Intussusception In Older Children Research Articles

Intussusception in Older Children: A Single Center Experience

Background: Intussusception in older children may be less common than intussusception in infants. However, it is a significant cause of bowel obstruction across all age groups. The aim of this study was to evaluate our experience with regards to older children (5 years and above) who were managed for intussusception in a single tertiary center in a developing country. Materials and Methods: This was a retrospective study of children, aged 5 year and above, who presented with intussusception (ultrasound confirmed) over a 5-year period at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. The information analyzed included the patients’ age (in years), gender, time interval between onset of symptoms and presentation to the hospital, presenting symptoms, operative procedure performed, complications of treatment and outcome of treatment. Results: A total of 378 cases of childhood intussusception were seen during the study period. Out of this number, 18 (4.8%) patients were older than 5 years of age. There was male predominance. Abdominal pain was the most common and consistent symptom in all the patients and majority of the patients had bowel resection (right hemicolectomy with ileotransverse anastomosis). One-fifth of the patient had pathologic lead point (PLP) Wound infection was the most common post-operative complication and one patient expired due to overwhelming sepsis. Conclusion: Although intussusception is more common in infants; it’s occurrence in older children is not uncommon and may be associated with PLP. Non-operative treatment is often ineffective and operative treatment is always required.

A Clinical Analysis of 10 Cases of Intussusception in Older Children

A Clinical Analysis of 10 Cases of Intussusception in Older Children

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.

Chronic ileocolic intussusception due to transmural infiltration of diffuse large B cell lymphoma in a 14-year-old boy: a case report.

Chronic intussusception, defined as intussusception continuing over 14 days, is rare in children. We herein report a case of chronic ileocolic intussusception caused by the transmural infiltration of diffuse large B cell lymphoma in a 14-year-old boy. The patient had been suffering from anorexia and intermittent abdominal pain for 5 weeks, during which his body weight decreased by around 7 kg. Upon admission to our hospital, ultrasonography and enhanced computed tomography (CT) of the abdomen showed ileocolic intussusception. A retrospective examination of abdominal CT led us to suspect that the intussusception had initially appeared 5 weeks before admission, presumably coinciding with the beginning of the patient’s abdominal symptoms. Since hydrostatic reduction was unsuccessful, laparotomy was performed, which showed unreducible ileocolic intussusception with a marked edematous ileum and mesentery. Ileocecal resection without lymph node dissection was carried out, and a histological examination of the resected specimen revealed the transmural infiltration of diffuse large B-cell lymphoma of the terminal ileum. The patient’s postoperative course was uneventful, and adjuvant chemotherapy was administered. This case illustrates the diagnostic challenges of confirming ‘chronic’ intussusception in older children.

Pathologic leadpoint is uncommon in ileo-colic intussusception regardless of age

PurposeHistorically, the rate of pathologic leadpoints in older children with intussusception is quoted as 20%–25%. Our anecdotal experience suggested a lower rate. We therefore compiled a case series to examine the actual incidence of pathologic leadpoint, and treatment success, by age. MethodsA retrospective review was performed of all patients admitted with intussusception between 1998 and 2012 and tested for differences in anatomic location, presence of pathologic leadpoint, and need for operative intervention, on the basis of age. ResultsIn total, 154 cases of intussusception were diagnosed in 141 patients (136 ileo-colic), 38 of which were in children older than 3 (29 ileo-colic). Considering all anatomic locations, older children were more likely to have a pathologic leadpoint (p-value 0.01); however subgroup analysis of ileo-colic intussusception demonstrated no difference (p-value 0.38). Additionally, there was no difference in the success of pneumatic or barium enema reduction on the basis of age (p-value 0.56). ConclusionDespite historical reports of increased pathologic leadpoints in ileo-colic intussusception in older children, in this series the majority were idiopathic. Non-operative management was successful approximately 75% of the time, irrespective of age. In older age groups, there was an increased frequency of pathologic leadpoints in small bowel-small bowel intussusception.

Surgical approach to intussusception in older children: Influence of lead points

BackgroundThe likelihood of a lead point as the cause of ileocolic intussusception increases as children get older. This study looks at whether a different management strategy should be employed in older patients. Methods7year multi-institutional retrospective study of intussusception in patients aged <12years. ResultsIleocolic intussusception with complete data was found in 153 patients: 109 0–2years, 34 3–5years, and 10 6–12years, respectively. Bloody stools occurred in 42/143 of 0–5years and 0/10 of 6–12years, p<0.001. Combined hydrostatic and/or surgical reduction was successful in 113/143 0–5year olds vs 5/10 6–12year olds, p<0.001. Enemas were safe but reduced only 1patient over age 5. Resections were required in 29 patients (15 idiopathic, 14 lead points). Lead points were found in 4/109 children under 3years, in 5/34 aged 3–5years and 5/10 aged 6–12years (p=0.04 vs 3–5years and p <0.001 vs 0–5years). Lead points consisted of 7 Meckel’s diverticula and 7 others. ConclusionChildren older than 5years are much more likely to have a pathologic lead point and early surgical intervention should be considered. In this study, enema reduction was safe but minimally beneficial in this age group.

