Intussusception In Pediatric Patients Research Articles

Clinical features of intussusception in children secondary to small bowel tumours: a retrospective study of 31 cases

BackgroundSummarizing the clinical features of children with intussusception secondary to small bowel tumours and enhancing awareness of the disease.MethodsRetrospective summary of children with intussusception admitted to our emergency department from January 2016 to January 2022, who underwent surgery and were diagnosed with small bowel tumours. Summarize the types of tumours, clinical presentation, treatment, and prognosis.ResultsThirty-one patients were included in our study, 24 males and 7 females, with an age of onset ranging from 1 m to 11y 5 m. Post-operative pathology revealed 4 types of small intestinal tumour, 17 lymphomas, 10 adenomas, 4 inflammatory myofibroblastomas and 1 lipoma. The majority of tumours in the small bowel occur in the ileum (83.9%, 26/31). Abdominal pain, vomiting and bloody stools were the most common clinical signs. Operative findings indicated that the small bowel (54.8%, 17/31) and ileocolic gut were the main sites of intussusception. Two types of procedure were applied: segmental bowel resection (28 cases) and wedge resection of mass in bowel wall (3 cases). All patients recovered well postoperatively, with no surgical complications observed. However, the primary diseases leading to intussusception showed slight differences in long-term prognosis due to variations in tumor types.ConclusionsLymphoma is the most common cause of intussusception in pediatric patients with small bowel tumours, followed by adenoma. Small bowel tumours in children tend to occur in the ileum. Therefore, the treatment of SBT patients not only requires surgeons to address symptoms through surgery and obtain tissue samples but also relies heavily on the expertise of pathologists for accurate diagnosis. This has a significant impact on the overall prognosis of these patients.

Air enema reduction versus hydrostatic enema reduction for intussusceptions in children: A systematic review and meta-analysis.

We conducted a comprehensive meta-analysis to compare the effectiveness and safety of fluoroscopy-guided air enema reduction (FGAR) and ultrasound-guided hydrostatic enema reduction (UGHR) for the treatment of intussusception in pediatric patients. A systematic review and meta-analysis were conducted on retrospective studies obtained from various databases, including PUBMED, MEDLINE, Cochrane, Google Scholar, China National Knowledge Infrastructure (CNKI), WanFang, and VIP Database. The search included publications from January 1, 2003, to March 31, 2023, with the last search done on Jan 15, 2023. We included 49 randomized controlled studies and retrospective cohort studies involving a total of 9,391 patients, with 4,841 in the UGHR and 4,550 in the FGAR. Specifically, UGHR exhibited a significantly shorter time to reduction (WMD = -4.183, 95% CI = (-5.402, -2.964), P < 0.001), a higher rate of successful reduction (RR = 1.128, 95% CI = (1.099, 1.157), P < 0.001), and a reduced length of hospital stay (WMD = -1.215, 95% CI = (-1.58, -0.85), P < 0.001). Furthermore, UGHR repositioning was associated with a diminished overall complication rate (RR = 0.296, 95% CI = (0.225, 0.389), P < 0.001) and a lowered incidence of perforation (RR = 0.405, 95% CI = (0.244, 0.670), P < 0.001). UGHR offers the benefits of being non-radioactive, achieving a shorter reduction time, demonstrating a higher success rate in repositioning in particular, resulting in a reduced length of postoperative hospital stay, and yielding a lower overall incidence of postoperative complications, including a reduced risk of associated perforations.

Lymphoma-related intussusception in children: diagnostic challenges and clinical characteristics.

Swift identification of lymphoma-related intussusception, distinguished by unique clinical and ultrasound features, is imperative for timely intervention and treatment. Further research is warranted to refine diagnostic approaches. • Intussusception in pediatric patients can be caused by a wide spectrum of underlying diseases including lymphoma. • Early Identifying the exact underlying cause of intussusception is crucial for tailored therapy, however often challenging and time-consuming. • Lymphoma-related intussusception may present with increased abdominal fluid accumulation, intestinal obstruction, and a higher likelihood of failed reduction during enema procedures. • For high-risk children, repeated ultrasound examinations or further investigations may be necessary to confirm the diagnosis.

