Recurrent Intussusception Research Articles

A case of recurrent intussusception in young adult female: Peutz Jegher syndrome

Peutz Jegher syndrome (PJS) is an autosomal dominant inherited polyposis syndrome, in which multiple characteristic polyps occur in the gastro-intestinal tract associated with mucocutaneous pigmentation especially of vermillion border of the lips. Small bowel obstruction is presenting complaint in half of the cases-intussusception due to polyp being lead point is the high risk for obstruction. A 21 year old female patient with presented to emergency department with complaining of intermittent episodes of abdominal pain and multiple episodes of billious vomiting since 7 days. Patient had history of exploratory laparotomy 10 years back for similar complaints. On examination, melanocytic pigmentation present over vermillion border and palmar aspect. Enhanced computed tomography reveals telescoping of the distal jejunum to proximal ileal loops s/o jejuno-ileal intussusception with ileo-ileal intussusception were noted. On surgical decision, patient again underwent exploratory laparotomy which revealed intussusception with non-viable small bowel segment were found, Small bowel resection was performed and jejuno-ileal anastomosis was done. Patient follow up was maintained to go with colonoscopic evaluation. In conclusion, recurrent intussusception is a rare cause of acute abdomen in adults. A high index of suspicion and appropriate investigations are helpful in prompt diagnosis. Thorough evaluation intra operative and then regular periodic follow up is required in such cases for early detection of disease before complication occurs.

The Role of the Multidisciplinary Approach in the Diagnosis and Treatment of Intussusception

Abstract Introduction: Intestinal intussusception, the most common cause of intestinal obstruction in children, is an intestinal obstruction that occurs by telescoping one intestinal segment into another, pulling also the mesentery which determine venous congestion phenomena and arterial insufficiency with intestinal wall necrosis. The cause of intussusception in children is frequently attributed to viral infections. Symptoms include abdominal pain, vomiting and hemorrhagic stools. Untreated, it is complicated by intestinal wall perforation and peritonitis. Currently, abdominal ultrasound is the gold standard method for confirming the diagnosis. Treatment should be started as soon as possible after the patient’s diagnosis. Methods: This is a 15 years retrospective study carried out in the “Sfântul Ioan” Clinical Emergency Hospital for Children in Galati. In this study we included 37 patients aged 0-18 years with the diagnosis of intussusception admitted between 2008 and 2022. We included in the study demographic data (age, sex, rural or urban origin), comorbidities, type of invagination, clinical data, laboratory and imaging examinations, therapeutic management, and complications. Results: Intestinal intussusception is more common in children between 1 and 12 months of age, predominantly affecting males (2/1). Symptomatic triad was present in 24% of cases and only in patients under 1 year of age, with onset of symptoms greater than 6 hours. The most common symptom was abdominal pain, which was observed in 92% of patients, followed by vomiting which had a frequency of 86%. In 84% of cases, the intussusception was primary, the most common anatomical form being ileocolic in 67.5%. The main operative technique was manual reduction of the intussusception, associated with cecopexy in 63% of cases, and circumstantial appendectomy in 100% of cases. Bowel resection was performed in only 7 (26%) of patients. There were 2 recurrences of intussusception, 1 case of evisceration and 1 case of secondary necrosis of the uninvaginated loop. Conclusions: Intussusception is a serious surgical pathology and treatment delays are common in our setting. Delayed presentation contribute to considerable morbidity and mortality. Training the family physicians and health staff of the local hospitals and raising awareness of the people to present early after the warning signs, will help to enhance early diagnosis of intussusception. In addition, the accessibility of the ultrasound and the training of specialists in the fields related to the pediatric pathology are also important. This information will contribute to the early diagnosis and non-operative treatment of intussusception.

