Intestinal Obstruction In Infants Research Articles

Predictive Factors for Bowel Resection in Childhood Intussusception.

Intestinal intussusception is the most common cause of intestinal obstruction in infants and children under 3 years of age. Any delay in diagnosis or management can lead to intestinal ischaemia and perforation. The aim of this study is to determine the sociodemographic and clinical risk factors associated with bowel resection in infants and children with intussusception. This is a retrospective analytical study of 118 patients operated at the Hassan II Hospital and University of Fez between 1 January 2008 and 1 January 2018. A comparison of risk factors between patients with and without bowel resection was performed using multivariate logistic regression. One hundred and eighteen patients met the inclusion criteria. Of these, 44% had undergone bowel resection. Age >2 years (P = 0.006), duration of symptoms progression of more than 2 days (P = 0.002), bilious vomiting (P = 0.04) and palpation of an abdominal mass (P = 0.01) were significantly associated with bowel resection. Multivariate logistic regression showed that age <2 years (odds ratio [OR] =4.47 95% confidence interval [CI]: 1.12-17.78) and duration of symptom progression of more than 2 days (OR = 2.62 95% CI: 1.12-6.11) were independent risk factors for bowel resection. Intussusception that occurs in child old than 2 years of age, or which has progressed for more than 2 days, is associated with an increased risk of intestinal resection.

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.

Chylolymphatic cyst as a rare cause of acute intestinal obstruction in infants

BackgroundChylolymphatic cysts are benign pathology in lymphatic vessels due to obstruction in the lymphatic system. Their incidence is still unknown. However, they account for approximately 3 to 9% of all pediatric lymphangiomas. Most of these lesions are asymptomatic and are discovered accidentally. They can be presented with nonspecific abdominal pain, vomiting, and changes in bowel habits. Rarely, chylolymphatic cysts can as intestinal obstruction, volvulus or even torsion.Case presentationA 3-month-old male presented to our unit with manifestations of acute intestinal obstruction. Abdominal examination revealed signs of generalized peritonitis and intestinal obstruction. Abdominal ultrasound revealed minimal turbid intraperitoneal collections and no motility of bowel loops. Plain erect abdominal radiograph revealed multiple small bowel air fluid levels. Abdominal exploration revealed a large chylolymphatic cyst causing acute intestinal obstruction. Excision of the cysts was done with preservation of adjacent bowel loop. The patient was discharged in good health on the 6th day postoperative. A chylolymphatic cyst with a diameter of 5 cm was identified by histological investigation.ConclusionsMost chylolymphatic cysts in infants are asymptomatic, but they can cause fatal complications such as intestinal obstruction, volvulus, or even torsion.

Management of intussusception in children: A comparative study of hydrostatic reduction with saline under ultrasound guidance versus laparoscopic assistance.

Intussusception is a common cause of intestinal obstruction in infants and children. Ultrasound-guided hydrostatic reduction (USGHR) with saline is considered the gold standard with a success rate of more than 90%. Hydrostatic reduction with laparoscopic assistance has its own advantage of direct visualisation, assessment of bowel vascularity and controlled distension. The choice of procedure depends on available resources and surgeon's preference. This study aims to compare the outcomes of the two methods, i.e., laparoscopic-assisted hydrostatic reduction (LAHR) and USGHR under general anaesthesia (GA). This was a prospective study carried out at two different centres over a 3-year period. All patients of intussusception were managed by either hydrostatic reduction with saline under ultrasound guidance or hydrostatic reduction with laparoscopic assistance. Both the procedures were done in operation theatre under GA. The operating time and amount of fluid used for reduction were noted. There were 27 patients in Group 1 (USGHR) and 20 patients in Group 2 (LAHR). The two groups were similar in terms of demographic parameters. The various outcomes such as number of attempts for reduction, fluid required for reduction, time to start oral feeds, complication and length of stay were similar in both the groups. The mean operating time for Group 1 was 19.4 ± 4.5 min and for Group 2 was 34.9 ± 4.8 min (P < 0.001). Both the procedures fare equally in terms of outcome except mean operating time, therefore, LAHR is a good alternative to USGHR in resource-poor nations where logistics of intraoperative ultrasound may not be present.