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.

Diagnostic Accuracy of Ultrasonography for Detection of Intussusception in Children; a Systematic Review and Meta-Analysis.

The diagnosis of intussusception can be challenging in children due to the fact that the findings of clinical evaluations are nonspecific and most of the patients present with unclear history. Therefore, in this systematic review and meta-analysis, we aimed to investigate the diagnostic accuracy of ultrasonography for detection of intussusception and also compare the efficacy of point-of-care ultrasound (POCUS) with radiologist-performed ultrasound (RADUS). Two independent reviewers systematically searched different online electronic databases including MEDLINE, Scopus, Web of Science, Google Scholar, Embase, and Cochrane from inception to December 1, 2022 to identify published papers reporting accuracy of ultrasonography for diagnosis of intussusception. The quality assessment of the included studies was investigated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. A total of 1446 records were retrieved in the initial search of databases. After screening the titles, a total of 344 studies were retrieved for the detailed assessment of full-text. Finally, 37 studies were included in qualitative and quantitative analysis. The pooled sensitivity and specificity of ultrasonography for diagnosis of intussusception were 0.96 (95% CI: 0.95-0.97) and 0.97 (95% CI: 0.97-0.98), respectively. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 24.57 (95% CI: 8.26-73.03) and 0.05 (95% CI: 0.04-0.08), respectively. The area under the hierarchical summary receiver operating characteristic (HSROC) curve was 0.989. Mete-regression showed that there is no significant difference between diagnostic performance of POCUS and RADUS (p = 0.06 and rDOR (diagnostic odds ratio) = 4.38 (95% CI: 0.92-20.89)). This meta-analysis shows that ultrasonography has excellent sensitivity, specificity, and accuracy for diagnosis of intussusception in pediatric patients. Moreover, we found that diagnostic performance of POCUS is similar to that of RADUS for diagnosis of intussusception.

Factors associated with surgical treatment in pediatric intussusception.

The study aimed to identify factors related to the need for surgical treatment of intussusception in pediatric patients. The medical charts of 106patients diagnosed with intussusception and treated at the Imam Khomeini Medical Center in Ahvaz city between September 2019 and October 2020 were retrospectively reviewed. Patients were compared in terms of risk factor groups treated with surgery (12pediatric patients) and nonsurgical methods (92pediatric patients). Size of intussusception, free fluid in the abdomen, and currant jelly stool were compared between the groups. The mean age in the group treated with surgery was significantly higher (p = 0.01). The duration of symptoms in patients treated with surgery was significantly higher (p = 0.033). The size of intussusception in the surgical treatment group was significantly larger than in the nonsurgical recovery group (p = 0.042). The rates of presence of free fluid in the abdomen and currant jelly stool were significantly higher in patients treated with surgery (p = 0.001 and p = 0.004, respectively). Age > 1year, duration of symptoms > 24 h, currant jelly stool, intussusception > 3.5 cm, and free peritoneal fluid are factors associated with surgical treatment of intussusception in children.

Ileocolic intussusception in pediatric SARS-CoV-2 patients: experience at a tertiary pediatric center.

PurposeCOVID-19 disease can manifest with intussusception in pediatric patients, but prevalence of abnormalities on ultrasounds performed for intussusception is uncertain. We aim to report our experience in children with COVID-19 presenting with suspected intussusception imaged with ultrasound.MethodsChildren under 18 years who had an ultrasound for possible intussusception underwent retrospective analysis and were tested for COVID-19 between April 1 and December 14, 2020. Patients’ demographic, clinical, radiological and surgical characteristics were reviewed.ResultsTwenty-four COVID-19-positive patients were identified; 19 boys with mean age 3 years (range: 3 months–18 years). Ultrasound was abnormal in 11 patients (11/24, 46%). Sonographic features of enterocolitis were documented in seven children (7/24, 29%). Three boys (3/24, 13%) were found to have ileocolic intussusception on ultrasound and underwent air enema with failed reduction (3/3, 100%), precipitating surgical reductions, all with favorable outcomes. One patient (1/24, 4%) was found to have a long segment of persistent small bowel–small bowel intussusception which was surgically repaired.ConclusionGiven the known association between failed reduction at air enema and delayed presentation, heightened awareness for intussusception in the setting of COVID-19 should be maintained, though more often, the etiology was attributed to other GI manifestations of COVID-19.

