Neonatal Intussusception Research Articles

Ileoileal intussusception due to Meckel's diverticulum in a pre-term neonate

Presented is a case of ileoileal intussusception in a pre-term male born at 24 weeks gestation caused by a Meckel's diverticulum, which likely occurred in utero. Neonatal intussusception accounts for less than 1.3% of all intussusception cases and is exceedingly rare in premature infants [2]. Around 90% of pediatric intussusceptions involve the ileum telescoping into the cecum or ascending colon (ileocolic), however, ileoileal intussusception due to Meckel's diverticulum is less common [6]. The diagnosis of intussusception in the neonatal period requires a high index of suspicion and does not have any specific radiological findings or signs, in contrast to older children. Misdiagnosis leads to delay in treatment, which leads to intestinal perforation and necrosis [3]. Radiologic studies to help differentiate intussusception from other disease entities, including necrotizing enterocolitis (NEC). These studies include ultrasound, plain abdominal films, and air or contrast enema. Treatment of neonatal intussusception is primarily operative versus necrotizing enterocolitis(NEC) in which medical treatment can be considered initially. This case presentation reports an exceedingly rare cause of intestinal obstruction in a neonate and reminds clinicians to expand the differential diagnosis when consulted by the NICU.

Jejunal intussusception as a rare cause of newborn bowel obstruction

Neonatal intussusception is a rare cause of intestinal obstruction in the neonate, particularly in a newborn. It can present similar to necrotizing enterocolitis (NEC), with findings such as abdominal distension, feeding intolerance, and gastrointestinal bleeding. This often results in delayed diagnosis leading to increased morbidity and mortality. For jejunal intussusception, non-operative reduction may be attempted, but is not often successful, so surgical intervention is usually required. While newborn presentation is out of the typical age for idiopathic intussusception without a lead point and a lead point should be assessed for, it may be idiopathic. Although rare, intussusception should be in the differential for bowel obstruction in the neonatal period. X rays and contrast studies may suggest obstruction and it can be reliably diagnosed with abdominal ultrasound (US). We present a case of an early near term neonate presenting with bilious emesis in first 24 hours of life, with contrast studies concerning for proximal obstruction, who on surgical exploration was found to have an isolated jejuno-jejunal intussusception.

Intussusception in preterm neonates: A systematic review of a rare condition

BackgroundWhile necrotizing enterocolitis (NEC) is a prevalent condition in preterm neonates admitted to neonatal intensive care unit (NICU), intussusception is exceedingly uncommon and often overlooked. This is due to the fact that they share many clinical characteristics. The initial misdiagnosis of intussusception in preterm neonates (IPN) especially has led to a delay in their management, which increases the risk of developing compromised bowel. Additionally, it is difficult to reach a diagnosis as neonatal intussusception does not have any classical radiological signs even when contrast enema is used. This systematic review is based on the published literature including case reports and case series to review the clinical features of IPN and how to differentiate it from NEC in order to shed the light on this rare disease and how having a high index of suspicion would help practitioners to make an early and accurate diagnosisMethodsA systematic literature search to report all cases of relevant articles that reported IPN till date. All cases that were born before 37 weeks gestational age, presented within the neonatal period and having well established documentation were included in the study. Any case that did not have these criteria was excluded from our study.ResultsOnly 52 cases met these criteria during the period from 1963 till date. An average of 10 days had elapsed before the cases were confirmed to have IPN either clinically or intraoperatively. The most frequent manifestations were abdominal distension and bilious gastric residuals, occurring in 85% and 77% of the cases respectively, followed by bloody stools in 43% of cases. However, this triad was present only in approximately one-third of the cases. Only 13 cases were diagnosed as having intussusception preoperatively. About two thirds of the intussusception were located in the ileum. Pathological lead point was present in 7 cases only; 4 of them were due to Meckel’s diverticulum. Nine cases only out of the 52 cases with IPN died.ConclusionIt is crucial to detect the clues for diagnosis of intussusception because in contrast to NEC, it is unresponsive to conservative management, affects the viability of the bowel and surgery is essential.

Neonatal intussusception secondary to intestinal duplication cyst: A case report

Background: Intussusception is a rare cause of bleeding per rectum in neonates. Duplication cyst as a pathological lead point for intussusception is rarer too. Case Presentation: A female neonate presented with bilious vomiting and bleeding per rectum. Ultrasonography diagnosed it as intussusception. Intraoperatively, on reduction of intussusception, a mass was found which on histopathological examination (HPE) revealed a duplication cyst. Conclusion: A high index of suspicion is required for an early diagnosis of neonatal intussusception, which is essential for preventing complications and mortality.

