Recurrent Intussusception Research Articles

Enema-Reduced Intussusception Management

To describe the demographic and clinical characteristics of hospitalized children with enema-reduced intussusception and to determine the necessity of hospitalization. Retrospective cross-sectional study of patients (0-17 years of age) with enema-reduced intussusception hospitalized at a 110-bed urban children's hospital. For this study, potential necessity of hospitalization was defined as the presence of associated dehydration, persistent symptoms and signs of intussusception requiring repeated radiographic studies, and/or enema-reduced serious complications (bowel perforation and/or sepsis). For a 12-year period (January 1995 to December 2006), 45 patients who had enema-reduced intussusception were hospitalized. There were 32 males (71%). Three (6.7%) of the 45 patients had recurrent episodes of intussusception occurring at 2, 7, and 45 months after the initial episode. The initial episode for only 1 of these 3 was an enema-reduced hospitalization event. Thus, the following results include 46 episodes among 45 patientsThe mean (SD) age at the time of intussusception was 19.6 (25.4) months, and the median age was 10 months (range, 2-135 months). There were 27 episodes (59%) of patients 12 months or younger. The types of intussusception were ileocolic, 44 and ileoileum, 2. In 13 episodes (28%), patients were described as dehydrated and/or having an abnormal basic metabolic panel test result and meeting one of the study criteria for potential necessity of hospitalization. During the hospitalization, enema was repeated in 1 patient (2%) who had recurrent pain. The repeated enema was normal. No patient had a recurrent intussusception or developed signs of bowel perforation or sepsis while hospitalized. The mean (SD) hospital length of stay was 25.6 (9.9) hours, and the median time was 23 hours (range, 12-60 hours). Hospitalized children with enema-reduced intussusception required minimal interventions, had a low rate of signs and symptoms requiring further radiographic studies, and had no enema-reduced serious complications during hospitalization. These results support outpatient management as an acceptable alternative.

Contrast enema for pediatric intussusception: is reflux into the terminal ileum necessary for complete reduction?

Purpose Complete contrast enema reduction of intussusception is traditionally considered confirmed when contrast is seen refluxing into the terminal ileum. Operative intervention is typically indicated when the intussusception is not completely reduced. This study reviews the outcomes after symptomatic reduction of intussusception without requiring reflux of contrast into the terminal ileum. Methods A retrospective review of all pediatric patients treated for intussusception between 1996 and 2006 was performed. Diagnostic modality, operative reports, and hospital records were reviewed. Results One hundred sixty-eight patients were treated for intussusception during the study period. Median age was 9.9 months (59 days to 16.7 years). One hundred thirty-seven (81.5%) patients underwent contrast enema as the initial diagnostic/therapeutic modality. On contrast enema, 15 (10.9%) patients demonstrated reduction of the intussusception but without contrast refluxing into the terminal ileum. All 15 patients had improvement of symptoms. Six (40%) patients underwent operative intervention and were found to have a completely reduced intussusception. Two (13.3%) patients had repeat contrast enema the next day confirming complete reduction. The remaining 7 (46.7%) patients were observed without further radiographic studies, and all 7 patients were discharged the following day tolerating full feedings. There were no recurrent intussusceptions. Conclusion Nonoperative management may be used in patients with reduced intussusception despite lack of contrast refluxing into the terminal ileum if symptoms resolve.

Clinical Analysis of Recurrent Intussusception and the Pathologic Lead Point in a Single Center

Clinical Analysis of Recurrent Intussusception and the Pathologic Lead Point in a Single Center

Childhood intussusception in north eastern Nigeria: a review of its surgical management