Pattern, presentation, and management of intussusception at Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria

Objectives: Intussusception is the most common cause of intestinal obstruction in infants. In developing countries, presentation is usually late with an attendant high mortality rate. Material and Methods: Records of children managed for intussusception at the Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Bauchi State from 2013 to 2017 were retrieved. Information including the sociodemographic data, the pattern of presentation, treatment, and treatment outcomes were obtained and analyzed using tables. Results: There were 22 patients, 15 (62%) of whom were male (male-female ratio 2.1:1). Age at presentation ranged from 3 months to 14 years with a peak incidence at 7–8 months. The most common symptoms were vomiting (68%), abdominal pain (59%), and bloody stool (41%). Only 1 patient (4.5%) presented within 24 h of onset of symptoms while 13 (59%) presented after 72 h of onset of symptoms. All patients had open surgery, and ileocolic intussusception was the most common type. Ten patients (45.5%) had a manual reduction, while 12 (55.5%) had resection and anastomosis. Surgical site infection was ranked the highest post-operative complication; the mortality rate was 32%. Conclusion: Intussusception is a common cause of intestinal obstruction in infants and children in our environment; presentation is usually late. A high index of suspicion is necessary for early diagnosis and treatment to reduce the associated high mortality rate.

Management of Symptomatic Meckel's Diverticulum in Infants and Children

Objectives The primary objective of the present study was to review the demographics of infants and children operated upon for Meckel's diverticulum. The secondary objectives were to review the clinical characteristics, surgical procedures performed, postoperative complications, and the outcome. Materials and Methods This study is a single-institutional, retrospective study and descriptive in nature. It consisted of infants and children below 12 years who were operated upon for Meckel's diverticulum at the author's institute and included data from January 1, 2000 to December 31, 2020. Results Eighty-four children below 12 years were operated upon for Meckel's diverticulum during the study period. The ratio for males to females was 3:1. This study consisted of infants, (n = 22, 26.19%), children of 1 to 5 years of age (n =19, 22.61%), and children of 6 to 12 years of age (n = 43, 51.19%). Clinically, children with Meckel's diverticulum presented in the following order of frequency: (1) intestinal obstruction (n = 59, 70.23%), (2) perforation peritonitis (n = 17, 20.23%), (3) lower gastrointestinal bleeding (n = 4, 4.76%), and (4) incidental finding (n = 4, 4.76%). In 35 (41.66%) children, bowel gangrene was detected. One-fifth (n = 17) of Meckel's diverticulum was responsible for the secondary intussusception. The surgical procedures were performed in the following order of frequency: (1) resection of Meckel's diverticulum, an adjacent segment of ileum and ileoileal anastomosis (n = 36, 42.85%); (2) Meckel's diverticulectomy (n = 32, 38.09%); (3) resection of Meckel's diverticulum, an adjacent segment of ileum with or without cecum and an ileostomy (n = 12, 14.28%); and (4) resection of Meckel's diverticulum, an adjacent segment of ileum, cecum, part of the colon, and ileocolic anastomosis (n = 4, 4.76%). In 8 (9.52%) children, complications were documented during the postoperative period. The present study observed three (3.57%) deaths during the postoperative period. Conclusion Meckel's diverticulum was one of the common causes of acute intestinal obstruction in infants and older children. Ninety percent of children with Meckel's diverticulum presented with features of an acute abdomen. Forty percent of children evidenced bowel gangrene during the surgical procedures. In these children, early diagnosis, timely referral, and institution of surgical therapy for acute abdomen/intestinal obstruction may prevent the development of bowel gangrene and the requirement of bowel resections to some extent.

TP7.2.6 Frequency of Obstructed Inguinal Hernia in Infants

Abstract Inguinal hernia in children is the result of the failure of obliteration of processus vaginalis or weakness of the abdominal wall. The incidence of inguinal hernia ranges from 0.8-5%. It is more common in preterm babies with an incidence of up to 30%.There is disagreement concerning the management of inguinal hernia in infants worldwide with few in favor of early repair of the hernia due to fear of incarceration while some are against it. This study was conducted to determine the frequency of intestinal obstruction in infants with an inguinal hernia for the development of a proper protocol for the management of inguinal hernias. Methods A total of 112 patients were included in the study. The patient’s gender and age were recorded. The presence of hernia was confirmed clinically and by performing an ultrasound. All the relevant data was recorded in a pre-designed printed proforma. Results In this study, 112 children were included. 73% of children were in the age between 1-6 months and 27% children were in age between 7-12 months. The mean age was 5 months ±5.87. Male children were 86% and female children were 14%. An obstructed inguinal hernia was observed in 11% of children while 89% of children didn’t have obstructed inguinal hernia. Conclusion Our study concludes that the frequency of incarcerated inguinal hernia was 11% in infants mostly occurring at a younger age and in male children.

