Recurrent Intussusception Research Articles

Developing a nomogram to predict recurrent intussusception after pneumatic reduction of primary intussusception in children

BackgroudIntussusception is a common acute abdominal disease in children, often leading to acute ileus in infants and young children.ObjectiveThis study aimed to develop and validate a nomogram for predicting recurrent intussusception in children within 48 h after pneumatic reduction of primary intussusception.MethodsClinical data of children with acute intussusception admitted to multiple hospitals from March 2019 to March 2021 were retrospectively analyzed. The children were divided into a successful reductioncontrol group (control group) and a recurrent intussusception group (RI group) according to the results of pneumatic reduction.ResultsA total of 2406 cases were included in this study, including 2198 control group and 208 RI group. In the total sample, 1684 cases were trained and 722 cases were verified. A logistic regression analysis was conducted to establish a predictive model based on age, abdominal pain time, white blood cells count, and hypersensitive C-reactive protein levels as independent predictors of intussusception recurrence. The nomogram successfully predicted recurrent intussusception after pneumatic reduction.ConclusionIn this study, a nomogram was developed based on clinical risk factors to predict recurrent intussusception following pneumatic reduction in children. Age, abdominal pain time, white blood cell counts, and hypersensitive C-reactive protein levels were identified as predictors and incorporated into the nomogram. Internal validation demonstrated that this nomogram can offer a clear and convenient tool for identifying risk factors for recurrence of intussusception in children undergoing pneumatic reduction.

Classic triad of intussusception in patients aged 0 to 2 years in a tertiary hospital

Intussusception is an infantile abdominal emergency where one portion of the intestine is introduced into another, varying its incidence according to the region. This study will focus on characterizing and analyzing cases of intussusception in children treated at the Antiguo Hospital Civil of Guadalajara "Fray Antonio Alcalde" between 2019 and 2024. The aim is to quantify the cases, describe the symptoms, and identify seasonal patterns. Methods: A total of 82 children aged 0 to 2 years with a diagnosis of intussusception were included in the Antiguo Hospital Civil Hospital of Guadalajara "Fray Antonio Alcalde", from January 1, 2019 to May 31, 2024. Sex, age, symptoms, type of management implemented, type of research, recurrent intussusception, association between therapeutic management and recurrent intussusception were reviewed, seasonal pattern, mortality. Results: A total of 82 children aged 0 to 2 years, with a median age of 7 months, were included. 50% were boys and 50% girls. 65 presented vomiting, 62 abdominal pain and 75 bloody stools; 6 children showed a single symptom, 32 had two, and 44 exhibited the complete triad. Use of laparotomy in 48.8% of cases, hydroenema in 28%. Ileoechocolic intussusception was the most common (50%), followed by ileocolic (40%). A seasonal pattern was observed, with 49 cases in the first six months of the year, with February standing out with 10 cases. Fisher's exact test showed a moderate association between therapeutic management and recurrence of intussusception (p=0.018). There was a mortality rate of 24.39%.

Searching for a Lead: Diagnosing a Rare Cause of Recurrent Intussusception.

Searching for a Lead: Diagnosing a Rare Cause of Recurrent Intussusception.

Non-Hodgkin’s lymphoma as a cause of intussusception: a case report

Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment. This condition is frequent in children and presents with the classic triad of cramping abdominal pain, bloody diarrhea and a palpable tender mass. Secondary intussusception is caused by organic lesions, such as Meckel’s diverticulum, benign and malignant lesions, metastatic neoplasms or sometimes iatrogenically. Surgery is the definitive treatment of secondary intussusception. Formal bowel resection with oncological principles is followed for every case where a malignancy is suspected. A ten-year-old female presented to the casualty with severe pain in abdomen associated with 1 episode of blood in stools diagnosed with intussusception. She was taken for emergency laparotomy, and no lead point was identified. She presented with recurrent intussusception and was taken for re-exploration, when a definitive approach was opted for, and she underwent a resection of the obstructed bowel at the ileo-caecal junction and an ileo-ascending anastomosis. On histopathology, the ileo-caecal junction showed a proliferative, circumferential mass which was confirmed to be a diffuse large B cell lymphoma. It is uncommon for pediatric intussusception to result from a neoplasm. It takes imaging modalities to make the diagnosis. Surgical intervention is required as soon as a suspicion is raised in order to avoid consequences such gut necrosis and ischemia.