Background: Intussusception is the commonest cause of intestinal obstruction in the 3 months to 2 years age group. Adequate awareness of its presenting features is important for an early diagnosis and treatment. Aim: To present an experience of its surgical management in Nigerian infants and children. Setting: The University of Maiduguri Teaching Hospital. Methods: A retrospective study of patients with intussusception seen and treated between January 1999 and December 2002 was done. Their case files were studied for age, sex, presentation, definitive treatment and outcome of treatment. These were analyzed using tables. Results: Thirty-seven infants and children were seen during the study period. There were 24 males (64.8%) and 13 females (35.1%). The male to female ratio was 1.8:1. The mean age was 14.7 ± 22.61 months (range 2 months - 8 years). Twenty-two (59.4%) of the patients were aged between 3 and 9 months and 25 (67.5%) were below one year. The commonest presenting symptoms were abdominal pain (86.4%), vomiting (75.6%) and palpable abdominal mass (54.0%). Twenty-one patients (56.7%) presented to hospital latter than 72 hours from the onset of symptoms. At laparotomy, the commonest type of intussusception was ileocolic (48.6%). Twenty-three (62.1%) patients had simple manual reduction while 14 (37.8%) had bowel resection and anastomoses. There was no recurrence of intussusception after a mean follow-up of 27.8 ± 29.5 weeks. The mortality rate was 16.2%. Conclusion: Intussusception is a common cause of intestinal obstruction in infants and children in this environment. Late presentation is common and accounts for the high mortality. Outcome of treatment can be improved with high index of suspicion Keywords: Intussusception, Infants, Childhood, Surgical and non-surgical reductionPort Harcourt Medical Journal Vol. 3 (1) 2008: pp. 27-31

Intérêt de la corticothérapie dans l’invagination intestinale aiguë sur hyperplasie nodulaire lymphoïde du grêle (iléite folliculaire)

We report a case of recurrent intussusception in a 6-year-old boy associated with Intestinal Lymphoid Hyperplasia (ILH). A single course of steroids resulted in resolution of both symptoms and hyperplasia. We conclude that steroids treatment must be considered in recurrent intussusception associated with ILH and no other lead point identified (lymphoma or intestinal malformation) instead of a more radical surgical approach by a ileum resection.

Failure of appendectomy to resolve appendiceal intussusception

Appendiceal intussusception is a rare entity that primarily affects children. The optimal surgical management is not known. We describe a child with appendiceal intussusception treated by simple appendectomy who suffered recurrent intussusception of the cecum at the base of the appendiceal stump. He was cured by resection of a rim of cecum around the appendiceal staple line. Partial cecectomy with appendectomy may be the most effective operation for appendiceal intussusception.

Multiple Surgical Interventions Due to Recurrent Intussusception in a Patient with Henoch-Schönlein Purpura: A Case Report

Gastrointestinal (GI) symptoms in Henoch-Schönlein purpura (HSP) are common and occur in about two-thirds of patients. Surgical complications, while uncommon, are potentially severe. The preoperative diagnosis is based mainly on a high index of suspicion leading to imaging studies that may include abdominal sonography. We describe here the first case of a patient who developed recurrent intussusception attributed to HSP that led to repeated surgical interventions.

Early laparoscopy for ileocolic intussusception with multiple recurrences in children

The risks of subsequent episodes and a lead point are common problems in ileocolic intussusception with more than two recurrences. To decrease subsequent recurrence and to detect a lead point, an early laparoscopy was performed for children with ileocolic intussusception. This study enrolled six children with multiple recurrences of ileocolic intussusception from January 2004 to August 2007. Using a 5-mm laparoscope and two additional transabdominal wall stab incisions, an appendectomy and an ileocolonic pixie with nonabsorbable sutures were performed simultaneously for all the children after the last successful hydrostatic reduction. The mean operating time was 68.8 +/- 12.6 min (range, 55-86 min). There was no operative morbidity, and no lead point was found in any child. The mean follow-up period was 10.8 +/- 6.7 months (range, 2-20 months). No recurrence was observed during this period. The authors suggest that early intervention should be undertaken for ileocolic intussusception with multiple recurrences in children after the last nonsurgical reduction has been attempted successfully. Under this strategy, laparoscopy is an acceptable approach. It allows differentiation of a specific etiologic lesion, the possibility of incomplete reduction, and additional proximal invaginations. Later complications, such as repeat recurrence and associated surgical morbidity, also can be avoided.