Small intestinal submucosal lipoma: a rare cause of secondary intussusception in a child

BackgroundIntestinal lipomas are benign, non-epithelial, intestinal tumors with an exceptionally rare localization at the ileum. Lipomas in the small intestine occur mainly in elderly patients and seldom occur in childhood. They are frequently asymptomatic, possibly due to their slow growth. These tumors may act as a lead point of intussusception.Case presentationWe report a rare case of double compounded ileo-ileal intussusception due to a submucosal intestinal lipoma in an 8-year-old female. To our knowledge, this is only the seventh pediatric case to be reported in the medical literature.ConclusionsSmall intestinal submucosal lipoma should be considered in case of intussusception in pediatric patients. Surgical resection seems sufficient in case of symptomatic intestinal lipoma with low morbidity.

Identifying Predictive Factors for the Recurrence of Pediatric Intussusception.

PurposeThe aim of the study was to identify factors related to the recurrence of intussusception in pediatric patients.MethodsThe medical charts of patients diagnosed with intussusception and treated at Dongsan Medical Center, between March 2015 to June 2017, were retrospectively reviewed. Univariate and multivariate analyses were performed.ResultsAmong 137 patients, 23 patients (16.8%) had a recurrent intussusception and 8 of these patients (6%) had more than 2 episodes of recurrence. The age at diagnosis was significantly different between the non-recurrence and recurrence group (p=0.026), with age >1 year at the time of diagnosis associated with a greater rate of recurrence (p=0.002). The time interval from symptom onset to the initial reduction (<48 vs. ≥48 hours) was significantly longer in the recurrence group (p=0.034) and patients in the recurrence group had higher levels of C-reactive protein (CRP) (p=0.024). Bloody stools and a history of infection were significantly more frequent in the non-recurrence group (p=0.001 and p<0.001, respectively). On stepwise regression analysis, age >1 year at the time of presentation (odds ratio [OR], 4.79; 95% confidence interval [CI], 1.56–14.06; p=0.016) and no history of infection (OR, 0.18; 95% CI, 0.06–0.58; p=0.004) were retained as predictors of recurrence.ConclusionPatients with intussusception who are older than 1 year at diagnosis, have an elevated CRP level, a delay of ≥48 hours between symptom onset and the initial reduction, an absence of bloody stools, and no history of infection should be closely monitoring for symptoms and signs of a possible recurrence.

Risk factors for failure of hydrostatic reduction of intussusception in pediatric patients: A retrospective study.

The aim of this current study was to explore the risk factors associated with failure of hydrostatic reduction of intussusception in pediatric patients.Patients with intussusception treated with hydrostatic reduction from January 2010 to December 2016 were retrospectively analyzed. Candidates for inclusion in the study were children from 0 to 18 who were diagnosed with intussusception and treated with hydrostatic reduction. We excluded the patients who had contraindications for hydrostatic reduction, which included peritonitis, perforation signs, and non-responsive shock that required surgery. The data collected included: demographic data (sex, age, and bodyweight), symptoms (vomiting, abdominal pain, rectal bleeding, diarrhea, distention, constipation, and duration of symptoms), signs (temperature, palpable mass, and location of the mass), and other investigations (white blood cell counts, neutrophils, electrolytes, and ultrasound findings).The risk factors for failure of hydrostatic reduction of intussusception were analyzed using the univariable analysis and the multivariable analysis. In the univariable model, the significant risk factors for failure of hydrostatic reduction of intussusception analyzed were age, bodyweight, duration of symptoms, rectal bleeding, constipation, palpable abdominal mass, poor prognosis signs on ultrasound scans and location of mass (the P value for each parameter are stated in Table 1Table 1Baseline characteristics of the study population and univariate comparison of failed versus successful group. ). After the multivariable analysis was done, we found that the significant risk factors for failure of hydrostatic reduction of intussusception were an age of under 1-year-old (OR = 3.915, P = .027), duration of symptoms more than or equal to 48 h (OR = 0.056, P < .001), rectal bleeding (OR = 0.283, P = .003), constipation (OR = 0.086, P < .001), palpable abdominal mass (OR = 0.370, P = .010), and location of mass (left over right side) (OR = 13.782, P < .001).Our study found that an age of under 1-year-old, a duration of symptoms of more than or equal to 48 h, rectal bleeding, constipation, palpable abdominal mass and location of mass (left over right side) were risk factors for the failure of hydrostatic reduction of intussusception.