Surgical Management of Intussusception in Children: A Retrospective Review of 212 Cases

Objectives The primary objective of this study was to analyze and review the demographics of children operated upon for intussusception. Secondary objectives were to review the clinical characteristics, surgical procedures performed, postoperative complications, and outcome. Materials and Methods It is a single-institution, retrospective study and consists of children below the age of 12 years. This study was conducted at the author's department of pediatric surgery for the past 21 years, from January 1, 2000 to December 31, 2020. Results During the study period, 212 children were operated upon for intussusceptions and included 146 (68.86%) boys and 66 (31.13%) girls. This review consisted of infants 158 (74.52%), and children of 1 to 5 years of age (30; 14.15%), and 6 to 12 years of age (24; 11.32%). Clinically, 177 (83.49%) children presented with the features of acute intestinal obstruction, and the remaining 35 (16.5%) presented with features of perforation peritonitis. Primary (idiopathic) intussusception was documented in 188 (88.67%) of the cases. Gangrenous bowel was evident in 98 (46.22%) children. Sixty-two percent of the cases required bowel resection. Surgical procedures were executed in children for intussusception in the following order of frequency: (1) operative reduction with or without serosal tear/bowel perforation repair, n = 81 (38.2%); (2) resection of diseased ileum and ileoileal anastomosis, n = 52 (24.52%); (3) resection of diseased ileum ± part of colon and an ileostomy, n = 36 (16.98%); and (4) resection of diseased ileum, cecum, part of colon, and ileocolic (ileo-ascending or ileo-transverse) anastomosis, n = 43 (20.28%). Postoperatively, 9 (4.24%) children required reexploration for the management of their complications. Twenty-one (9.9%) children died during the postoperative period. Conclusion Intussusception remains the most common cause of acute intestinal obstruction in infants and young children. Delay in the referral, diagnosis, and seeking treatment were significantly associated with bowel gangrene, required bowel resection during the surgical therapy, and also culminated in significantly higher mortalities.

Profile of Children Treated for Uncomplicated Intussusception in a Tertiary Hospital in Enugu, Nigeria

Background: Intussusception is a common cause of intestinal obstruction in infants. The aim of study was to evaluate our experience in the management of children who presented with uncomplicated intussusception. Materials and Methods: This was a retrospective study of children (12 months and younger) who were treated for uncomplicated intussusception (ultrasound confirmed) between January 2014 and December 2018, at the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH) Enugu, Nigeria. Results: There were 255 cases of intussusception seen during the 5-year study period. Out of this number, 85 (33.3%) patients had uncomplicated intussusception. There was male predominance and the ages of the patients ranged from 4 to 12 months with a mean age of 6 months. Abdominal pain was the most common symptom in the patients. On the average, one-fifth of the patients had a preceding history of respiratory and enteral infection. Half of the patients had a hemoglobin level of less than 10g/dl at presentation. Abdominal ultrasound was the imaging modality of choice and was diagnostic in all the patients. Three-quarters of the patients were successfully treated by hydrostatic reduction and there was recurrence of intussusception in 2 patients. There was no mortality. Conclusion: Only one-third of our patients present with uncomplicated intussusception during the study period. Non-operative (hydrostatic reduction) treatment is an effective modality of treatment for uncomplicated intussusception.

Associations of Intussusception With Adenovirus, Rotavirus, and Other Pathogens: A Review of the Literature.

Intussusception is the leading cause of acute intestinal obstruction in infants. Intussusception is mostly idiopathic, but infectious pathogens are sometimes implicated. In addition, live oral rotavirus vaccines have been associated with intussusception. We searched the literature published between January 1, 1990, and March 16, 2020, to describe the association between intussusception among infants and young children and various pathogens, particularly adenovirus and wild rotavirus. We tallied the number of evaluations reporting a statistically significant positive association, no association and a protective association by pathogen, using any statistical method. We also calculated the median reported odds ratios (OR) of intussusception with adenovirus and rotavirus. We identified 3793 records on intussusception from the literature; 17 evaluations from 15 countries that evaluated 52 pathogens were included in the analysis. All 14 evaluations of adenovirus reported a statistically significant positive association with intussusception; the median OR from 9 evaluations was 3.7 (interquartile range, 3.3, 8.2). Nine of 12 evaluations assessing rotavirus found no statistically significant association, 1 found a positive association and 2 reported a protective effect; the median OR from 12 evaluations was 0.9 (interquartile range, 0.2, 1.8). No consistent relationship was observed between any other pathogens and intussusception. We documented a consistent association of intussusception with adenovirus, but no relationship between wild-type rotavirus and intussusception. Future research should focus on better understanding the mechanisms of intussusception with infectious pathogens, including following a rotavirus vaccination.