Post operative recurrent acute jejuno-jejunal intussusception

A case of recurrent acute jejuno-jejunal intussusception presenting in the post operative period of the surgery for acute ileocolic intussusception is presented. Post operative intussusception is defined as intussusception occurring within 30 days of the primary surgery [1]. This is a rare entity. Jejuno-jejunal intussusception is also rare. Recurrent intussusception is uncommon. The present case is a combination of all these rarities.

Multiple primary small-bowel carcinomas presenting with anaemia and intussusception.

This case is unique because of the patient's presentation with multiple polypoidal high-grade primary adenocarcinomas. It highlights the role of computed tomography (CT) scanning in the diagnosis of recurrent intussusception presenting with sub-acute obstruction.

P-125 Treatment of recurrent intussusception(Poster Session Intussusception 2,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

P-125 Treatment of recurrent intussusception(Poster Session Intussusception 2,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

Results, Outcome Predictors, and Complications after Stapled Transanal Rectal Resection for Obstructed Defecation

Obstructed defecation may be treated by stapled transanal rectal resection, but different complications and recurrence rates have been reported. The present study was designed to evaluate stapled transanal rectal resection results, outcome predictive factors, and nature of complications. Clinical and functional data of 123 patients were retrospectively analyzed. All patients had symptoms of obstructed defecation before surgery and had rectocele and/or intussusception. Of them, 85 were operated on by the authors and 38 were referred after stapled transanal rectal resection had been performed elsewhere. At a median follow-up of 17 (range, 3-44) months, 65 percent of the patients operated on by the authors had subjective improvement. Recurrent rectocele was present in 29 percent and recurrent intussusception was present in 28 percent of patients. At univariate analysis, results were worse in those with preoperative digitation (P<0.01), puborectalis dyssynergia (P<0.05), enterocele (P<0.05), larger size rectocele (P<0.05), lower bowel frequency (P<0.05), and sense of incomplete evacuation (P<0.05). Bleeding was the most common perioperative complication occurring in 12 percent of cases. Reoperations were needed in 16 patients (19 percent): 9 for recurrent disease. In the 38 patients referred after stapled transanal rectal resection, the most common problems were perineal pain (53 percent), constipation with recurrent rectocele and/or intussusception (50 percent), and incontinence (28 percent). Of these patients, 14 (37 percent) underwent reoperations: 7 for recurrence. Three patients presented with a rectovaginal fistula. One other patient died for necrotizing pelvic fasciitis. Stapled transanal rectal resection achieved acceptable results at the cost of a high reoperation rate. Patients with puborectalis dyssynergia and lower bowel frequency may do worse because surgery does not address the causes of their constipation. Patients with large rectoceles, enteroceles, digitation, and a sense of incomplete evacuation may have more advanced pelvic floor disease for which stapled transanal rectal resection, which simply removes redundant tissue, may not be adequate. This, together with the complications observed in patients referred after stapled transanal rectal resection, suggests that this procedure should be performed by colorectal surgeons and in carefully selected patients.

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

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

Recurrent Intussusception and Gastrointestinal Bleeding Secondary to Gastric Heterotopia of the Small Intestine

Recurrent Intussusception and Gastrointestinal Bleeding Secondary to Gastric Heterotopia of the Small Intestine

Small Intestinal Mucosa Associated Lymphoid Tissue (MALT) Lymphoma in a Child Presenting with Recurrent Intussusception: A Case Report

Mucosa associated lymphoid tissue (MALT) lymphoma is a malignant B cell lymphoma that develops from MALT. The stomach is the most common site of MALT lymphomas but be found anywhere in the body. Adult MALT lymphomas are not rare diseases, but in children, intestinal MALT lymphomas are very rare. We treated a 12-year-old boy who underwent segmental resection of the small intestine due to recurrent intussusceptions, 2 months apart, and was diagnosed with an intestinal MALT lymphoma. He received multiple chemotherapeutic agents (vincristin, cyclophosphamide, prednisone, methotrexate, doxorubicin and cytosine arabinoside) according to the CCG-5961 protocol for 3 months. Currently, he

Jejunal and Multiple Mesenteric Calcifying Fibrous Pseudotumor Induced Jejunojejunal Intussusception

