Management Of Intussusception Research Articles

Practice variation in the management of pediatric intussusception: a narrative review.

This review has identified practice variations in several key areas of ileocolic intussusception management. The findings underscore the need for further research in these areas and the establishment of uniform standards aimed at improving the care of children with ileocolic intussusception. • Ileocolic intussusception necessitates rapid diagnosis and a collaborative treatment approach involving emergency medicine, radiology, surgery, and often anesthesia. • A previous study reported variations in the practice of pain management and sedation among these patients. • This narrative review identified practice variations in several key areas within the diagnostic and treatment pathways of ileocolic intussusception.

Association of Time Since Diagnosis of Pediatric Ileocolic Intussusception With Success of Attempted Reduction: Analysis in 1065 Patients.

BACKGROUND: Radiologists generally treat pediatric ileocolic intussusceptions emergently given potential worse outcomes from delayed reduction attempts. However, relevant literature is conflicting. OBJECTIVE: To identify factors associated with successful image-guided ileocolic intussusception reduction in children, with attention to the time interval since diagnosis. METHODS: This retrospective study included patients <6 years old who underwent attempted image-guided enema reduction of ileocolic intussusception between May 2009 and July 2023. Patients were separated into two groups: those presenting directly to the institution (nontransferred patients, who all underwent attempted reduction <8 hours after ultrasound diagnosis), and those transferred from outside facilities. EHR data were extracted. Each patient's first image-guided reduction attempt was classified as successful or unsuccessful. Univariable and multivariable analyses were performed. RESULTS: The study included 1065 patients (649 male, 416 female; mean age, 18.1 months; age range, 2.2-71.0 months; 793 nontransferred and 272 transferred patients). In nontransferred patients, the mean interval between ultrasound diagnosis and reduction attempt was 150.8 minutes; in transferred patients, the mean interval between outside facility advanced imaging and reduction attempt was 460.1 minutes (p<.001). Successful reduction occurred in 84.6% and 81.6% of nontransferred and transferred patients, respectively (p=.25). In nontransferred patients, success occurred in 85.6% of attempts <2 hours after diagnosis versus 84.0% of attempts 2-<8 hours after diagnosis (p=.54); the mean interval from diagnosis to attempted reduction was 149.7 minutes and 156.8 minutes for successful and unsuccessful attempts, respectively (p=.53). In multivariable analysis, factors showing independent associations with success were proximal intussusception location (OR=3.63, p<.001) and absence of high-risk ultrasound findings (OR=2.57, p<.001); success was not independently associated with age, sex, bloody stools, reduction method, or time since diagnosis <2 hours (p>.05). In transferred patients, the mean interval from outside advanced imaging to attempted reduction was 463.1 minutes and 440.2 minutes for successful and unsuccessful attempts, respectively (p=.74). CONCLUSION: Intussusception reduction may not require completion emergently (within 2 hours after diagnosis), but potentially may be safely performed on an urgent basis (within 8 hours). CLINICAL IMPACT: The findings have implications for determining the standard of care, including criteria for oncall activation of radiologic resources, in pediatric intussusception management.

A Study of Predictors of Failure of Nonoperative Management of Ileocolic Intussusception in Children.

Surgery remains the mainstay in treating intussusception in developing nations. A correspondingly high bowel resection rate exists despite a shift to nonoperative reduction in high-income countries. We aimed to study the clinical profile of the patients with intussusception presenting to our hospital and to assess the clinical and radiological predictors of success or failure of nonoperative management of intussusception. This prospective study was conducted in the Department of Pediatric Surgery over a period of 3 years and included a total of 118 patients who presenting to our emergency division with features suggestive of intussusception and were managed accordingly either with hydrostatic reduction or by surgical intervention. We observed that the majority of the patients were males (65.5%). The mean age was 13.54 months. Intermittent pain was the most common symptom. Both pain and vomiting did not affect the outcome. Lab parameters like raised total leukocyte counts (TLC), C-reactive protein (CRP) and lactate levels were significantly associated with failure of hydrostatic reduction. Patients with air fluid levels on X-ray were more likely to end up in surgery. Ultrasound findings of bowel wall edema, aperistaltic gut loops and a pathological lead point was associated with failure of hydrostatic reduction as well. The overall success rate of hydrostatic reduction was 85.5%. Hydrostatic reduction of intussusception is a safe and effective method of management of intussusception whenever indicated. Factors that might reduce the chance of its success include continuous pain, irritability, tenderness, deranged lab parameters like TLC, CRP and lactate levels, air fluid levels on X-ray, bowel wall edema, aperistalsis and the presence of a lead point. Shah JY, Banday I, Hamdani HZ, et al. A Study of Predictors of Failure of Nonoperative Management of Ileocolic Intussusception in Children. Euroasian J Hepato-Gastroenterol 2024;14(1):81-85.