Pediatric Ileocolica Invagination: A Case Report

Invagination or intussusception is an inversion of intestinal segments into other intestinal segments which is the most common cause of intestinal obstruction in infants and children. Early diagnosis and therapy can cause intestinal ischemia, perforation, and peritonitis which can be fatal. Trias classic symptoms consist of abdominal pain, vomiting, and blood in the stool. Invagination often occurs in children under 2 years old, with the highest incidence in children aged 4 - 9 months. The most common cause of invagination is idiopathic. Reportedly a boy, 10 months with a history of mucus with blood, vomiting, flatulence, history of colds cough. Physical examination reveals that the child is aware and active. The abdomen appears distended, palpable mass such as sausages, and intestinal hyperperistaltic. In the rectal toucher, there is mucus and blood on the handscoon. Investigations found anemia and leukocytosis. Stool examination showed blood, erythrocytes 4-6 LPB and leukocytes 8-10 LPB. Radiological examination of the abdomen appears to dilate the intestine (colon) with a coffee bean sign, the impression is in accordance with the picture of invagination. Abdominal ultrasound impression according to the picture of invagination (colo-colica). The patient was diagnosed as ileocolica intussusception and acute diarrhea without dehydration.

Pediatric Ileocolica Invagination: A Case Report

Invagination or intussusception is an inversion of intestinal segments into other intestinal segments which is the most common cause of intestinal obstruction in infants and children. Early diagnosis and therapy can cause intestinal ischemia, perforation, and peritonitis which can be fatal. Trias classic symptoms consist of abdominal pain, vomiting, and blood in the stool. Invagination often occurs in children under 2 years old, with the highest incidence in children aged 4 - 9 months. The most common cause of invagination is idiopathic. Reportedly a boy, 10 months with a history of mucus with blood, vomiting, flatulence, history of colds cough. Physical examination reveals that the child is aware and active. The abdomen appears distended, palpable mass such as sausages, and intestinal hyperperistaltic. In the rectal toucher, there is mucus and blood on the handscoon. Investigations found anemia and leukocytosis. Stool examination showed blood, erythrocytes 4-6 LPB and leukocytes 8-10 LPB. Radiological examination of the abdomen appears to dilate the intestine (colon) with a coffee bean sign, the impression is in accordance with the picture of invagination. Abdominal ultrasound impression according to the picture of invagination (colo-colica). The patient was diagnosed as ileocolica intussusception and acute diarrhea without dehydration.

Ileal duplication cyst: a rare cause of intestinal obstruction in infants

Ileal duplication cyst (IDC) is a rare congenital anomaly where there is an abnormal portion of intestine attached to or intrinsic with the normal bowel. A 6-month-old male child presented with obstipation and bilious vomiting at emergency. X-ray abdomen showed multiple air fluid level suggestive of intestinal obstruction. Laparotomy was performed. Diagnosis of IDC was made and resection with primary anastomosis was done. Post-operative period was uneventful, and patient did well during 3 month follow-up checkup. IDC is a rare cause of intestinal obstruction which can present with different clinical symptoms posing a diagnostic dilemma. Diagnostic laparotomy is a suitable approach for both diagnosis and treatment to avoid delays in treatment where imaging method is unavailable for exact diagnosis.

Trans-anal protrusion of intussusception

Abstract Intussusception is a common cause of intestinal obstruction in infants and toddlers. Uncommon presentation with a mass protruding from the anus is often misdiagnosed as rectal prolapse when a high index of suspicion is not maintained, with the likelihood of worse outcomes. We report the successful management of an 8 month old infant with prolapsed ileo-colic intussusception at the Moi Teaching and Referral Hospital (MTRH) which had been mistaken for rectal prolapse. We discuss how to differentiate trans-anal protrusion of intussusception (TAPI) from other prolapsing conditions and highlight the common challenges encountered in managing an infant with delayed presentation.