Feasibility of Laparoscopic Surgery for Intussusception in Pediatric Patients and Risk of Bowel Resection

Feasibility of Laparoscopic Surgery for Intussusception in Pediatric Patients and Risk of Bowel Resection

Feasibility of Laparoscopic Surgery for Intussusception in Pediatric Patients and Risk of Bowel Resection

Feasibility of Laparoscopic Surgery for Intussusception in Pediatric Patients and Risk of Bowel Resection

Risk factors for recurrence of intussusception in pediatric patients: A retrospective study

ObjectivesThe aim of this study was to explore the risk factors associated with recurrence of intussusception after operative or nonoperative reduction in children. MethodsBetween January 2004 and December 2012, patients with intussusception treated with nonoperative and operative reduction were retrospectively analyzed. We included the patients who were diagnosed with intussusception from the age of 0 year to 18 years who received nonoperative and operative reduction as an initial treatment. The data collected included demographic data (sex, age, and bodyweight), symptoms (vomiting, abdominal pain, rectal bleeding, diarrhea, distention, constipation, and duration of symptoms), signs (temperature, palpable mass, and location of the mass), investigations (ultrasound findings) and the method of reduction. ResultsThe risk factors for recurrence of idiopathic intussusception were analyzed by the univariable analysis and multivariable analysis. In the univariable model, the significant risk factors for recurrence of intussusception analyzed were age, bodyweight, duration of symptoms, rectal bleeding, poor prognosis signs on ultrasound scans, location of mass, and pathological lead point. After multivariable analysis was done, we found that the significant risk factors for recurrence of intussusception were age ≥ 2 years (OR = 5.597, P = 0.044), duration of symptoms ≥48 h (OR = 91.664, P < 0.001), rectal bleeding (OR = 4.758, P = 0.009), location of mass (left over right side) (OR = 0.038, P < 0.001), pathological lead point (OR = 0.002, P < 0.001). ConclusionOur study found that age ≥ 2 years, duration of symptoms≥48 h, rectal bleeding, location of mass (left over right side) and pathological lead point were risk factors for recurrence of intussusception. Level of evidencePrognosis study. Type of studyRetrospective study.

A randomized trial of pneumatic reduction versus hydrostatic reduction for intussusception in pediatric patients

ObjectivesData of randomly controlled trials comparing the hydrostatic and pneumatic reduction for intussusception in pediatric patients as initial therapy are lacking. The aim of this study was to conduct a randomly controlled trial to compare the effectiveness and safety of the hydrostatic and pneumatic reduction techniques. Study designAll intussusception patients who visited West China Hospital of Sichuan University from January 2014 to December 2015 were enrolled in this study in which they underwent pneumatic reduction or hydrostatic reduction. Patients were randomized into ultrasound-guided hydrostatic or X-ray-guided pneumatic reduction group. The data collected includes demographic data, symptoms, signs, and investigations. The primary outcome of the study was the success rate of reduction. And the secondary outcomes of the study were the rates of intestinal perforations and recurrence. ResultsA total of 124 children with intussusception who had met the inclusion criteria were enrolled. The overall success rate of this study was 90.32%. Univariable analysis showed that the success rate of hydrostatic reduction with normal saline (96.77%) was significantly higher than that of pneumatic reduction with air (83.87%) (p=0.015). Perforation after reduction was found in only one of the pneumatic reduction group. The recurrence rate of intussusception in the hydrostatic reduction group was 4.84% compared with 3.23% of pneumatic reduction group. ConclusionOur study found that ultrasound-guided hydrostatic reduction is a simple, safe and effective nonoperative treatment for pediatric patients suffering from intussusceptions, and should be firstly adopted in the treatment of qualified patients. Level of evidenceTherapeutic study Type of studyProspective study