Jejunal intussusception and perforation due to enteric muco-submucosal elongated polyp: a case report and literature review

BackgroundA muco-submucosal elongated polyp is a non-neoplastic growth composed of mucosa and submucosa. Although muco-submucosal elongated polyps are commonly reported in the large intestine, they are rare in the small intestine, in which they are called enteric muco-submucosal elongated polyps. We herein present a case of jejunal intussusception and perforation due to an enteric muco-submucosal elongated polyp.Case presentationA 46-year-old woman presented with abdominal pain and vomiting. Computed tomography revealed jejunal intussusception, which was reduced via a nasointestinal ileus tube. Oral double-balloon endoscopy showed an elongated polyp in the proximal jejunum. The patient refused surgical resection and thus, the polyp was monitored. Six months later, the patient was readmitted with the recurrence of jejunal intussusception and underwent emergency surgery. Intraoperative findings revealed an intussuscepted bowel with an elongated polyp and multiple perforations in the proximal jejunum. We resected approximately 90 cm of the bowel, including the intussuscepted segment and perforated sites. The pedunculated polyp, which was 60 mm in length, was located on the oral side of the resected specimen. Histopathologically, the polyp was covered by normal mucosa and the submucosa consisted of edematous loose connective tissue. The histopathological diagnosis confirmed an enteric muco-submucosal elongated polyp.ConclusionsSymptomatic patients with enteric muco-submucosal elongated polyps may be at risk of complications, as observed in the present case, and need to undergo timely resection.

Post-operative ileo-ileal intussusception one week after hemicolectomy for ileo-colic intussusception

Intussusception is a common pediatric surgical emergency that results from the introversion of one loop of bowel into another. It is common in children between 3 months and 3 years. Recurrence of intussusception is said to be common in non-operative reduction and negligible after operative reduction. In this case report, we aim to discuss a case of post-operative ileo-ileal intussusception (POI) 7 days after a laparotomy and resection on account of gangrenous ileo-colic intussusception. A 13-month-old male patient presented with bloody stools associated with abdominal distention and fever. Clinical findings were suggestive of intussusception. Diagnosis was confirmed with an abdominopelvic ultrasound. A laparotomy revealed a gangrenous ascending colon extending to the terminal ileum so a right hemicolectomy was performed. The patient was well until post-operative day 7 when he developed abdominal distention associated with vomiting. An abdominal x-ray revealed multiple air fluid levels. A re-laparotomy was performed and a new intussusception was found proximal to an intact and patent anastomotic site. The involved bowel was reduced because it was viable. He was discharged on post-operative day 14. This was a rare case of recurrent intussusception with resection and anastomosis on account of intussusception in a 13-month-old boy.

Role of Dexamethasone as an adjuvant in the treatment of intussusception: A prospective study

Background: Intussusception is one of the most commonly encountered abdominal emergencies in children for which the preferred treatment modality has always been non operative hydrostatic reduction. Recurrence is a common concern after a successful hydrostatic reduction. Adjuvant treatment with pharmacological agents have been considered to reduce chances of recurrence. Aim: The study was conducted to examine the role of dexamethasone in decreasing early recurrent intussusception. Materials and methods: A prospective cohort study was conducted in a tertiary care center from June 2018- June 2022 on 51 pediatric patients, admitted with intussusception and divided into a dexamethasone and non-dexamethasone group. Data was collected regarding demography, rate of recurrences, duration of hospital stay, surgery performed if any including the intraoperative findings and associated complications. The level of significance was set at 5%. SPSS version 27 was used to perform the statistical analysis. Result: After ultrasound-guided hydrostatic reduction, the dexamethasone group showed significant reduction in recurrence, compared to the non-dexamethasone group. In this study, 7 cases showed recurrence despite three attempts of hydrostatic reduction and intraoperatively noted to have a pathological lead point. Conclusion: Dexamethasone is one of the greatest discoveries of the 20th century with its vast use in multiple diseases. The use of dexamethasone during hydrostatic reduction of intussusception in a pediatric population makes it a wonderful drug with remarkable results and patient outcome.

Length of Bowel Rest Does Not Predict Gastrojejunostomy Tube-Associated Intussusception Recurrence.