Epidemiology, clinical features, and outcomes of intussusception in young children: A tertiary center experience

Background: Intussusception in young and old children is different. A study of clinical features, associations, and outcomes of these cases would enhance understanding to guide proper management. Objectives: Analysis of the epidemiology, associations, clinical features, and management outcomes of intussusception in children younger than 2 years. Patients and Methods: A retrospective descriptive study on intussusception patients younger than 2 years was conducted from January 2018 to December 2022 in the department of pediatric surgery at a tertiary center. Demographic details, clinical features, and management outcomes data were collected and analyzed. Results: A total of patients were 133 with mean, median, and modal age of 9.5, 7, and 6 months, respectively; the maximum incidence was in March. 81.95% of cases were idiopathic; important lead points were Meckel diverticulum, inflamed appendix, roundworm, cecal duplication, and intraluminal polyps. Two postoperative cases occurred in Wilms’ tumor and congenital diaphragmatic hernia patients, whereas two postrotavirus vaccination cases were seen. Ten (7.5%) had associated malrotation which necessitated Ladd’s procedure. Only 15 cases presenting early responded to nonoperative treatment (9/15 hydrostatic reduction and 6/15 conservative management); among late presenters, 12.71% had manual reduction, 68.64% had resection and anastomosis while in 16.95%, temporary stoma was needed. Wound infection, burst abdomen, subacute intestinal obstruction, recurrent intussusception, peristomal excoriation, and stomal prolapse were a few complications along with one death. Conclusion: Intussusception in children younger than 2 years is a heterogeneous group. Although mostly idiopathic, several associations and well-defined lead points require additional intervention. Early diagnosis and prompt intervention ensure a favorable outcome with fewer complications.

Impact of a 6–12-h delay between ileocolic intussusception diagnostic US and fluoroscopic reduction on patients’ outcomes

BackgroundImage-guided reduction of intussusception is considered a radiologic urgency requiring 24-h radiologist and technologist availability.ObjectiveTo assess whether a delay of 6–12 h between US diagnosis and fluoroscopic reduction of ileocolic intussusception affects the success frequency of fluoroscopic reduction.Materials and methodsRetrospective review of 0–5-year-olds undergoing fluoroscopic reduction for ileocolic intussusception from 2013 to 2023. Exclusions were small bowel intussusception, self-reduced intussusception, first fluoroscopic reduction attempt>12 h after US, prior bowel surgery, inpatient status, and patient transferred for recurrent intussusception. Data collected included demographics, symptoms, air/contrast enema selection, radiation dose, reduction failure, 48-h recurrence, surgery, length of stay, and complications. Comparisons between<6-h and 6–12-h delays after ultrasound diagnosis were made using chi-square, Fisher’s exact test, and Mann–Whitney U tests (P< 0.05 considered significant).ResultsOf 438 included patients, 387 (88.4%) were reduced in <6 h (median age 1.4 years) and 51 (11.7%) were reduced between 6 and 12 h (median age 2.05 years), with median reduction times of 1:42 and 7:07 h, respectively. There were no significant differences between the groups for reduction success (<6 h 87.3% vs. 6–12 h 94.1%; P-value = 0.16), need for surgery (<6 h 11.1% vs. 6–12 h 3.9%; P-value=0.112), recurrence of intussusception within 48 h after reduction (<6 h 9.3% vs. 6–12 h 15.7%; P-value=0.154), or length of hospitalization (<6 h 21:07 h vs. 6–12 h 20:03 h; P-value=0.662).ConclusionA delay of 6–12 h between diagnosis and fluoroscopic reduction of ileocolic intussusception is not associated with reduced fluoroscopic reduction success, need for surgical intervention after attempted reduction, recurrence of intussusception following successful reduction, or hospitalization duration after reduction.Graphical

