Intestinal Intussusception In Children Research Articles

Acute Intestinal Intussusception in Children at Somine Dolo Hospital in Mopti

Introduction: It is defined as the penetration of an intestinal segment and its meso into the lumen of the distal segment by a glove-like turning mechanism (invagination sausage) whose perpetuation results in obstruction of the intestinal lumen and the intestinal necrosis. Acute intestinal intussusception (IIA) or intussusception is the most common cause of intestinal obstruction in infants. IIA is primary or idiopathic in 90% and mainly affects infants between 2 months and 2 years with a peak frequency between 6 and 9 months. Objectives: To study acute intestinal intussusception in children aged 0 to 15 years in the general surgery department of the “SOMINE DOLO” hospital in Mopti. Method: This was a retrospective, descriptive study which took place from January 2017 to September 2020 in the general surgery department of the Sominé Dolo Hospital in Mopti. Result: During the study period, 1244 children were operated on including 32 cases of IIA, representing a frequency of 2.57% of surgical interventions. The male gender was in the majority (62.5%) with a sex ratio of 1.7. The average consultation time was 6.2 ± 4.3 days. Infants were the majority in 68.8% of cases and the main reason for consultation was abdominal pain (78.1%). The average treatment time was 2.9 hours. The ileocecocolic form was more frequent in 50% cases. Manual disinvagination was most often performed in 75% and the postoperative course was simple in 56.3%. Conclusion: AII is a common condition in our structure. It mainly affects infants and boys. Patients consult late but early treatment reduces mortality.

New approaches to the diagnosis and tactics of surgical treatment of intestinal intussusception in children

Intestinal intussusception (IR) is an urgent problem of pediatric surgery. The relevance is high due to the incidence of the disease, which ranges from 1.5 to 4 per 1000 children and tends to increase cases over the past 10 years, as well as diagnostic difficulties and a high frequency of relapses of the disease. The frequency of diagnostic mistakes reaches 75-85%, and the mortality rate for intussusception ranges from 0.5 to 1%, reaching from 6 to 14.5% in complicated forms. The aim of the study is to improve the results of treatment of intestinal intussusception in children by optimizing approaches to diagnosis and tactics of surgical treatment. Materials and methods. Over the past 20 years, 237 children aged 3 months to 12 years were hospitalized in the Department of Emergency Surgery, Specialized Pediatric Surgical Clinic of Samarkand State Medical University, with a diagnosis of intestinal intussusception, of which 116 were confirmed during a clinical examination. Depending on the applied therapeutic and tactical approaches, all examined patients with intestinal intussusception are divided into 2 groups. Group 1 (comparison group) consisted of 43 patients treated in the period from 2000 to 2013. In this group, the diagnosis was based on plain radiography and pneumoirrigoscopy. Group 2 (main group) consisted of 73 patients treated for the period from 2014 to the present. In this group, diagnosis and conservative treatment was based on the method of hydroechocolonographic disinvagination under ultrasound control.

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

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.

Factors associated with in-hospital recurrence of intestinal intussusception in children.

A minority of children experience in-hospital recurrence of intestinal intussusception after treatment. This study investigated the factors associated with in-hospital recurrence of intussusception in pediatric patients in China. This retrospective study included patients aged 0-18 years-old with intestinal intussusception treated at Hainan Women and Children's Medical Center between January 2019 and December 2019. Demographic and clinical characteristics were extracted from the medical records. Factors associated with in-hospital recurrence of intussusception were identified by logistic regression analysis. The analysis included 624 children (400 boys) with a median age of 1.8 years (range, 2 months and 6 days to 9 years). Seventy-three children (11.7%) had in-hospital recurrence of intussusception after successful reduction with air enema. Multivariate logistic regression analysis identified age > 1 year-old (odds ratio [OR]: 7.65; 95% confidence interval [95%CI]: 2.70-21.71; P < 0.001), secondary intestinal intussusception (OR: 14.40; 95%CI: 4.31-48.14; P < 0.001) and mesenteric lymph node enlargement (OR: 1.90; 95%CI: 1.13-3.18; P = 0.015) as factors independently associated with in-hospital recurrence of intussusception. Age > 1 year-old, secondary intussusception and mesenteric lymph node enlargement were independently associated with increased odds of in-hospital recurrence of intussusception after successful reduction with air enema.