One potential treatment for gastrojejunostomy (GJ) tube-related intussusception is bowel rest, whereby the GJ tube is replaced with a gastrostomy tube. The aim of this study was to determine whether bowel rest length was associated with decreased risk of re-intussusception. Pediatric patients with GJ tube-related intussusceptions were identified during the study period of January 1, 2010 and August 1, 2021. Records were reviewed for demographics, symptoms, need for central access to initiate parenteral nutrition, and length of stay. Comparison was made between patients with intussusception recurrence within 30 days and those without. Those undergoing earlier replacement, defined as the first quartile of rest time, or 72 hours, were then compared to longer periods of bowel rest. Forty-six intussusceptions were included, with a median age of 2.8 years (interquartile range, IQR: 1.4-4.1) and weight of 12 kg (IQR: 8.9-15.4). All patients diagnosed as outpatient (54.3%) required hospital admission and 9 of 46 (19.6%) required central access. There were 7 recurrences (15.2%). There was no difference in recurrence based on time of bowel rest (5 days in those without vs 6 days in those with, P = 0.30) nor a difference in recurrence with <72 hours of bowel rest compared to >72 hours (1/15, 6.7% vs 6/31, 19.3%). Patients undergoing earlier exchange had a shorter median length of hospital stay (3 vs 8.5 days, P = 0.003). Length of bowel rest was not associated with recurrent GJ tube-related intussusceptions. If bowel rest is utilized, <72 hours may be sufficient to decrease length of hospital stay.

Intestinal tumor lesions leading to intussusception in children: a report of four cases and literature review

BackgroundIntussusception is commonly idiopathic in children. Pathologic lead points (PLP) especially intestinal tumors (IT) are extremely rare. The diagnosis of intussusception secondary to pediatric IT is difficult due to the non-specific nature of symptoms. Its management remains a challenge. We report here four pediatric cases of intussusception secondary to IT lesions in order to analyze the clinical and therapeutic characteristics of this unusual condition.Case presentationsFour children were diagnosed and operated in our center for intussusception secondary to IT during the period from February 2017 to February 2021. Patients’ demographics, clinical presentations, investigations, operative data, and postoperative outcome were recorded and analyzed. There were three girls and one boy. Ages ranged between 1 and 8 years (average of 5.5 years). Intermittent abdominal pain with acute exacerbation and vomiting were the main clinical signs. Radiologic investigations showed the intussusception in all cases but the tumor lead point was evident only during the surgical exploration in most cases. All patients underwent surgical treatment with intussusception reduction and mass removal. Pathological examination of these masses revealed: submucosal intestinal lipoma (1 case), hamartomatous polyposis (2 cases), and Burkitt’s lymphoma (1 case). For this last case, adjuvant chemotherapy was also needed. The postoperative period was uneventful in all cases.ConclusionPediatric intussusception secondary to IT lesions is an unusual and challenging condition that requires high preoperative diagnostic suspicion, considerate intraoperative judgment, and appropriate postoperative follow-up for successful outcomes.These tumors should be considered by the pediatric surgeons as possible PLP for recurrent intussusception, especially in older children. Surgeons should be familiar with the various treatment options, because the real cause of the intussusception is often accurately diagnosed by laparotomy.

Intussusception causing bowel obstruction in a child due to ectopic pancreas: A rare case report and literature review