Burkitt lymphoma as a cause of recurrent abdominal pain and ileocolic intussusception in a 6-yar-old boy

Burkitt lymphoma is a highly aggressive form of Non – Hodgkin lymphoma that responds favorably to early treatment. The disease has many forms of clinical presentations. It is diagnosed in children usually as an abdominal mass. The tumor causes either indirect symptoms, due to pressure phenomena or direct involvement of the bowel lumen leading to either intestinal obstruction or intussusception. We report a case of a 6-year-old immunocompetent Caucasian boy who experienced a recurrent abdominal pain (RAP) for the last four months. After symptoms of bowel obstruction, we operated on him at the Department of Pediatric Surgery and ileocolic intussusception was found. We performed right colectomy. Sectioning the invaginate we found a tumor, spreading from the terminal ileum and involving the ileocecal valve. The tumor was immunohistochemically verified as Burkitt lymphoma. CT of neck, mediastinum and abdomen showed polyadenopathy. The child was referred to the pediatric hematology center for chemotherapy. Conclusion: Burkitt lymphoma rarely causes recurrent abdominal pain in children. The common presentation are bowel obstruction and intussusception. The possibility of lymphoma should be considered in case of intussusception in older children. Therapeutic approach includes combination of surgery and chemotherapy.

Intussusception and metastatic colon cancer in an adult with cystic fibrosis

Cystic fibrosis (CF) is a true multi-system disease and as life expectancy continues to increase, the spectra of symptoms and diagnoses seen in patients is ever expanding. Some of the conditions that are now seen in CF are specific to the underlying disease process, others are side-effects of long term medications and some are simply related to patients older age. Cancers of the digestive tract were previously extremely rare in patients with CF as they were unlikely to live to an age at which they would present. Over recent years they have been seen more frequently and research has shown that their incidence is higher in patients with CF when compared to the general population.1 In contrast, it has been known for some time that intussusception is more common in children with CF with the peak incidence at 3–12 months of age.2 More recently, in association with patients increased life expectancy, there have been a number of reports of intussusception in older children and adults with CF.3–7 Most of these reports have found the lead point to be inspisated faeces and none have identified a malignant lead point. We present the case of a 35-year-old woman with CF who presented with a sigmoid intussusception caused by 2 malignant polyps. At the time of diagnosis, metastases were identified in 2 local lymph nodes and the liver. As well as being the first reported case of intussusception in a patient with CF in which a malignant lead point has been identified, the case highlights a number of other important clinical, psychological and social issues.

Management of pediatric intussusception in general hospitals: diagnosis, treatment, and differences based on age

age related differences in the management and outcomes of children with ileocolic intussusception have not been previously published. The purpose of this study is to compare the differences in diagnosis and treatment of pediatric ileocolic intussusception based upon age in general hospitals. a review was made of pediatric patients treated for intussusception at 11 hospitals between 1996 and 2007. The patients were divided into 3 groups based on age: group A: <6 months (n=37), group B: 6 months to 4 years (n=126), group C: >4 years (n=25). Diagnostic modality, operative reports, and hospital records were reviewed. altogether 188 patients were treated for ileocolic intussusception. Contrast enema was performed in 80.3% of the patients. Initial treatment for the patients included contrast enema in 80.3%, immediate operation in 3.2%, and others in 16.5%. Older patients were less likely to undergo a contrast enema (P<0.05) but more likely to be successfully reduced. Patients in group A had the lowest rate of successful reduction (P<0.05). Overall, 3.2% of the patients were taken to the operating room without any diagnostic evaluations, but 65% of the patients ultimately required operative intervention. Patients in groups A and C were more likely to undergo an operation (P<0.05). Rates of bowel resection and length of hospital stay were similar among the three groups. enema reduction for ileocolic intussusception is moderately successful in general hospitals and lower than that reported in children's hospitals. The lowest reduction rate occurs in patients of less than 6 months old and the diagnosis of intussusception in older children is rarely made by contrast enema. There is a higher operative rate in children of less than 6 months or older than 4 years and the rate of intestinal resection is higher than that in children's hospitals.

B-020 Intussusception in older children(Oral Presentation Alimentary tracts 1,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

B-020 Intussusception in older children(Oral Presentation Alimentary tracts 1,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

Clinico-pathological features of intussusception in children beyond five years old.