Інвагінація кишечника в дітей: навчання та практика

Intestinal invagination is a mixed form of intestinal obstruction that occurs when one section of the intestine is telescopically immersed in the lumen of another and occurs mainly at the age of 3 months to 1 year, which is 90%, and mortality, according to the literature, ranges from 6 to 14.5%. Despite a sufficient number of scientific and clinical publications on the pages of medical journals regarding the diagnosis and treatment of intestinal intussusception, there are no fake simulators in the training of students and interns, which determines the relevance of this publication. Purpose - to improve the results of diagnosis and treatment of children with intestinal intussusception by analyzing domestic developments and visually studying the mechanism of its development with the help of a simulator both for the purpose of diagnosis and treatment - conservative disinvagination. Results. In today’s conditions, general practitioners and pediatricians are not trained to diagnose intussusception in children, that is, they do not have simple methods of examination. Hospitals usually do not have the equipment to examine and diagnose acute intussusception. In order to eliminate the gaps at the Department of Pediatric Surgery of the Bukovinian State Medical University, a dummy-simulator of intestinal intussusception «Garant» was developed and introduced into the educational process. Training on a simulator allows you to master the practical skills of diagnostics in the conditions of an X-ray room and conservative disinvagination followed by X-ray control. In turn, the development of skills by primary care physicians and pediatric surgeons in diagnosis and treatment will primarily improve the understanding of the onset of the disease and treatment methods. Conclusions. With certain and significant developments regarding the diagnosis and treatment of intestinal intussusception in children, the problem has not been solved, since some children seek help at the wrong time, and as a result of complications - necrosis, peritonitis with organ and multiple organ failure. The use of a scoring system for assessing the stage of invagination makes it possible to systematize the main prognostic indicators of sonographic and dopplerographic studies in order to determine an adequate method of treatment. Practicing the skills of diagnosis and treatment on the self-developed dummy «Garant» allows you to clearly understand the essence and purpose of the measures taken to establish and confirm the diagnosis of intestinal intussusception, evaluate the possibilities of various methods of conservative and surgical treatment and indications for them. No conflict of interests was declared by the authors.

Predisposing factors of intestinal intussusception in older children

The article provides a brief description of the causes and mechanisms of intestinal intussusception and a description of two cases of invagination in children over 7 years. The occurrence of intestinal intussusception in children older than 1 year often has a pathological leading point – a disease or pathological condition, as a result, of the course or complication of which it is possible to introduce one section of the intestine into another. Two children, 8 and 7 years old, were hospitalized at our clinic with signs of acute surgical pathology in the abdominal cavity, were operated on in an emergency order. In both cases, necrosis of the intestinal area, as a result, of invagination was detected, resection and anastomosis were performed. The leading points in these cases were Schönlein-Genoch purpura and Peutz-Jeghers polyps. Invagination of the intestines in these diseases occurs with atypical clinical symptoms, making it difficult to diagnose in time and leads to more frequent development of ischemia and necrosis of the intestinal wall.

Інвагінація кишечника у дітей. Історія та сучасний стан проблеми (огляд літератури)

Acute intestinal intussusception in children is a frequent type of acquired intestinal obstruction and ranks second among nosologies in pediatric emergency surgery after acute appendicitis. Of course, today there remains an interest in the issue of improving the efficiency of diagnosis and treatment of this pathology of children. Laparoscopy allows you to identify invaginate, assess the condition of the intestine in the area of infringement and identify (or exclude) concomitant pathology contributing to the occurrence of invagination, and the simultaneous use of pneumocompression can greatly facilitate the smoothing of invaginate. Nevertheless, the number of scientific reports and works on, possibly, the negative effect of increased pressure in the abdominal cavity on the function of individual organs and systems of newborns and young children is not enough. That is why a number of questions about the safety of the use of laparoscopic method in the treatment of intussusception in infants in combination with pneumocompression, because at this moment there is a sharp increase in intra-abdominal pressure. Answers to questions can be obtained by studying the effect of combined pressure on the state of internal organs. This became the basis for conducting an appropriate clinical experimental study. The results of the study should determine the safe limits of intra-abdominal pressure when using the method of laparoscopy in combination with pneumocompression.

Postoperative intestinal intussusception in children, an easily missed culprit of postoperative intestinal obstruction: Case series and literature review

BackgroundPostoperative intestinal intussusception (POI) is a rare cause of intestinal obstruction with POI after surgical reduction of ileocolic intussusception being an extremely rare variant. POI was reported to follow many abdominal and non-abdominal operations. A late diagnosis can risk ischemia and necrosis. POI also increases the morbidity and mortality, rendering an early diagnosis and prompt management as lifesaving. MethodsWe reviewed the medical charts retrospectively for the last ten years for patients with POI at Palestine Red Crescent Society Hospital, Hebron, Palestine. We reviewed the literature and presented the characteristics of the most reported cases of POI following surgical reduction of ileocolic intussusception. ResultsWe presented three cases of ileoileal POI and one case of ileocolic POI followed different primary operations. All but one patient presented in the first two weeks. The delayed presentation came two months after revision of a prolapsed colostomy. All patients managed successfully with operative manual reduction with no postoperative complications. Initially, we had struggles in the diagnosis of POI largely due to a low suspicion for this rare entity, but thereafter we kept POI in mind and managed the after-coming cases in an expeditious manner. ConclusionFrequently, POI is misdiagnosed as postoperative adhesive obstruction. POI is challenging in diagnosis and needs a very high index of suspicion, mainly due to its rarity and atypical presentation. By keeping the possibility of POI in mind, one can easily diagnose it and prevent its consequences.