Duplication cyst of the cecum; a rare cause of intestinal obstruction in infants

Duplication cyst of the cecum; a rare cause of intestinal obstruction in infants

Intussusception: A 14-year experience at a UK tertiary referral centre

AimsIntussusception is the most common cause of acute intestinal obstruction in infants. First line management in uncomplicated cases at our centre is fluoroscopy guided air enema reduction. This study reports a 14 year UK single centre experience highlighting management and outcomes of intussusception in children. MethodsAll cases of intussusception (ICD 10-code K56.1) at a single tertiary referral centre from 2004 to 2017 were analyzed. Data evaluated included patient demographics, clinical presentation, treatment modality(s), complications and outcome(s). ResultsTwo hundred ninety confirmed cases (69% male) of intussusception were identified during the study period. The median age at presentation was 9.5 months (range 4 days–15 years). One hundred eighty-six (64%) cases occurred in children who were transferred to Alder Hey from peripheral district hospitals. One hundred ninety-six cases (68%) proceeded directly to air enema reduction and successful reduction was achieved in 129 cases (66%). A single case (0.5%) of attempted air enema reduction was complicated by perforation. Early recurrence rate following air enema reduction was 9%. Operative management was indicated in 140 (48%) cases of which 66 required bowel resection (47%). There were no deaths. ConclusionsWe highlight one of the largest single centre UK studies defining practice outcomes for intussusception across the British Isles. Our centre has achieved a 66% success rate of non-operative reduction over 14 years in line with the British Society Pediatric Radiology (BSPR) recommendations and within 5% of the national median metric (71%). Moreover these outcomes were achieved with a very low complication rate (0.5%) from air enema reduction and no mortality in the series. Type of studyRetrospective study. Level of evidenceIII

Evaluation of Intussusceptions in Under - Five Children in Aba Nigeria

Background: Intussusception remains a common cause of intestinal obstruction in infants and children. The operative treatment remains the main stay of treatment due to late presentation, long referral chain, paucity of knowledge about the disease condition by midwife and doctors. This study is intended to ascertain the pattern of presentation, management and outcome. Method: This is a prospective study of 48 children that was managed for intussusceptions at the Abia State University Teaching Hospital from November 2016 t0 November 2018. Structured proforma was opened for demography, clinical presentation, investigation, treatment modalities and outcome. Data was analysed using SPSS version 17 for proportions and percentages. Results: There were 24 boys and 24 girls aged 3 months to 13 months with a mean of 8months. The median duration of symptoms onset and presentation was 4 days {1 day to 14days}. Thirty-six patients {75%} presented after 48hours of onset of symptoms. A classic triad {bilious vomiting, bloody mucoid stool and abdominal mass} was present in over 40 patients {83%}. Ten patients did not pass bloody mucoid stool. Thirty patients {62.5%} had predisposing factors which included gastroenteritis and/or respiratory tract infection. 8 patients had hydrostatic saline reduction under ultrasound with success in six patients. Forty-two patients were operated {40 patients primarily and 2 patients following failed hydrostatic reduction}. Twenty-eight patients had resection and anatomises of ileocolic segment due to gangrenous bowel. Fourteen patients had manual reduction of intussuception with healthy bowel. Mortality was 8.3% {4 patients} from overwhelming sepsis and respiratory distress. Twenty patients had surgical site infection and 4 patients had incisional hernias. Conclusion: Late presentation was high in this series, however, emphasis on health education of mothers during antenatal visit that passage bloody mucoid stool by their child needs evaluation by a paediatrician will reduce late presentation morbidity and mortality in our patients.

Cecal duplication cyst associated with a malfixed right colon presenting as an abdominal mouse in an infant causing a diagnostic dilemma

Duplication cysts (DCs) of the cecum are extremely rare anomalies. A DC causing luminal obstruction and presenting as a recurrent intestinal obstruction in infants is quite a rare occurrence. They usually present with a palpable lump, but when associated with malrotation, can result in a diagnostic dilemma. We report a rare case of a cecal DC associated with a malfixed right colon presenting with a wandering intra-abdominal lump and recurrent intestinal obstruction, resulting in a diagnostic dilemma in an infant. Keywords: abdominal mouse, Cecal duplication cyst, malrotation, Renu’s sign

Neonatal Intussusception: A Review

Intussusception is defined as a process in which a segment of bowel invaginates into the adjoining intestinal lumen, causing bowel obstruction. It is the most common cause of intestinal obstruction in infants and children between 6 months to 18 months of age. In neonates and premature infants, it accounts for only 3% of intestinal obstruction and 0.3% (0–2.7%) of all cases of intussusception Since neonatal intussusception is an uncommon entity, we conducted this review to examine its occurrence, clinical features, diagnostic modalities, and treatment options.

Incidence of acute intussusception among infants in eastern France: results of the EPIstudy trial.

The incidence rate of intussusception in the eastern part of France is comparable to that of other European countries. There was a significant trend towards a decrease in the incidence of intussusception. What is known • Intussusception is the most frequent causes of intestinal obstruction in infants and young children. Overall incidence of intussusception in infants aged <1year varies widely around the world. No specific epidemiological studies have not been conducted in France on intussusception. What is new: • This prospective and multicenter study provides important information about the epidemiology of intussusception in infants in France over a period of 4years.