Intussusception in Neonates: Clinical Characteristics of Eight Cases in a Single Center

Intussusception in Neonates: Clinical Characteristics of Eight Cases in a Single Center

Jejuno-jejunal intussusception in a neonate without any lead point: A rare case report

Neonatal intussusception is rare entity.We report this very rare case of a term male newborn, with acute jejunojejunal intussusception without any lead point. He presented with abdominal distension and signs of intestinal obstruction and abdominal sonography showed a jejunojejunal intussusceptionswhich was confirmed at laparotomy. Interestingly, no lead point was found. Rather 8cm of bowel distal to intussuscepted segment was found to be gangrenous bowel. Resection with Bishop Koop anastomosis done for the baby resulted in good outcome. The case is being presented for rare presentation of a rare surgical condition in a neonate with an endeavour to establish etiology for its occurrence.

Bile Stained Vomiting in Neonates: Radiological and Surgical Correlation

Abstract Background: Bile stained vomiting in neonates is fre-quently encountered clinical symptom in pediatric practice. It is very important to examine them and exclude or confirm surgical condition. Aim of Study: This work is advocated to illustrate the spectrum of radiological findings in neonates with bile stained vomiting and correlate them with surgical data. Patients and Methods: All included neonates presented with bile stained vomiting were referred to Diagnostic Radi-ology Department at Sohag University Hospitals. Abdominal X-ray, abdominal ultrasound, Doppler and contrast imaging were done to identify the surgical causes of bilious vomiting with clinical and surgical correlation. The patients were treated surgically in Pediatric Surgery Unit at Sohag University Hospitals. Patients with bilious vomiting caused by non-surgical causes were excluded. Results: Our study included 31 bile stained vomiting neonates with age range from one day to 30 days and with male sex predominance (17 boys and 14 girls). Four patients were found to have necrotizing enterocolitis, 5 cases with mid-gut volvulus, 3 cases were found to have distal duodenal atresia, one case with duodenal stenosis, 5 cases with jejunal atresia, 4 cases with ileal atresia, 2 cases with congenital bands, 2 cases with complicated congenital inguinal hernias, 2 cases with meconium plug, 1 case with neonatal intussus-ception, 1 case with iatrogenic clamping of umbilical hernia and 1 case with anal stenosis. Imaging techniques were diagnostic in most of the cases and correlate with surgical findings. Conclusion: Bile stained vomiting in the newborn usually indicative of surgical conditions and needs surgical consulta-tion. Imaging studies are of utmost important to investigate and diagnose these cases before surgery.

Trans-anal protrusion of intussusception in a neonate

Abstract Intussusception in neonates is an exceedingly rare entity. The incidence of malrotation in cases of childhood intussusception is around 40%. However, there is no clear data on the incidence of such occurrence in a neonate. We describe a case of compound intussusception with intestinal malrotation in a neonate presenting as trans-anal prolapse.

Management of Intussusception in the Era of Ultrasound-Guided Hydrostatic Reduction: A 3-Year Experience from a Tertiary Care Center.

Introduction:Ultrasound-guided hydrostatic reduction (HSR) is currently the initial management tool in the treatment of intussusception. HSR is, however, confronted with failures besides there are still a number of patients who primarily undergo surgical intervention for the management of intussusception. We undertook this study to assess the efficacy of HSR and also to look for factors demanding the surgical exploration in patients with intussusception.Materials and Methods:A total of 215 patients with intussusception from June 2014 to June 2017 were prospectively studied. HSR was carried out in 203 patients, which was successful in 187 and unsuccessful in 16. These two groups were compared using the Student's t-test. Significance was set at P < 0.05. Twelve patients undergoing surgery primarily were also assessed for the factors affecting the decision-making.Results:HSR was successful in 187 and unsuccessful in 16. The failed group was more likely to have symptoms over 24 h, appearance of crescent, and ≥10-cm length on ultrasonography (USG). Two of these patients had ischemic bowel, two had ileoileal intussusception, and eight had pathological lead points, whereas no obvious cause could be identified in the rest of the four patients. Among the 12 patients who were primarily operated, four patients had peritonitis and other four patients were neonates. Laparoscopic reduction was done in four patients.Conclusion:HSR is a safe and effective treatment modality for intussusception. However, it is met with higher failure rates in patients with risk factors such as delayed presentation, appearance of crescent on USG, and length >10 cm. The role of HSR is also dubious in situations such as neonatal intussusception, small-bowel intussusception, and multiple intussusceptions and also in preventing the future recurrence. Such patients ought to be managed by laparotomy or where feasible by laparoscopy. Furthermore, before embarking on HSR, peritonitis and bowel ischemia should be ruled out clinically and radiologically. In the suspicious cases of bowel ischemia, USG Doppler may be helpful.

A Case of Neonatal Intussusception Treated by Enema Reduction on the Third Day of Life

A Case of Neonatal Intussusception Treated by Enema Reduction on the Third Day of Life

Neonatal Intussusception: A Review

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

Intussusception in a preterm newborn

Intussusception in a preterm newborn

A Rare Case of Neonatal Intussusception Caused by Cytomegalovirus

Intussusception in neonates is a rare representing less than 1% of all cases of intussusception and making up for less than 3% of neonatal bowel obstructions. Clinical features are vague, such as abdominal distension, bilious vomiting, and bloody stools, hence the possible misdiagnosis of necrotizing enterocolitis (NEC). It is most commonly ileoileal, compared with ileocolic in the older age groups.[1] In the absence of a definite lead point, the etiology of neonatal intussusception is mostly unknown with some evidence in the literature suggesting a link with different viral infections. Here, we present a unique case of intussusception caused by a cytomegalovirus (CMV) infection in a newborn twin.