Predictive factors for failure of nonsurgical management of intussusception and its in-hospital recurrence in pediatric patients: a large retrospective single-center study

BackgroundThis study explores the effectiveness of ultrasonography (USG)-guided saline enema reduction for ileocecal intussusception. It investigates factors, ascertainable through physical examination, ultrasound, and medical history, that impact the success of the procedure and the likelihood of recurrence.ResultsConducted at a tertiary referral center, the study included 323 pediatric cases diagnosed with intussusception between 2017 and 2023. Patient data, symptoms, signs, and outcomes were collected. Hydrostatic saline enema, performed under USG guidance, served as the primary non-operative treatment. Logistic regression models assessed the impact of clinical factors on success and recurrence rates. Out of 323 patients examined for eligibility, 184 met inclusion criteria and were analyzed. Successful reduction with saline enema was achieved in 86.7%. In-hospital recurrence occurred in 17.1%, notably higher for intussusceptions extending into the rectum (p < 0.03). Pathologic lead point was identified in 33.3% of operated cases. The study revealed a correlation between the increasing number of symptoms (p < 0.001) and reduced success rates in enema reduction, with vomiting (p < 0.02), diarrhea (p < 0.05), and peritoneal fluid (p < 0.008) negatively affecting outcomes. Symptom duration of 1–9 h (p < 0.001) and 10–24 (p < 0.01) correlated with higher success rates, but prolonged symptom duration of > 24 (p = 0.4) and 48–72 (p = 0.2) hours did not decrease chances for successful reduction.ConclusionsProlonged symptom duration of over 24 and 48–72 h should not be a definitive contraindication for non-operative treatment. Cumulation of symptoms typical for intussusception might reduce the chances of success. These findings contribute valuable insights into optimizing non-operative strategies for managing pediatric intussusception.

The Management of Intussusception: A Systematic Review.

Intussusception (ISN) is adangerous condition where a portion of the intestine slides into an adjacent area of the intestine. This telescoping motion frequently prevents liquids or food from flowing through. Developing management guidelines for ileocolic (IC) intussusception was the aim of this systematic study.Data sources were PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, and Embase databases. Our review investigated English-language articles (from 2010 to 2023) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Overall, there were 15 articles. Surveys and analyses of national databases were the most widely used methods (n=15). The search identified 561 studies; 15 were eligible for inclusion in the analysis. Further understanding of the management of intussusception may help improve evaluation and management in the future. The use of preventive antibiotics does not reduce problems following radiologic reduction. When clinically appropriate, repeated attempts at enema reduction may be made. After the enema reduction of ileocolic intussusception, patients can be safely watched in the emergency room (ER), thereby avoiding hospitalization. Success rates for laparoscopic reduction are high. When it comes to intussusception in children who are hemodynamically stable and do not have a serious illness, there is no need for pre-reduction antibiotics. Prioritizing nonoperative outpatient (OP) therapy is recommended as the primary approach, with the utilization of minimally invasive procedures to avoid the necessity for laparotomy. The management of colonic intussusception involves complete removal in one piece, while enteric intussusception can be addressed through reduction followed by resection. A targeted approach is recommended, recognizing the intermediate forms of intussusception that may exist between the colonic and enteric types. It is essential to note that the prevailing treatment for adult intussusception remains to be surgical intervention.

The success of ultrasound-guided hydrostatic reduction in managing delayed presentation of childhood intussusception: A single center experience

BackgroundChildhood intussusception is a common surgical emergency. The current practice for non-operative management in Sri Lanka is ultrasound-guided hydrostatic reduction (USGHR). This retrospective study aims to demonstrate the efficacy and safety of this procedure even in a setting of delayed presentation. MethodWe explore outcomes of USGHR in the management of intussusception in children presenting to a single tertiary care center in Sri Lanka, between November 2019 and March 2021. Hydrostatic reduction was performed in patients with radiologically confirmed intussusception in the absence of contraindications. In failed attempts or early recurrences, USGHR was repeated for a maximum of 2 more attempts. ResultsOur study included 135 participants. Of the patients for which data on symptom duration was available 31.5% (n = 41) presented delayed (t>48 hrs). Hydrostatic reduction showed an overall success rate of 86.4%. No association was seen between time since onset of symptoms and success of USGHR (p<0.05). In 19 patients (14.1%) operative intervention was required. The rates of operative intervention were comparable between those presenting within (12.4%) and after 48 h (12.2%). One case (0.7%) of bowel perforation and 1 case of peritonitis (0.7%) occurred in those presenting within and after 48 h respectively. ConclusionThe success rate of USGHR was high despite delays in patient presentation. Thus, hydrostatic reduction is a safe, effective procedure to be performed as the first-line management option in childhood intussusception even in a setting of delayed presentation. Overall success increases with repeat reduction. Level of evidenceRetrospective study comparative – level III

