Cases Of Intussusception In Children Research Articles

Exploring the feasibility of integration of surveillance for intussusception into the routine monitoring of adverse events following immunization by countries of the WHO African Region for Africa.

Surveillance for intussusception (IS) post-rotavirus vaccine introduction in World Health Organization Africa Region (WHO/AFRO) has been restricted mainly to the large referral teaching hospitals. The choice of these facilities for surveillance was made to utilize the abundant expertise of specialists in paediatrics and surgery in these hospitals who can diagnose and manage such patients with IS. The surveillance has been well coordinated by the African Intussusception Surveillance Network established in 2012. This network has supported surveillance across the African region and has accumulated a huge database of IS cases in children < 1 year with findings that have demonstrated safety of the monovalent rotavirus vaccine, Rotarix (GlaxoSmithKline). However, safety data on the pentavalent and RotaTeq (Merck Vaccine) is not yet available from the African region. Although, this network has provided much needed data, there is an inherent bias in monitoring and reporting of IS cases in only large tertiary hospitals. This time limited special project does not capture suspected intussusception cases with no access to hospital facilities used for monitoring IS. Additionally, the design requires extensive resources to support collection of high-quality data for monitoring IS, which is unsustainable. For these reasons suitable linkages between IS monitoring and routine Adverse Event Following Immunization (AEFI) should be established for continuity of monitoring of this condition. We propose alignment of the two systems that offers opportunity for high profile recognition and to enhance a sustainable system for diagnosis, treatment and continuous assessment of intussusception occurring in infancy.

Colocolic intussusception in a child due to a sigmoid polyp

Intussusception cases in children are mostly ileocolic, whereas, the colocolic variety is uncommon and few cases have been reported in literature. Together with intestinal malrotation, ileocolic intussusception is frequently the cause of an intestinal obstruction in children and rarely due to a lead point. In children, if present, the lead point is located in the ileum and is related to o lymphoma o lymphangioma or rarely to ectopic mucosa. We describe the case of o 8-year child with colocolic intussusception (CCI) and rectal bleeding due to a voluminous sigmoid polyp. The intussusception was reduced two times in 36h and then the polyp was resected by colonoscopy.

Intussusception in children: lessons learned from intestinal lymphoma as a rare lead-point.

Most cases of intussusception in children are idiopathic. Rarely, a malignant disease such as intestinal lymphoma may cause intussusception. Due to dramatic changes of expected outcome with chemotherapy regime alone, the surgical management of patients with intestinal lymphoma presenting with intussusception has to be reevaluated. Retrospective chart review from May 2011 to February 2017. We included all patients with intestinal lymphoma presenting with intussusception. We found five patients with a mean age of 6.4years (range 3-16). The most common presenting symptom was abdominal pain for several weeks which had acutely worsened. In all but one patient an ultrasound before pneumatic or hydrostatic reduction showed a finding suspicious of a pathological lead-point. Pneumatic or hydrostatic reduction was attempted in all patients, no complications were noted. In one patient reduction was not successful. Recurrence after reduction occurred in two patients. Two patients needed surgery, three had a percutaneous ultrasound-guided biopsy for diagnostic purposes. All patients had aggressive mature B cell non-Hodgkin lymphoma. A high index of suspicion for the presence of a pathological lead-point in children older than 4years and children with recurrent intussusception is necessary in patients presenting with intussusception. Malignant, highly aggressive B cell non-Hodgkin lymphoma, although rare, must actively be searched for. Pneumatic or hydrostatic reduction should remain the first line treatment in most cases.

Potential of colonoscopy as a treatment for intussusception in children.

Background and study aims Invagination, which can occur in any part of the intestine, usually affects children and is the second most common cause of intestinal obstruction after pyloric stenosis. The cause of these intussusceptions in children is usually unknown and they typically occur within the ileocolic region. Management of pediatric patients with the condition often consists of surgical intervention. However, this retrospective study from the University Hospital of the University of São Paulo, Brazil, reports a series of cases of intussusception in children in whom a colonoscopy was used to reverse the intussusception. Patients and methods From April 2010 to January 2015, 30 pediatric patients underwent a colonoscopy as an noninvasive method for treatment of children’s intestinal intussusception. Results Overall, treatment with colonoscopy was successful in reversing invagination in 66.7 % of the patients. However, 33.3 % of patients required surgery to resolve the intussusception. Conclusion Noninvasive colonoscopy is a potential treatment for intussusception in children.

Colocolic Intussusception in a Child with Pathologic Lead Point Along with Intestinal Malrotation-A Rare Case Report and Brief Review

Intestinal obstruction in children is frequently caused by intussusception and intestinal malrotation and when these two conditions co-exist, it is called Waugh's syndrome. Intussusception cases in children are mostly ileocolic, whereas, the colocolic variety is a rare entity and very few cases have been reported in literature. In all the reported cases of Waugh's syndrome, the intussusceptions were ileocolic type except one case, where colocolic type was mentioned with lymphangoima as Pathological Lead Point (PLP). We report a seven-year-old child of colocolic intussusception with juvenile polyp being the PLP along with intestional malrotation. It is an extremely rare association which has not been reported previously.