Beckwith-Wiedemann Syndrome, Delayed Abdominal Wall Closure, and Neonatal Intussusception –Case Report and Literature Review

We present the extremely rare case of a male newborn with Beckwith-Wiedemann Syndrome (BWS) presenting as delayed abdominal wall closure and neonatal intussusception. Fetal ultrasound had shown omphalocele that resolved spontaneously. When feeding was attempted, he had various episodes of vomiting. An x-ray showed signs of high bowel obstruction. Jejunal intussusception was found on laparotomy. Enterectomy and primary jejuno-jejunal anastomosis was performed. During post-operative period subtle physical findings became prominent: plain hemangioma, posterior helical indentations, and macroglossia. Cardiac ultrasonography showed a patent foramen oval with small left-to-right shunt. Ultrasonography showed renal hyperplasia. Genetic study showed hypomethylation of DMR2 region of 11p15 chromosome.

Neonatal intussusception: A rare but important condition to diagnose

Intussusception is one of the most common causes of intestinal obstruction in infancy but rarely occurs in the neonatal period. The presentation, pathology and management of neonatal intussusception are quite different from the usual childhood intussusception. Over a 2‐year period, we have managed three cases. We herein report our experience to highlight the diversity in presentation and management of neonatal intussusception.

An Analysis of characteristic of primary neonatal intussusception

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Intussusception in neonates: analysis of 14 Japanese patients.

To clarify the clinical features and pathogenesis of intussusception in neonates. Fourteen neonates were diagnosed with intussusception between June 1974 and January 2001. Patients were divided into two groups according to whether or not signs were present on the first day of life. The clinical features were interrelated with the pathological findings. All six patients in the group whose signs were present on the first day of life also had intestinal atresia or malrotation. Among patients whose signs began less than 24 h after birth, five of eight patients suffered hypoxia. Moreover, it was very difficult to establish the diagnosis of intussusception, particularly in the group of late-onset type intussusception. Hypoxic events may play a crucial aetiologic role in the pathogenesis of late-onset neonatal intussusception.

Clinical features and treatment outcome of intussusception in premature neonates

Background/Purpose: Less than 1.3% of all cases of intussusception occur in term neonates. Intussusception in premature neonates (IPN) is exceedingly rare. Its rarity and difficulty to differentiate IPN from common neonatal diseases like necrotizing enterocolitis (NEC) often delays its diagnosis. The authors set out to characterize diagnosis, treatment, and outcome of this rare condition. Methods: The authors analyzed 2 new cases of IPN and 33 previously reported cases from the literature. Results: The 35 patients with IPN had an average gestational age, postconceptual age at diagnosis, and birth weight of 28.4 ± 0.6 weeks (all data, mean ± SEM), 31.1 ± 0.5 weeks, and 1,165 ± 21 g, respectively. Gastrointestinal symptoms first presented at age 8 ± 1 days. A preoperative diagnosis of NEC was assumed in 24 patients, delaying diagnosis by 10 ± 2 days. Intussusception was diagnosed radiographically in 2 patients (1 contrast enema and 1 ultrasound scan) and during surgery or autopsy in the remainder. Resection was reported in 28 patients for bowel that was irreducible, necrotic, or perforated. The overall mortality rate was 20%, mainly owing to sepsis. Conclusions: Intussusception in the premature neonate often is misdiagnosed as NEC, delaying operative intervention. Contrast enema has limited diagnostic capability. Early diagnosis may be achieved with use of ultrasound scan. Intussusception can be treated successfully with resection and primary anastomosis, achieving good results.

Sonographic Diagnosis of Neonatal Intussusception with Perforation in a Premature Neonate

Sonographic Diagnosis of Neonatal Intussusception with Perforation in a Premature Neonate

The clinical implications of non-idiopathic intussusception.

A pathological lesion can be identified at the leadpoint of intussusception in about 6% of episodes. Occasionally, general manifestations of an underlying disease indicate the specific cause of an intussusception (e.g., perioral pigmentation in Peutz-Jeghers syndrome), but usually the clinical features provide no clues as to the aetiology. Neonatal intussusception may be caused by a duplication cyst or Meckel's diverticulum. Beyond 12 months, the proportion of intussusceptions due to a pathological lesion at the leadpoint increases with age. There is an identifiable lesion in the majority of children over 5 years of age. Postoperative intussusception accounts for between 0.5% and 16% of intussusceptions, although it has a variety of causes; it typically follows retroperitoneal dissection. It is unusual for an intussusception due to a pathological lesion at the leadpoint to be reduced by enema. If it is reduced, the lesion may be seen at the time of reduction or fluoroscopy, or subsequently on ultrasonography.