Post-reduction observation and recurrence of pediatric intussusception in New Zealand: A national multicenter retrospective study

BackgroundIntussusception is the most common cause of preschool intestinal obstruction. International data suggest that following uncomplicated enema reduction, 4-hour observation with prompt return to oral diet is safe. We aimed to investigate the rate and timing of intussusception recurrence across Aotearoa New Zealand, compared to the cost of routine post-reduction observation. MethodsWe performed a national 15-year retrospective, multicenter cohort study of all children treated for intussusception between 01 Jan 2007 and 01 Jan 2022 across AoNZ. A robust clinical dataset was collected using a REDCap proforma. We also investigated the financial and time costs of current in-hospital observation practices. ResultsDuring this period, primary enema reduction without general anesthetic was successful in 339 cases, requiring a median of 2 attempts (1–8). The median age was 0.8 years; 70.8% were male, and 17.1% were Māori. The median length of hospital stay was 25.9 h, primarily comprised of post-reduction observation (21.6 h). Intussusception recurrence within 30 days occurred in 29 children (8.5%) at a median time of 24.7 h post-reduction. Of the 19 cases recurring before discharge, 12 (3.5%) recurred between 4 and 24 h. The median observation period for those with successful primary enema reduction was 21.6 h; if reduced to 4 h, savings of NZD 883,632 (USD 529,825) and 7342 ward hours were possible. ConclusionsNationally, the intussusception recurrence rate after uncomplicated enema reduction was 8.5%, but only 3.5% occurred between the 4–24 hour period post-reduction. Expediting discharge by avoiding routine overnight observation appears safe and economically viable.

Peutz-Jeghers syndrome: management for recurrent intussusceptions.

Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder characterized by hamartomatous gastrointestinal polyps along with the characteristic mucocutaneous freckling. Multiple surgeries for recurrent intussusception in these children may lead to short bowel syndrome. Here we present our experience of management in such patients. From January 2015 to December 2023, we reviewed children of PJS, presented with recurrent intussusceptions. Data were collected regarding presentation, management, and follow-up with attention on management dilemma. Diagnosis of PJS was based on criteria laid by World Health Organization (WHO). A total of nine patients were presented with age ranging from 4 to 17years (median 9years). A total of eighteen laparotomies were performed (7 outside, 11 at our centre). Among 11 laparotomies done at our centre, resection and anastomosis of bowel was done 3 times while 8 times enterotomy and polypectomy was done after reduction of intussusception. Upper and lower gastrointestinal endoscopy (UGIE & LGIE) was done in all cases while intraoperative enteroscopy (IOE) performed when required. Follow-up ranged from 2months to 7years. Children with PJS have a high risk of multiple laparotomies due to polyps' complications. Considering the diffuse involvement of the gut, early decision of surgery and extensive bowel resection should not be done. Conservative treatment must be tried under close observation whenever there is surgical dilemma. The treatment should be directed in the form of limited resection or polypectomy after reduction of intussusception.

Recalcitrant intussusception: exploring potential associations with Helicobacter pylori infection - a case report and literature review

BackgroundIntussusception, a common cause of abdominal pain in children, often lacks clear underlying causes and is mostly idiopathic. Recurrence, though rare, raises clinical concerns, with rates escalating after each episode. Factors like pathological lead points and Henoch-Schönlein purpura (HSP) are associated with recurrent cases. On the other hand, the prevalence of Helicobacter pylori (H. pylori), often asymptomatic, in children has been declining. Although its infection is reported to be linked with HSP, its role in recurrent intussusception remains unexplored. Further research is needed to understand the interplay among H. pylori (culprit pathogen), HSP (trigger), and intractable intussusception so as to develop effective management strategies.Case presentationA two-year-old girl experienced four atypical episodes of intussusception at distinct locations, which later coincided with HSP. Despite treatment with steroids, recurrent intussusception persisted, suggesting that HSP itself was not a major cause for intractable presentations. Subsequent identification of H. pylori infection and treatment with triple therapy resulted in complete resolution of her recalcitrant intussusception.ConclusionThis instructive case underscored a sequence wherein H. pylori infection triggered HSP, subsequently resulting in recurrent intussusception. While H. pylori infection is not common in young children, the coexistence of intractable intussusception and steroid-resistant recurrent HSP necessitates consideration of H. pylori infection as a potential underlying pathogen.