We describe here a patient with an unusual presentation--mesenteric calcifying fibrous pseudotumor in association with jejunojejunal intussusception. This 25-year-old woman came to our emergency department with severe abdominal distension and intermittent epigastric cramping pain. She was found to have rebound tenderness and an ill-defined mass palpable in her lower abdomen. Abdominal computed tomography revealed an inhomogeneous soft tissue mass with target sign and intussusception of small intestine was suspected. Emergency laparotomy showed jejunojejunal intussusception involving ~30cm of jejunum with multiple tumors on the mesentery surface extending over the whole bowel mesenteric and peritoneal surfaces. One of the mesenteric tumors formed the leading point of the intussusception. Segmental resection of jejunum with primary anastomosis was done. Some larger tumors were resected but most of the other tumors were left in place because they were small and numerous and total resection was impossible. Pathology confirmed that the lesions were benign mesenteric calcifying fibrous pseudotumors. In such patients, surgery might be curative. If a large segment of the bowel is affected by calcifying fibrous pseudotumor, smaller pseudotumors might be left in place because these tend to be asymptomatic. But they might become the leading points of recurrent intussusception.

Ileal Duplication Causing Recurrent Intussusception

Intestinal duplications are rare congenital lesions that can develop anywhere along the alimentary tract. Symptoms usually appear during the first year of life and are varied. Diagnosis is difficult to achieve, and surgery is required for treatment. Here the case of a 6-month-old male with history of recurrent intussusception is reported. Surgery was indicated, and an ileal duplication was found. Intestinal duplication is discussed based on its epidemiology, clinical presentation, diagnosis, and treatment.

Double-balloon endoscopy: Extending the arm of the gastroenterologist

Double-balloon endoscopy: Extending the arm of the gastroenterologist

Recurrent ileocolic intussusception after different surgical procedures in children

Intussusception in children may recur after surgical correction. Ileopexy has popularly been used as a procedure to prevent recurrent intussusception, but its effect has not been well evaluated. The present study compared the incidence of recurrent intussusception after several different surgical procedures for intussusception in children. The charts of 278 children undergoing surgical reduction of ileocolic intussusception over 17 years were retrospectively reviewed. The incidence of recurrent intussusception was compared among the three surgical procedures: simple manual reduction, manual reduction plus ileopexy, and segmental resection. Simple manual reduction was performed in 67 (24.1%) of the 278 patients, manual reduction plus ileopexy in 186 (66.9%), and resection of the involved segment in 25 (9.0%). There were four episodes of recurrence in three (4%) patients who had had manual reduction, nine episodes in eight (4%) patients who had undergone ileopexy, and none after segmental resection. There was no statistical difference in recurrent rate among the three groups (reduction vs. ileopexy, P = 0.95; reduction vs. resection, P = 0.28; ileopexy vs. resection, P = 0.29). Ileopexy is not better than simple manual reduction in preventing recurrence of ileocolic intussusception in children.

Utility of hospital admission after successful enema reduction of ileocolic intussusception

Background In-hospital observation of 24 to 48 hours has been the standard practice after successful enema reduction (ER) of ileocolic intussusceptions, but this practice has not been validated. We evaluated retrospectively the safety of short-term emergency department observation. Methods Between April 2000 and October 2004, 121 patients presented to the emergency department with ileocolic intussusception, and all had ER attempts. Results Ninety-six patients had successful reduction, 25 were excluded for failed reduction or unconfirmed diagnosis, and another 16 needed observation anyway for high white blood count or persistent postreduction pain. Of the remaining 80 patients, the mean time from symptoms to reduction was 45.9 hours (4 hours to 10 days). All patients, except one, were admitted for observation for a mean period of 1.6 days (8 hours to 6.5 days). No complications were associated with air ER; however, 6 (7.5%) patients had reintussusception during the observation period and 5 (6.3%) recurred after discharge. The mean intervals for recurrence postreduction were 17.8 hours and 14.5 months with no mortality or morbidity in either. Conclusions Short-term emergency department observation could be a safe practice in more than 90% of the selected cases, recurrence of intussusception outside the hospital is not associated with unfavorable outcome, and routine admission is not warranted.