical reasons. Thus, HEC was effective in 95% of cases; relapses after HEC amounted up to 10.6%. Surgical interventions ( in 15.6%) were started with laparoscopy; laparoscopic disinvagination was effective in 68% of cases. Colonoscopy after successful laparoscopic disinvagination was performed in 5.6%, conversion to laparotomy was in 5% of the total number of observations.
 Conclusion. HEC is a highly effective and safe option for HEC conservative management in children regardless of child’s age and disease duration. Indications for surgical treatment for uncomplicated ICI are hydrostatic disinvagination failure and disease relapse.