Adenovirus infection: A potential risk for developing intussusception in pediatric patients.

The pathogenesis of intussusception without obvious anatomical leading points remains unclear. The objective of this study was to determine a feasibility of association between certain gastroenteritis viruses and intussusception. This was a prospective cohort study. Forty intussusception cases and 136 acute gastroenteritis controls with comparable age and gender were separately consecutively enrolled and relevant clinical data of both groups were recorded. The clinical specimens collected from all patients were screened for adenovirus, rotavirus, norovirus, and astrovirus by PCR and RT-PCR using specific primers. The genomes of detected viruses were characterized further to identify their genotypes by nucleotide sequencing. In 40 intussusception cases, adenovirus, rotavirus, and norovirus were detected in 12 (30.0%), 2 (5.0%), and 2 (5.0%), respectively while astrovirus was undetectable. In contrast, 136 acute gastroenteritis patients, adenovirus, rotavirus, and norovirus were detected in 11 (8.1%), 24 (17.7%), and 24 (17.7%) patients, respectively and again astrovirus was undetectable. The detection of adenovirus in intussusception patients was significantly higher than those in the control group (P < 0.001) with an odd ratio of 4.87 (95%CI: 1.95, 12.16). Interestingly, molecular analysis of adenovirus genome demonstrated that all of adenovirus detected in intussusception patients belonged to adenovirus C. This could be a potential risk factor or pathogenesis for developing intussusception in the cases of those without apparent anatomical leading points. J. Med. Virol. 88:1930-1935, 2016. © 2016 Wiley Periodicals, Inc.

Emergency bedside ultrasound for the diagnosis of pediatric intussusception: a retrospective review.

Ultrasound diagnosis of pediatric intussusception is feasible with limited operator training. The authors report the test characteristics of bedside ultrasound (BUS) for the diagnosis of pediatric intussusception at a single institution. Inclusion criteria were: 1) patients of 0-18 years old were seen in the pediatric emergency department (ED) with a clinical presentation suspicious for intussusception; 2) BUS was performed to identify intussusception and bedside impression documented in the medical record; 3) a "formal" diagnostic study (such as computed tomography, ultrasound, or barium enema) was performed by the radiology department after BUS was completed. Electronic medical record and ED BUS archive were screened for potentially eligible ED visits between January 1(st) 2009 to October 3(rd) 2012. These records were then reviewed to identify patients for inclusion in the study. All emergency physicians who performed the BUS had undergone a minimum of 1-hour didactic training on the use of BUS to diagnose pediatric intussusception. A total of 1 631 charts were reviewed, with 49 meeting inclusion criteria. Five of those were later excluded for incomplete documentation or lack of saved BUS images. The prevalence of intussusception was 23%. The mean age of the subjects was 31 months. BUS was 100% sensitive (95%CI 66%-100%) and 94% specific (95%CI 79%-99%) for detection of pediatric intussusception compared to radiology study results. Positive and negative likelihood ratios were 16.5 (95%CI 4.30%-63.21%) and 0 (95%CI 0-0) respectively. BUS is an accurate means of diagnosing acute intussusception in pediatric patients. Further study might be indicated to confirm such benefits.