A CLINICAL STUDY OF INTUSSUSCEPTION IN CHILDREN

A CLINICAL STUDY OF INTUSSUSCEPTION IN CHILDREN

Intestinal intussusception in adults: Location, causes, symptoms, and therapeutic management

ObjectiveIntestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. Materials and methodsThis retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged <16 years. Thus, 21 cases in adults (mean age, 57 years) were analyzed. ResultsThe most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumours were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). ConclusionsCT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its aetiology and therapeutic management.

Intussusception among Children Admitted in a Department of Pediatric Surgery of a Tertiary Care Centre: A Descriptive Cross-Sectional Study.

Intussusception is the second most common cause of acute abdominal pain in infants and preschool children. The aetiology for intussusception is idiopathic at this age. Hydrostatic reduction and exploratory laparotomy with proceed are the options for the management of intussusception. The aim of this study was to find out the prevalence of intussusception among patients admitted to the Department of Pediatric Surgery of a tertiary care centre. This is a descriptive cross-sectional study conducted among admitted patients in the Department of Pediatric Surgery of a tertiary care centre after ethical approval from the Ethical Committee (Reference number: A37-77/78). Data were collected from 1 January 2018 to 31 December 2020 from admitted children aged 6 months to 5 years of age. Data collection was done from the hospital record section using the convenience sampling method. Point estimate and 95% Confidence Interval were calculated. Among 1785 admitted patients, 267 (14.96%) (13.31-16.61, 95% Confidence Interval) were found to have intussusception. Among them, the hydrostatic reduction was successful in 246 (92.13%). Meanwhile, 21 (7.86%) of cases underwent laparotomy. The peak age of patients was seen in 148 (55.43%) in the age group of 1-3 years. Intussusception is one of the common surgical emergencies in children. Hydrostatic reduction of intussusception is a simple and effective method for the treatment of intussusception in children. intussusception; laparotomy; paediatrics; prevalence; ultrasound.

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.

Ultrasound Guided Hydrostatic Versus Open Reduction in Intussusception

The surgical and nonsurgical technique has been utilized to manage intussusception. Surgical management of intussusceptions involves open laparotomy along with manual reduction. The non-surgical technique, Ultrasound-guided hydrostatic reduction (USGHR) is a renowned alternative technique for intussusception reduction. Objective: To compare the ultrasound-guided hydrostatic reduction versus open reduction for the management of intussusception in terms of successful reduction, recurrence, and hospital stay. Methods: It was a randomized controlled trial in which 158 cases were admitted through the Emergency Department of Pediatric Surgery of The Children’s Hospital Lahore, from August 2018 to August 2019. These patients were divided into 2 groups (79 in each group), Group A (ultrasound-guided hydrostatic reduction) and group B (open reduction). Data were collected through a questionnaire, which was entered into the computer using SPSS version 24.0. Results: Among 79 patients treated in-group A, 54.4% were up to 12 months old, and 67.1% males, in this group the hospital stay for 74.7% was 1-2 days and 74.7% had a successful reduction. In group B; patients treated in group B, 77.2% were up to 12 months old, and 72.2% were males. The hospital stay for 59.5% of patients was 5-7 days, and 83.5% had a successful reduction of intussusceptions. The recurrence was only in group B (3.8%) after the reduction of intussusceptions. Conclusion: The study concluded that ultrasound-guided hydrostatic is effective in terms of successful reduction, recurrence and hospital stay and should be preferred among children due to its safety and effectiveness.

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.

Process Management of Intussusception in Children: A Retrospective Analysis in China.