Intussusception in southern India: Comparison of retrospective analysis and active surveillance

Surveillance for intussusception is a post marketing requirement for rotavirus vaccines following observation of a small increased risk of intussusception after rotavirus vaccination in some global settings. This study presents the clinical presentation and outcomes of children who presented with intussusception at a large tertiary care facility directly (non-surveillance) as retrospective analysis of a period where rotavirus vaccine was not in routine use, or as part of active surveillance in a phase III oral rotavirus vaccine trial.Hospital records of children under 2 years of age treated for intussusception between 1 January 2010 and 31 August 2013 at the Christian Medical College Hospital, Vellore, India, were reviewed. Sixty-one cases of intussusception in children under two years of age presented at the hospital. An additional 16 cases of ultrasound diagnosed intussusception were identified through the active surveillance of a cohort of 1500 children participating in a rotavirus phase III trial in the same period.In the nonsurveillance group, median age at presentation was 214 days (IQR 153–321) with 52 events (85.3%) occurring in the first year of life. Cases were seen year-round with no definitive evidence of seasonality. Thirty-one (50.8%) intussusceptions required surgical reduction, 26 (42.6%) had pneumatic reduction and 2 (3.3%) barium enema reduction. Two intussusceptions (3.3%) resolved spontaneously. There were no deaths, all children were discharged after recovery.Active surveillance identified 16 children with a median age at event of 375 days (IQR 248–574). Nine (56%) children had small bowel or transient intussusception that resolved spontaneously. Seven intussusceptions were reduced radiologically; none required surgery.In summary, there were significant differences between presentation and outcomes in cases of intussusception identified by passive and active surveillance, likely related to enhanced and early detection of intussusception through active monitoring in the trial. The WHO recommendation of sentinel hospital based surveillance for post-marketing surveillance after rotavirus vaccine introduction is likely to a better approach than active surveillance.

Retrospective surveillance for intussusception in children aged less than five years at two tertiary care centers in India

BackgroundA rotavirus vaccine could soon become part of India's national immunization program. However the occurrence of intussusception due to rotavirus vaccine is a potential safety concern. This surveillance aimed at the collection of baseline data on childhood intussusception which would facilitate the monitoring of intussusception cases after the introduction of rotavirus vaccines. MethodsWe retrospectively reviewed medical records of confirmed intussusception cases in children under the age of five, treated during 2007–2012 at two tertiary care hospitals attached to medical schools in India. Demographic, clinical, diagnostic and treatment practices data were obtained from hospital records. ResultsOver a five to six year observation period, we identified 187 confirmed cases of intussusception, of which 75% were males. The median age of intussusception was 8 months, and we observed a possible trend in the distribution of cases with the highest number of cases being reported in the month of April and lowest in the month of October. The most common diagnostic methods used were ultrasonography and abdominal radiography with most cases being treated surgically (71%). The median length of hospital stay was 8 days (range 1–40) and mean was 10.2 days. Records of any fatality due to intussusception were not found during the review of the records. ConclusionsThis analysis provides an estimate of the baseline data of childhood intussusception prior to the introduction of the rotavirus vaccination as a part of routine immunization in India. A prospective surveillance system using a standardized case definition is needed in order to better examine the incidence of intussusception in developing countries.

Left sided colo-colic intussusception in a child with acute lymphoblastic leukemia: A case report and systematic review of the literature

Abstract Intussusception in children with acute lymphoblastic leukemia (ALL) is uncommon. Colo-colic intussusception is a very rare entity in children and when it does occur, a lead point is most often identified. We present the first reported case of a left-sided colo-colic intussusception without a lead point in a child with ALL. In addition a comprehensive systematic review of the literature is presented. This was carried out using MeSH terms and free text. This includes both intussusception in ALL as well as colo-colic intussusceptions in children. All major databases including EMBASE, PubMed and Medline ® were accessed. Seven relevant articles outlining 9 cases of intussusception in children with ALL were obtained ranging from 1930 to 2005. Ages ranged from 7 months to 9 years. Four cases of colo-colic intussusception in children without an obvious lead point have been described in the literature. Details are presented in this report. Awareness of the association between ALL and intussusception is important to prevent complications related to delayed diagnosis.

Childhood intussusception in Uzbekistan: analysis of retrospective surveillance data.