Colocolonic intussusception in a four‐yr‐old with a heart transplant: A case report and review of the literature

A rare case of a colocolonic intussusception in a pediatric cardiac transplant patient is reported along with a review of colocolonic intussusception in pediatric patients after organ transplantation. A four-yr-old girl with a history of heart transplantation shortly after birth presented with a 12-hour history of abdominal pain, vomiting, and bloody stools. Initial abdominal x-ray showed rectal edema. A rectal examination revealed a palpable intussusceptum that prompted a therapeutic contrast enema, which failed to reduce the intussusception. Surgical exploration was performed with reduction of the intussusception and resection of the terminal ileum and cecum. A pathologic lead point was not identified.

Radiographic Findings in the Diagnosis of Pediatric Ileocolic Intussusception

Several previous studies have evaluated the usefulness of plain abdominal radiographs for the diagnosis of pediatric intussusception, although investigation of the most specific clues to diagnose intussusception has not been studied alone. The 3 most specific findings of intussusception include intraluminal mass or intussusceptum, nonvisualized air-filled cecum, and obscured liver margin or right upper-quadrant mass. In this study, a retrospective review of 73 known cases of intussusception with age- and sex-matched controls was performed. The cases were reviewed by 2 blinded, board-certified pediatric radiologists to aid in the determination of sensitivity and specificity. The sensitivity and specificity of plain radiographs to correctly diagnose ileocolic intussusception in pediatric patients compared with a control population were 77% and 97%, using a 50% or greater receiver operating characteristic curve cutoff.

Clinical implications and surgical management of intussusception in pediatric patients with Burkitt lymphoma

Background/Purpose Intussusception as a presenting feature of Burkitt lymphoma may be associated with early stage disease, which is curable with less intensive therapy. We determined the incidence, presentation, stage, and outcome of children with Burkitt lymphoma presenting with intussusception. Methods The medical records of patients with Burkitt lymphoma treated at our hospital from 1962 to 2005 were reviewed, and the patients presenting with intussusception were then further analyzed. Results Of 189 patients with primary abdominal Burkitt lymphoma, 33 (17.5%) presented with intussusception. Their median age at diagnosis was 10 years (range, 3-19 years). Most patients presented with abdominal pain (88%) and/or nausea/vomiting (42%). Twenty-three (70%) of these 33 patients as compared with 10 of the other 156 patients with abdominal lymphoma could have complete resection of their tumor ( P < .0001) and hence had low stage disease (stage II). Only 10 patients with intussusception had stage III (n = 7) or stage IV (n = 3) unresectable disease. Twenty-five of the patients remained alive in continuous complete remission for 3 months to 31 years (median, 14 years). Conclusion Pediatric patients with Burkitt lymphoma presenting with intussusception often have completely resectable disease and are older than general pediatric patients with intussusception.

Sonographic features of small-bowel intussusception in pediatric patients.

Small-bowel intussusception (SBI) for pediatric patients is unusual and difficult to diagnose preoperatively. This study sought to determine the sonographic findings of pediatric SBI. The sonographic features and surgical findings of 13 pediatric patients (7 boys, 6 girls; age range 4 months-15 years; average age 4 years and 2 months) with SBI encountered in the authors' hospital over a 12-year period were retrospectively reviewed. Most of the patients presented with nonspecific symptoms, including vomiting, abdominal pain, and/or irritable crying. Sonographic screening in the emergency department revealed a doughnut or crescent-in-doughnut sign, or a multiple-concentric-rings sign for 11 of the 13 patients, and the lesions appeared short. Eight lesions were found in the paraumbilical or left abdominal regions. Sonographic measurement of the size of the lesions from these 11 patients ranged from 2 cm to 3.7 cm (average 2.77 cm). Subsequent barium enemas were performed for these 11 patients, none of which revealed colon lesions. Surgery revealed ileoileal intussusceptions for eight cases, jejunoileal for three, and jejunojejunal for the remaining two. Bowel ischemia or necrosis and pathologic lead points were demonstrated for seven and six patients, respectively, although none were recognized preoperatively. Small-bowel intussusception is often over-looked due to nonspecific clinical presentations. Sonographic demonstration of a 2-3-cm sized, short, doughnut-like lesion, especially in the left abdomen or paraumbilical regions, should lead to strong suspicion of SBI.