ObjectivesThis was a retrospective analysis of the epidemiological features of pediatric intussusception, the effects of different management strategies and the factors affecting successful reduction.MethodsUsing our hospital database, data on pediatric intussusception from January 2019 to December 2020 were extracted for analysis, including demographic data, size of intussusception, treatment method, and effects.ResultsThe number of children diagnosed with intussusception was 726 (782 episodes). In all, 394 (54.27%) of these children were male. The male to female ratio was 1.19:1. The peak of the onset age was between 3 and 4 years. In the single intussusception group, the successful reduction rate of cleansing enemas was 65.25%, that of air enemas was 95.80%, and that of B-ultrasound–guided hydrostatic enemas (B-USGHEs) was 96.04%. In the multiple intussusceptions group, the successful reduction rate of cleansing enemas was 43.9%, air enemas were 75%, and B-USGHE was 57.6%. There were no significant differences between the air enema and B-USGHE groups. The diameter and length were related factors influencing successful reduction (P ≤ 0.05). Fifty-three (7.53%) children had recurrent intussusception within 4 years, and all of them were following successful enemas. Thirty-one (3.40%) episodes were found to have spontaneously reduced. Five patients (0.7%) underwent surgery after the failure of air enemas or B-USGHE.ConclusionsPediatric intussusception in our region showed a sex ratio difference and age difference of onset. For single intussusceptions and multiple intussusceptions, the successful reduction rate of cleansing enemas means that some children may avoid radiation exposure. The diameter and length of intussusception were related factors influencing successful reduction in cleansing enema. There were no significant differences in successful reduction between air enemas and B-USGHE. Most recurrent intussusceptions can still be reduced, avoiding surgery.

Itinerary of children in the management of intussusception: the true reasons of delayed medical care in a west African country

Background: The delayed medical care of intussusception is still the reason for morbidity and mortality in many developing countries. The objective of this study is to take stock of the itinerary of children treated for intussusception, in order to to reduce the delay of the treatment. Methods: This is a cross-sectional study, carried over three years (from 1st June 2016 to 31 May 2019), at a Paediatric Surgery department of Campus Teaching Hospital in Lomé (Togo). The medical record of 23 children whose median age was 12 months, were included. Symptoms, the average time before the first consultation, different health centres consulted and treatment received, and the average time before the admission in the specialised department were studied. Results: In three years, 23 children were managed for intussusception. The average time before the first consultation from home in a health centre was 1.87 days. No patient was admitted to the Paediatric Surgery department directly from home. Twelve patients consulted one centre, eight patients 2 centres, and one patient 3 centres before admission. Before referral, these patients were misdiagnosis as gastro-enteritis in 8 cases (38.10%), malaria in 8 cases (38.10%), and digestive salmonellosis in 3 cases (14.29%). The time elapsed between the beginning of the disease and the admission in specialised service was on average 5.39 days and 3.52 days elapsed then between the first consultation from home and the admission to the Paediatric Surgery service. Conclusion: Valuable time to manage intussusceptions is lost in other medical health services before admission to specialised services. Action on this route will have to be taken through an effective counter-referral system.

Review of Over 15 Years Postmarketing Safety Surveillance Spontaneous Data for the Human Rotavirus Vaccine (Rotarix) on Intussusception

IntroductionRotavirus (RV) is the most common cause of acute gastroenteritis in children <5 years of age worldwide, and vaccination reduces the disease burden. Evidence from postmarketing surveillance studies suggested an increased risk of intussusception (IS) in infants post-RV vaccination. An overall positive benefit–risk balance for the human RV vaccine (HRV) Rotarix (GlaxoSmithKline [GSK], Belgium) has been established and recent findings indicate an indirect effect of reduced IS over the long term.ObjectiveThe aim of this study was to discuss spontaneous data from the GSK worldwide safety database on IS post-Rotarix administration.MethodsThe database was reviewed for all spontaneous IS cases from 2004 to 2020. Additionally, an observed versus expected (O/E) analysis was done for adverse events attributed to IS. Data were reviewed as overall worldwide and stratified by region (Europe/USA/Japan) and dose.ResultsA male predominance of IS patients was observed, consistent with earlier reports. The most frequently reported events in confirmed IS cases (Brighton Collaboration Working Group [BCWG] level 1) with time to onset ≤ 30 days post-vaccination were vomiting (55.8%), haematochezia (47.2%), and crying (21.1%). The observations from the IS spontaneous cases review and results of the O/E analysis are consistent with the known IS safety profile of RV vaccines: a transient increased incidence of IS post-vaccination (primarily in Europe/Japan/worldwide), mostly within 7 days postdose 1.ConclusionSince the outcomes of early IS management are favourable over delayed management, healthcare professionals should inform parents about the importance of seeking immediate medical advice in case of unusual behaviour of the vaccinated infant. GSK continues to monitor the IS risk post-Rotarix administration through routine pharmacovigilance activities.Graphic abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s40264-021-01141-4.

Effectiveness of the implementation of pediatric intussusception clinical pathway: A pre- and postintervention trial.