Epidemiological characteristics, treatment, and outcomes of 586 cases of intussusception: a 4-year retrospective study in China.

This study aims to retrospectively analyze the epidemiological and clinical characteristics of acute intussusception in a tertiary-care pediatric hospital in China over 4 years and evaluate the effectiveness and recurrence of fluoroscopy-guided pneumatic reduction (FGPR) and ultrasound-guided hydrostatic reduction (UGHR). This retrospective study was conducted from January 2019 to December 2022 involving children admitted and managed for acute intussusception in a tertiary-care pediatric hospital in China. The epidemiology, clinical features, and therapeutic effects were analyzed using IBM SPSS Statistics 20.0. The study included 401 boys (68.43%) and 185 girls (31.57%) aged from 2 months to 12 years. The most common symptoms reported were abdominal pain or paroxysmal crying (95.73%), vomiting (45.39%), and bloody stool (7.34%). Vomiting and bloody stool became atypical with increasing age (P < 0.001). The total success cases of reduction accounted for 563 cases (96.08%), and the recurrent cases accounted for 71 cases (12.12%). No significant difference was observed in the success or recurrence rates between FGPR and UGHR (P > 0.05). Abdominal pain was an independent protective factor for successful enema (P < 0.01, OR = 72.46), while bloody stool (P < 0.01, OR = 0.06) and older age were independent risk factors (P < 0.001, OR = 0.51). Of the 71 patients with recurrent intussusception, 29 were successfully reduced by enema, and the other 23 required surgical reduction. Twelve of the surgical cases were secondary intussusception, including three cases of Meckel's diverticulum, five cases of polyps, and four cases of non-Hodgkin lymphoma. The epidemiological characteristics of children with intussusception in Xiamen showed peculiarity with a higher male-to-female ratio, older age at diagnosis, and no significant seasonality. Both FGPR and UGHR were effective and safe for intussusception, and surgical reduction was essential for patients with failed enema reduction.

Role of laparoscopy in recurrent pediatric intussusceptions: systematic review

Role of laparoscopy in recurrent pediatric intussusceptions: systematic review

Risk factors and predictive models for early recurrent intussusception in children: a retrospective cohort study.

Early recurrent intussusception (ERI) in children is common and seriously affects the physical and mental health of the children. There are few reports discussing risk factors for ERI in children, and this study aims to identify risk factors for ERI in children and build predictive models. We conducted a retrospective study of 787 children with no relapse intussusception (NRI) and 82 children with ERI between January 2011 and December 2021. Univariate and multifactorial stepwise logistic regression analysis was used to analyze the correlation between 11 factors and ERI, to determine the independent risk factors for ERI in children. The prediction model was established by independent risk factors and then verified. Age, vomiting, bloody stools, and monocyte ratios were independently correlated with the composite endpoint (P<0.05). A nomogram was constructed and a calibration curve was plotted, using independent risk factors. Based on the disease's diagnostic score, the predictive model's performance was validated by using logistic regression receiver operating characteristic (ROC) curve detection, with area under the curve (AUC) value of 0.883 [95% confidence interval (CI): 0.846-0.920], and the calibration curve was close to the ideal diagonal line. In addition, the decision curve analysis (DCA) showed that the model had significant net benefits. Independent risk factors for ERI in children are age, vomiting, bloody stool, and monocyte ratio. Children older than 1 year in age, who lacked vomiting and bloody stool symptoms, and who exhibited an elevated ratio of monocytes were more likely to relapse early. The predictive model constructed herein can predict the early recurrence of children with ERI, providing a reference for clinicians' individualized judgments.