A rare clinical case of retrograde small-bowel intussusception in pediatric practice

Intestinal intussusception in children is a mixed variant (with elements of obstruction and strangulation at the same time) of intestinal obstruction caused by isoperistaltic insertion of the proximal intestine into the distal. The article describes a rare clinical case of retrograde small bowel intussusception in a teenage girl aged 17 years with severe neurological pathology. Anamnesis, clinical symptoms and results of paraclinical methods of research, methods and results of the conducted treatment are given. The aim of the article is to familiarize doctors of practical health care with an extremely rare variant of intestinal intussusception. Retrograde (antiperistaltic) small bowel intussusception in children is very rare. Given the neurological status of the patient, the probable cause of intussusception was spastic neurogenic small intestinal dyskinesia. The direct cause of the disease was feeding mistakes in the form of feeding large amounts of strained food through the gastrostomy.

A 30-Year Experience in Treatment of Intestinal Intussusception in Children by Own Technique

The issues on objectification and selection of indications for conservative treatment of intestinal intussusception in children remain to be disputable.Materials and methods. The experience of treating 249 pediatric patients (172 boys and 77 girls) with intestinal intussusception at the age of 2 months - 13 years was analyzed. There were 265 cases of intestinal intussusception including 16 cases of the recurrence in 11 children. Conservative treatment was performed in 178 (71.5%) children, 71 (28.5%) children were operated on. To make the analysis, children were divided into 3 groups according to three ten-year periods.Results and discussion. The statistical analysis demonstrated the decrease in the number of patients with the increase in the number of children over 1 year of age over the past decade. The 1st decade was characterized by the introduction and experimental substantiation of flow-through pneumatic insufflation developed by the author with following refusal of X-Ray control. The methods of objectification of the criteria for non-surgical reduction of intussusception using flow-through pneumatic insufflation were developed experimentally. In the 2nd decade the algorithm for treatment of intestinal intussusception was developed; the indications for non-surgical reduction of intussusception were extended. 5 (22.7%) children out of 22 with disease duration of more than 24 hours and 6 (46.2%) children out of 13 over 1 year of age underwent non-surgical reduction of intussusception. In the 3rd decade the indications for non-surgical reduction of intussusception were extended. 11 (57.9%) children out of 19 with disease duration of more than 24 hours and 20 (74.1%) children out of 27 over 1 year of age underwent non-surgical reduction of intussusception. Only in 4 (28.5%) children out of 14 over 1 year of age who were operated on, we found out anatomical cause of the condition. We have analized the experience in treating 11 children with 16 recurrences of intestinal intussusception. In 7 cases non-surgical reduction was performed, 4 children were operated on. During surgeries there were observed no anatomical causes or predispositions to intussusception. Lethal outcomes were not registered.Conclusions. Thus, flow-through pneumatic insufflation is an effective and objective technique of non-surgical reduction of intestinal intussusception in infants. Non-surgical reduction of intestinal intussusception can be performed in the majority of patients without the signs of peritonitis. The duration of the condition, age of patients and the presence of recurrence should not be considered as absolute criteria in choosing treatment tactics in intestinal intussusception.

Experience of Diagnosis and Treatment of Intussusception in Children

The objective of the research was to establish the causes of complications of intestinal intussusception in children as well as to determine the optimal diagnostic and treatment strategy.Materials and methods. The analysis of medical records and examinations of 100 children with intestinal intussusception at the age of 1 month to 17 years who were treated at the clinic of pediatric surgery of the Ivano-Frankivsk National Medical University was made. Ileocecal intussusception was diagnosed in 77 children; 13 patients had small intestinal intussusception; there were no patients with colonic intussusception; in 10 patients the localization of intussusception was not established. Treatment of intestinal intussusception was performed urgently immediately after the diagnosis. High priority was given to conservative treatment (74 patients); it was effective in 64 (86.5%) patients. The remaining 36 patients underwent surgery, 9 (25%) of them underwent a laparoscopic disinvagination. In 27 cases open surgery – disinvagination – was used.Results and discussion. The typical age (4-12 months) was observed in 50% of patients only, however, 38% of patients were over 1 year of age, and 20% of children were older than 3 years. All children with intestinal intussusception recovered. The complications of intestinal intussusception were observed in 7 patients, most of them were admitted to the clinic 24 hours after the onset of the disease. Re-laparotomy was used in three cases; two patients underwent elective (programmed re-laparotomy) and one patient underwent urgent re-laparotomy due to the presence of signs of peritonitis. Recurrent intussusception was observed in 5 patients; 4 patients developed this condition after conservative disinvagination, one child - after surgery.Conclusions. The complications of intussusception in children are usually associated with untimely diagnosis and treatment.Diagnostic laparoscopy is a highly informative method of diagnosis in the absence of typical symptoms of intussusception being also an effective minimally invasive treatment.When selecting the method of intussusception treatment you should be guided by the duration of rectal bleeding and Doppler data being the most important criteria for determining the degree of the impairment of hemomicrocirculation in the invaginated intestine.Conservative disinvagination is the priority method of treating intussusception.