Intussusception is common among children at the pediatric emergency department (ED) with acute abdomen. Diagnosis and treatment delay remain a challenge. This study aimed to evaluate the impact of intussusception clinical pathways (CPs) implementation, including bedside point-of-care ultrasonography, on patient management in a pediatric ED.In January 2017, an intussusception management protocol was implemented for children with symptoms of intussusception. We retrospectively examined the charts of patients diagnosed with intussusception during the preprotocol (January 2015 to December 2016) and postprotocol (January 2017 to January 2019) periods and compared their outcomes.A total of 106 and 108 patients were included in the preprotocol and postprotocol groups, respectively. After CP implementation, the median door-to-ultrasonography time decreased from 66.5 (range: 13, 761) to 54 (20, 191) minutes; meanwhile, door-to-reduction time decreased from 121.5 (37, 1077) to 80.5 (40, 285) minutes; the median ED length of stay decreased from 440 to 303.5 minutes; and finally, admission rate increased from 18.9% to 40.7% (P < .01). There was no between-group difference in the rates of complications, readmission, emergency surgery, or reduction failure.The implementation of an intussusception CP decreased time-to-diagnosis, time-to-treatment, and ED length of stay estimates among children screened using point-of-care ultrasonography. The present findings suggest that the implementation of an intussusception CP may improve the efficiency of time and resource use.

Early discharge after nonoperative management of intussusception is both safe and cost-effective

Background/purposeWe implemented a quality improvement (QI) initiative to safely reduce post-reduction monitoring for pediatric patients with ileocolic intussusception. We hypothesized that there would be decreased length of stay (LOS) and hospital costs, with no change in intussusception recurrence rates. MethodsA retrospective cohort study was conducted of pediatric ileocolic intussusception patients who underwent successful enema reduction at a tertiary-care pediatric hospital from January 2015 through June 2020. In September 2017, an intussusception management protocol was implemented, which allowed discharge within four hours of reduction. Pre- and post-QI outcomes were compared for index encounters and any additional encounter beginning within 24 h of discharge. An economic evaluation was performed with hospital costs inflation-adjusted to 2020 United States Dollars ($). Cost differences between groups were assessed using multivariable regression, adjusting for Medicaid and transfer status, P < 0.05 significant. ResultsOf 90 patients, 37(41%) were pre-QI and 53(59%) were post-QI. Patients were similar by age, sex, race, insurance status, and transfer status. Pre-QI patients had a median LOS of 23.4 h (IQR: 16.1–34.6) versus 9.3 h (IQR 7.4–14.2) for post-QI patients, P < 0.001. Mean total costs per patient in the pre-QI group were $3,231 (95% CI, $2,442–$4,020) versus $1,861 (95% CI, $1,481–$2,240) in the post-QI group. The mean absolute cost difference was $1,370 less per patient in the post-QI group (95% CI, [-$2,251]–[-$490]). Five patients had an additional encounter within 24 h of discharge [pre-QI: 1 (3%) versus post-QI: 4 (8%), p = 0.7] with four having intussusception recurrence [pre-QI: 1 (3%) versus post-QI: 3 (6%), p = 0.6]. ConclusionsImplementation of a quality improvement initiative for the treatment of pediatric intussusception reduced hospital length of stay and costs without negatively affecting post-discharge encounters or recurrence rates. Similar protocols can easily be adopted at other institutions. Level of evidenceLevel III. Type of studyRetrospective comparative treatment study.

Recurrent intussusception as a rare clinical manifestation of intestinal malrotation in children\u2014a case report and review of literature

BackgroundMobile caecum along with malfixed small bowel mesentery in malrotation is incriminated to cause intussusception in children. This dual association is very rare and is labeled as Waugh’s syndrome. This is often missed during conservative management of intussusception and may manifest as chronic intussusception.Case presentationWe report a rare case of intestinal malrotation in a 13-year-old boy who presented as recurrent intussusception. The child was resuscitated and was operated, where malrotation of gut was detected. We discuss the clinical presentation, radiological findings, and management of this rare association in light of current available literature.ConclusionThe presence of mobile caecum and redundant bowel loops with narrow mesentery in case of malrotation is an important factor leading to intussusception.

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.

Invaginaciones intestinales en el adulto: localización, etiología, sintomatología y manejo terapéutico

ObjectiveIntestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. Materials and methodsThis retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged<16 years. Thus, 21 cases in adults (mean age, 57 y) were analyzed. ResultsThe most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumors were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). ConclusionsCT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its etiology and therapeutic management.