BackgroundEstimates of baseline incidence of childhood intussusception could help safety monitoring after the introduction of rotavirus vaccines. We studied the incidence of intussusception in Uzbekistan, a GAVI-fund eligible state in Central Asia.MethodsWe retrospectively reviewed intussusception cases in children <2 years of age treated during 2004-2008 at 15 hospitals in the Bukhara region of Uzbekistan. Demographic and clinical data as well as information on diagnostic and treatment practices were obtained from hospital records. We categorized cases using the Brighton collaboration clinical case definition and calculated the national incidence rate.ResultsOver a 5-year study period, 67 confirmed cases were identified, of which 67% were boys. The median age was 12 months, and no seasonal trend in the distribution of cases was observed. The diagnostic methods used included abdominal radiography (87%) and ultrasonography (57%). Intussusception reduction by air enema was successful in 33 (49%) patients and 34 (50%) cases underwent surgery. A total of 4 deaths occurred, including 3 deaths in infants aged 0-6 months. The median length of hospital stay was 7.3 (range 0-37) days. The incidence of intussusception is estimated at 23 (95% CI 13.6-32.4) cases per 100,000 child-years, corresponding to approximately 237 cases annually.ConclusionsThis is the first study to estimate the incidence of childhood intussusception prior to the introduction of the rotavirus vaccination in Uzbekistan. A prospective surveillance system using a standardized case definition is needed in order to better examine the occurrence of intussusception in developing countries.

Intussusception in children 5-15 years of age.

Twenty cases of intussusception in children between the ages of 5 and 15 years were compared with intussusception in infancy and early childhood. They accounted for 18.5 per cent of all 108 children treated for intussusception in two large hospitals from 1964 to 1984. Diagnosis of intussusception was delayed, probably due to an unusual presentation. Fifty-five per cent had a definite predisposing factor precipitating the intussusception and 45 per cent had a small bowel intussusception, which warranted early surgical intervention. In the absence of contraindications no child should be disqualified from an attempt at hydrostatic reduction. After hydrostatic reduction careful follow-up is required to exclude an organic lesion, possibly by a small bowel follow-through meal. Surgery is indicated after hydrostatic reduction in case of chronically recurrent abdominal complaints.

Lack of association between intussusception and oral polio vaccine in Cuban children.

Two exploratory investigations found an increased risk of intussusception after oral polio vaccine (OPV). A large, national, population-based study was undertaken in Cuba to investigate a possible association. Three hundred and thirty-five cases of intussusception in children under 2 years of age occurring in 1995-2000 were identified and their OPV records retrieved. The relative incidence (RI) of intussusception in defined periods up to 42 days after OPV in children under 1 year was estimated using the self-controlled case series method, controlling for age and season. The RI was not significantly raised in any of the time intervals examined within the 0-42 day period after OPV. For the period 0-42 days as a whole the RI was 1.11, 95% CI 0.74-1.67. This study does not support the hypothesis that OPV causes intussusception.

Ultrasound of Intussusception with Lead Points

Ultrasonography of 4 cases of intussusception in children with proven lead points were reviewed retrospectively. The lead points were due to lymphosarcoma, inverted Meckel's diverticulum, jejunal polyps and an inverted appendiceal stump. The lead points form a complex mass in the centre of the intussusception in both transverse and longitudinal sections, distinct from primary intussusception. The presence of such ultrasonographic findings are suggestive of secondary intussusception with a lead point and surgical reduction rather than hydrostatic reduction should be considered.

Intussusception in older children.

In a retrospective series of 37 cases of intussusception in children over 2 years of age, it was found that a subacute or chronic presentation was more common than in infancy, that few of them had rectal bleeding, and only a minority had a palpable intussusception. Diagnosis was often difficult but was helped by plain abdominal x-rays. Although the majority of children underwent surgery, with a 22% incidence of lead points, it is concluded that attempted hydrostatic reduction in these older children is not contraindicated, provided x-rays do not show small bowel obstruction.

Pediatric tropical intussusception in Haiti.

Thirty cases of intussusception in children from the Hôpital Albert Schweitzer (HAS) in Deschapelles, Haiti, were compared with 35 cases from Yale-New Haven Hospital (YNHH) during a similar period. Most epidemiologic factors were similar. The principal difference was later appearance and diagnosis at HAS. The overall survival rate for this disease at HAS was 53%, while 100% of patients at YNHH survived. Careful preoperative management with fluids, electrolytes, and antibiotics, combined with the more routine use of the Mikulicz procedure, should help to reduce the high mortality that accompanies pediatric intussusception in Haiti.

Intussusception in Children

In 50 cases of intussusception in children, treatment was by barium enema reduction in 10 and operation in 40. There was one death in each group. Intestinal resection was required in 17 patients treated by operation.Causes of gastrointestinal bleeding in children are briefly reviewed.

Intussusception — A Radiological Study

The value of radiological investigation in intussusception is insufficiently appreciated by clinicians in this country. This paper is written in the hope that radiologists may be stimulated to prove to their colleagues that radiology has a distinct role in the diagnosis of intussusception and, in certain cases, also has a therapeutic value. The writer has, from time to time, shown case illustrations of intussusception at the Medical Meetings of the British Institute of Radiology, and it has been obvious from the interest shown that few radiologists in this country are requested to assist in the diagnosis or treatment of intussusception. The writer has now made personal observation of fifteen cases of intussusception in children and adults since 1933. As no important paper on the radiological aspects of intussusception has yet appeared in the British literature, this review is offered. It is intended to give a brief account of the pathology and clinical features of intussusception: this will be followed by...