Value of high-frequency ultrasoundvsbarium meal in diagnosis of intestinal intussusception in children

Value of high-frequency ultrasound<i>vs</i>barium meal in diagnosis of intestinal intussusception in children

Lymphome de Burkitt révélé par une invagination intestinale aiguë chez l’enfant

Study aim: Burkitt’s lymphomas are arely revealed by acute intestinal intussusception in children. The study aim was to report eight cases. Patients and methods: Between 1988 and 1999, eight children, seven boys and one girl (mean age: 6 years) were hospitalized for an acute abdominal syndrome. Abdominal ultrasonography showed intestinal intussusception ( n=8) primitive tumor ( n=2), mesentivic lymph nodes ( n=2) and liver nodes ( n=1). Enema ( n=6) confirmed presence and irreductibility of the intestinal intussusception. A laparotomy was performed on emergency in seven patients and found the primitive tumor in 6. The procedure consisted in desinvagination ( n=4) and intestinal resection for ischaemia ( n=2). One patient was not operated on and the diagnosis was performed through ultrasonography guided tumoral puncture. Results: According to the Murphy classification, there were 2 stage II, 3 stage III and 3 stage IV patients. With LMB protocol chemotherapy, a complete remission was observed following the first cure. All the children were alive at the time of this study with a follow-up longer than one year after the complete remission. Conclusion: Abdominal sonography is the most efficient examination for the diagnosis of intestinal intussusception and sometimes of the primitive lesion. In the absence of sonographic intestinal impair, thanks to ultrasonography guided tumoral puncture, diagnosis may be made and chemotherapy started. If the lymphoma is not visualized with ultrasonography, an emergency laparotomy is necessary for the diagnosis of the lymphoma and the intestinal resection in case of necessity. Burkitt’s lymphoma is very sensible to chemotherapy.

Enfrentamiento médico quirúrgico de la invaginación intestinal: Experiencia de una institución universitaria

Management of intestinal intussusception in children has evolved from exclusively surgical treatments to nonoperative reduction under fluoroscopic monitoring. To report a 10 year experience in a University Hospital in the management of intestinal intussusception. Seventy two patients, aged 2 to 72 months of age, with an uncomplicated intussusception, that were treated by barium or air enema, were studied. The success rate was 73% with barium reductions, and 100% with air reductions. In 17 patients (24%), enema reduction was unsuccessful and were subjected to a surgical reduction. Nonsurgical reduction is safe and effective as the initial treatment of uncomplicated intussusception in children.

Combination of different types of intestinal intussusception trauma in children

The issues of diagnosis and treatment of intestinal intussusception in children are still one of the most urgent in pediatric surgery. Often, intestinal intussusception is combined with various types of injuries.

Intussusception in children: reliability of US in diagnosis--a prospective study.

To assess the diagnostic value of ultrasound (US) in clinically suspected acute intestinal intussusception in children, the authors prospectively compared US and enema studies in 83 episodes. None of the cases negative at US proved to be intussusception at enema study (negative predictive value = 100%). The sensitivity of US was 100%, and the specificity was 88%. Most of the sonograms were initially obtained and examined by residents. Several unsuspected abnormalities were also found with US. The authors conclude that a few months of training in US appears to be sufficient for high-accuracy investigation of clinically suspected intussusception, enabling selection of those patients in need of an enema.

A CT sign: The “disappearing mass” as a clue to the diagnosis of intermittent intestinal intussusception in children

During the course of evaluation of a child with recurrent abdominal pain, a mass lesion was noted on computed tomography of the abdomen. This mass lesion was not evident within 30 min of the finding. Child was subsequently diagnosed to have intussusception. A “disappearing mass” lesion may therefore be a manifestation of recurrent intussusception.

Errors in the diagnosis and treatment of intestinal intussusception in children

The analysis of errors in the diagnosis and treatment of 49 children with intestinal intussusception is carried out according to the case histories. The most common causes of diagnostic errors are incorrect assessment of bloody discharge from the rectum, insufficiently careful examination of the patient, poor use of additional research methods, neglect of preoperative preparation in a serious condition of the child, inappropriate choice of anesthesia method and improper postoperative management of patients.