Patient Outcomes After Robotic Ventral Rectopexy With Sacrocolpopexy.

As few studies exist examining postoperative functional outcomes in patients undergoing robotic sacrocolpopexy and ventral rectopexy, results from this study can help guide surgeons in counseling patients on their outcomes. The aim of the study was to evaluate functional outcomes and overall postoperative satisfaction as measured by the Pelvic Floor Disability Index 20 (PFDI-20), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and Patient Global Impression of Improvement Scale (PGI-I) in patients who underwent combined robotic ventral rectopexy and sacrocolpopexy for concomitant pelvic organ prolapse (POP) and rectal prolapse or intussusception (RP/I). This was a retrospective cohort and survey study of patients with combined POP and RP/I who underwent the previously mentioned surgical repair between January 2018 and July 2021. Each patient was contacted to participate in a survey evaluating postoperative symptoms related bother, sexual function, and overall satisfaction using the PFDI-20, PISQ-12, and PGI-I. A total of 107 patients met study inclusion criteria with 67 patients completing the surveys. The mean age and body mass index were 63.7 ± 11.5 years and 25.0 ± 5.4, respectively. Of the patients, 19% had a prior RP repair and 23% had a prior POP repair. Rectal prolapse or intussusception recurrence was reported in 10.4% of patients and objective POP recurrence was found in 7.5% of patients. Sixty-seven patients (62%) completed the surveys. The median time to survey follow-up was 18 (8.8-51.8) months. At the time of survey, the mean PFDI-20 score was 95.7 ± 53.7. The mean PISQ-12 score for all patients was 32.8 ± 7.2 and the median PGI-I score was 2.0 (interquartile range, 1.0-3.0). In this cohort of patients who underwent a combined robotic ventral rectopexy and sacrocolpopexy, patient-reported postoperative symptom bother was low, sexual function was high, and their overall condition was much improved.

Ultrasound-guided pneumatic reduction of intussusception in children: 15-year experience in a tertiary children's hospital.

International practice regarding the method used to nonoperatively reduce pediatric intussusception is variable. To provide an overview of ultrasound-guided pneumatic intussusception reduction and assess its safety and effectiveness. A single-center prospective study was conducted in a tertiary referral pediatric hospital during the 15-year period between January 2008 and February 2023. All patients with ileocolic intussusception underwent abdominal sonographic examination for diagnosis. An ultrasound-guided pneumatic reduction of intussusception was then attempted. Children who were hemodynamically unstable, with signs of peritonitis or bowel perforation and those with sonographically detected pathologic lead points were excluded. A total of 131 children (age range 2months to 6years) were enrolled in this study. Pneumatic intussusception reduction was successful in 128 patients (overall success rate 97.7%). In 117 patients, the intussusception was reduced on the first attempt and in the remaining on the second. In three cases, after three consecutive attempts, the intussusception was only partially reduced. As subsequently surgically proven, two of them were idiopathic and the third was secondary to an ileal polyp. No bowel perforation occurred during the reduction attempts. There was recurrence of intussusception in three patients within 24h after initial reduction which were again reduced by the same method. Ultrasound-guided pneumatic intussusception reduction is a well-tolerated, simple, safe and effective technique with a high success rate, no complications and no ionizing radiation exposure. It may be adopted as the first-line nonsurgical treatment of pediatric intussusception.

Recurrence of pediatric intussusception: A nationwide population-based descriptive study in Taiwan.