The pathoetiology and outcomes of intussusception in older children are different from those in young children. This study aims to investigate the characteristics and outcomes of intussusception in children older than 5 years in a tertiary referring hospital. A retrospective review of patients aged older than five years having received a postoperative or roentgenographic diagnosis of intussusception between 1988 and 2005 was conducted. The clinical presentations, diagnostic and treatment methods, and outcomes of all cases were reviewed. A total of 12 cases were recorded. They were eight males and four females, with a median age of 7.6 years (range 5.0-11.1 years). Four (33.3%) children had symptoms lasting more than one week before a prompt diagnosis was made. The most commonly encountered symptom was abdominal pain (100%), followed by nausea/vomiting (75.0%). Recurrent intussusception occurred in 33% of cases. Abdominal sonogram identified intussusceptum in all patients when this procedure was performed. Six patients were treated operatively. Lead lesions including two malignant lymphomas, one Meckel diverticulum, and one colon polyp were found in 4 cases. Three of the four lead points were diagnosed and treated by colonoscopy preoperatively. Complications after operations were adhesive ileus (33.3%) and recurrent intussusception (16.7%). All patients remained well, including those who had lead points identified after prompt treatments. Intussusception in older children presents a higher frequency of persistent symptoms, lead points, and recurrence. Pediatricians need to be aware of the etiology and treatment options for intussusception in older children.

Is non-operative intussusception reduction effective in older children? Ten-year experience in a university affiliated medical center

Ileo-colic intussusception in older children is frequently caused by a pathological lead point. Therefore, in many cases, no attempts at hydrostatic or air reduction are performed in non-pediatric hospitals. This study summarizes our experience in management of intussusception in children aged 3 years or older, in order to determine its efficacy and safety in this age group. We retrospectively reviewed medical records and radiological images of 26 cases of intussusception in 24 children older than 3 years admitted to our hospital over a 10-year period. In one child no attempt of reduction was made. Three children underwent unsuccessful imaging-guided reduction and an underlying tumor was identified at surgery and resected. In 18 cases air reduction was successful and no pathological lead point was discovered. In four children hydrostatic or air reductions failed. Manual reduction was performed, with no predisposing cause found. No complications were observed in any of our patients. Older age is not a contraindication for imaging-guided intussusception reduction attempt. Most of these patients can benefit from such an attempt, thereby avoiding surgery.

Intussusception in cystic fibrosis.

Two cases of acute intussusception in older children with cystic fibrosis are reported. Both cases presented with symptoms and signs consistent with meconium ileus equivalent, which delayed the final diagnosis. Both cases required abdominal surgery but made full and uneventful recoveries.

Intussusception of the Vermiform Appendix

SummaryIntussusception of the vermiform appendix (IVA) in a 14‐year‐old girl is reported. The diagnosis was made preoperatively, which is rare: only five other cases have been reported. IVA can present with variable symptoms. This patient presented with episodes of recurrent severe paroxysmal pain and vomiting, each episode being separated by several uneventful weeks. The diagnosis of IVA could be made at the fourth attack of colic by the radiological visualization of a “spiral shell” filling defect at the bottom of the cecum that was reducible by intravenous injection of a spasmolytic. Laparotomy with appendectomy rescued the patient from these distressing episodes. Although IVA is an uncommon condition, one should be aware of its existence and include it in the differential diagnosis of acute abdominal syndromes. When confronted with a clinical picture of intussusception in older children or adolescents, one should especially remember this entity as a differential diagnosis with other causes of intussusception, especially tumors.

Intussusception in older children: D. Turner, A. M. K. Rickwood, and R. J. Brereton. Arch Dis Child 55:544–546, (July), 1980

Intussusception in older children: D. Turner, A. M. K. Rickwood, and R. J. Brereton. Arch Dis Child 55:544–546, (July), 1980

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.

Lymphosarcoma of the cecum causing intussusception in a nine-year-old boy.

INTUSSUSCEPTION is generally considered to be a condition of infancy and early childhood and is usually of the idiopathic type. Intussusception in older children and adults is less common and a causative factor such as a tumor, Meckel's diverticulum, or a foreign body can usually be determined. Few cases of lymphosarcoma of the cecum causing intussusception have been reported. We would like to add another case to the literature. This case was interesting from the standpoint of diagnosis and treatment. It is not being presented as a "cure," although no malignant disease could be demonstrated at reoperation. We feel that the second-look procedure was indicated in this case, and should be employed more frequently in certain selected cases. <h3>REPORT OF CASES</h3> The patient was a white boy, aged 9 years, who was admitted to the medical service of Milwaukee Children's Hospital on Jan. 3, 1952. He complained of abdominal pain