Intussusception is frequently observed pediatric emergency that is often followed by recurrent intussusception after initial treatment. This study investigated the risk factors associated with recurrent intussusception in children aged ≤ 3 years. Between January 2007 and December 2015, a cohort study was conducted by linking the Taiwan Maternal and Child Health Database to the Birth Certificate Application database and the National Health Insurance Research Database in Taiwan. Patients aged ≤ 3 years with intussusception diagnosis and related treatment were included in our study. Multivariable logistic regression was used to analyze the risk factors associated with recurrent intussusception. In total, 5341 children with intussusception aged ≤ 3 years were enrolled in our cohort. The adjusted odds ratio (aOR) for recurrent intussusception in children aged 2 to 3 years was 0.62 (95% confidence interval [CI]: 0.47-0.82) compared with children aged < 1 year, and surgery decreased the risk of recurrent intussusception (aOR = 0.64, 95% CI: 0.46-0.88). Male patients had higher risk of recurrent intussusception than female patients had (aOR = 1.41, 95% CI: 1.13-1.75). Higher birth weight may increase the risk of recurrent intussusception, but this association was not statistically significant. Furthermore, gestational age did not seem to affect the risk of recurrent intussusception. Surgical treatment and delayed onset of intussusception are associated with a reduced risk of recurrent intussusception; males are associated with increased risk of recurrent intussusception. In addition, we suggest that in early infancy, patients who received non-surgical treatment as the initial treatment for intussusception should be closely followed up for potential recurrence of intussusception.

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.

Endoscopic debulking of a large colonic lipoma causing recurrent intussusception using endoscopic mucosotomy technique.

Endoscopic debulking of a large colonic lipoma causing recurrent intussusception using endoscopic mucosotomy technique.

Th2/Th1 cytokine imbalance is associated with higher recurrent intussusception incidence in children: A 10-year retrospective study of 1657 patients.

Recurrent intussusception is one of the common acute abdominal diseases in infants, which seriously affects the physical and mental health of infants, but its risk factors have not been fully clarified. The objective of this study was to evaluate the relationship between Th2/Th1 cytokine imbalance and recurrent intussusception, so as to provide a theoretical basis for making a more comprehensive treatment strategy for patients with recurrent intussusception. A retrospective study was conducted between July 2012 and September 2022, enrolling patients with intussusception in Children's Hospital of Hebei Province. The patients were divided into recurrent group and non-recurrent group according to whether they suffered from recurrent intussusception. We summarized the clinical characteristics of recurrent intussusception and explored the role of T helper 2 (Th2)/T helper 1 (Th1) cytokine imbalance in it. A total of 2008 patients were initially enrolled and finally 1657 patients qualified for the study. The results showed that the incidence of recurrent intussusception was 18.41% and the Th2/Th1 cytokine imbalance was closely related to the incidence of recurrent intussusception. Th2/Th1 cytokine imbalance is a potential risk factor of recurrent intussusception and more likely to occur in children between the ages of 2 and 3. Future studies are needed to preemptively target the Th2/Th1 cytokine imbalance to formulate a reasonable treatment plan for children with intussusception to avoid recurrence.

Duodenal intussusception due to periampullary duodenal adenoma: A case report

Duodenal intussusceptions are uncommon due to their fixed location in retroperitoneum except when associated with bowel malrotation abnormalities. We present a case of recurrent duodenojejunal intussusception in a 34-year-old female diagnosed on imaging. The lead point, in our case, was periampullary duodenal tubulovillous adenoma which was confirmed on endoscopy and subsequent punch biopsy. The patient underwent segmental duodenal resection anastomosis preserving the ampulla with reduction of the intussuceptum and fixation of the jejunal loops and its mesentery.

Endoscopic fenestration treatment for pneumatosis cystoides intestinalis in patient with recurrent colonic intussusception.

Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by intestinal mural pneumatized cysts that appear most commonly in the colon [1] [2]. Although primarily asymptomatic, PCI occasionally causes intussusception that usually requires surgical treatment [3] [4]. Hyperbaric or high-concentration oxygen therapy is reportedly effective, though complete remission is uncertain [5]. We present the first report of an endoscopic fenestration procedure used for successful treatment of PCI with recurrent intussusception.