Introduction: Ectopic pancreas is a congenital anomaly in which the pancreatic tissue is located abnormally, lacking anatomical continuity with the main pancreas. This is not an uncommon anomaly, however the preoperative diagnosis is difficult and the majority of cases are diagnosed histologically after surgery. Ectopic pancreas is commonly found in the upper gastrointestinal tract (including stomach, duodenum and jejunum); rarer in the ileum. The main symptoms of ectopic pancreas in children include gastrointestinal bleeding, vomiting, recurrent abdominal pain, and intussusception. In this article, we report a case of a 4-year-old girl who was diagnosed with ectopic pancreas causing intussusception complicated by bowel obstruction. The patient was treated by laparotomy and recovered uneventfully. Case report: 4-year-old girl with a history of recurrent intussusception admitted with abdominal pain and vomiting. Abdominal ultrasound and computed tomography showed an intussusception complicated by bowel obstruction. The child underwent laparotomy with segmental intestinal resection and was diagnosed with intussusception due to ectopic pancreatic tissue in the ileal wall based on histopathological findings. After surgery, the child recovered uneventfully. Conclusion: Ectopic pancreas is common in the gastrointestinal tract, difficult to diagnose by imaging modalities. Most of cases are diagnosed histologically after sugery. Imaging methods, particularly abdominal ultrasound and computed tomography, play an important role in diagnosing the complications of ectopic pancreas such as intussusception and bowel obstruction. Key words: ectopic pancreas, recurrent intussusception, bowel obstruction

S3498 Multifocal Small Bowel Intussusceptions in an Adult with Strongyloidiasis

Introduction: Multifocal adult intussusceptions (AI) are rare with challenging diagnostic workup. Etiology of most adult intussusceptions are structural lesions, such as surgical adhesions or malignant neoplasm. Case Description/Methods: A 54-year-old man presented with severe abdominal pain. His medical history included diverticulosis and pulmonary histoplasmosis, but no prior abdominal surgeries. He works in construction, and he denied international travel. Vital signs were normal and labs notable for leukocytosis (17 x109/L). Physical examination revealed abdominal distension and tenderness to palpation of the left abdomen. Contrast CT of the abdomen showed multiple proximal small bowel intussusceptions without identifiable lead points or obstruction (a, arrows). HIV, histoplasmosis, tuberculosis, and celiac serologies were negative. He underwent exploratory laparoscopy with reduction of 9 segments of intussuscepted bowel involving the jejunum and proximal ileum, all without identifiable lead point (b). CT enterography post-operatively was normal. Antegrade double balloon-assisted enteroscopy showed no mucosal abnormality and jejunal biopsies were unremarkable. Patient was discharged with symptom resolution. He re-presented 2 months later with recurrent left-sided abdominal pain. Laboratory investigation showed leukocytosis (10.7 x10 9/L) with mild eosinophilia (0.63 x109/L). CT enterography showed a possible short-segment intussusception at the proximal jejunum without lead point. Comprehensive autoinflammatory and infectious workup revealed positive Strongyloides Antibody, IgG. Patient was treated with ivermectin and has remained symptom free without further events. (Figure) Discussion: AI is unusual and requires a high index of clinical suspicion combined with appropriate imaging to establish an early diagnosis.1 More than 90% are caused by a lead point or structural abnormality (e.g., tumor) and CT is best modality for diagnosis.1,2 Helminth infection is a well-recognized cause of pediatric intussusception, but few cases of helminth-related AI have been reported, and none secondary to Strongyloides have been documented. Our patient’s peripheral eosinophilia, abdominal pain, recurrent multifocal intussusceptions, and resolution of these symptoms after treatment of Strongyloides infection suggest Strongyloides as the etiology of his multifocal AI. This case highlights the importance of a risk factor driven differential in the workup of AI.Figure 1.: CT abdomen showing multifocal small bowel intussusceptions (a) and exploratory laparoscopy demonstrating segment of intussuscepted bowel (b).

Significance of MCP-1 in predicting the short-term recurrence of primary intussusception in children: An observational study.

To evaluate the relationship between the expression level of (MCP-1) in peripheral blood and the short-term recurrence of primary intussusception in children, a retrospective analysis of children with primary intussusception under ultrasound-guided hydrostatic reduction in our hospital from June 2019 to June 2021, a total of 412 cases, 37 cases of short-term recurrence. Enzyme-linked immunosorbent assay was used to detect the expression of MCP-1 in peripheral venous blood; receiver operating curve (ROC) was utilized to evaluate the diagnostic efficacy of MCP-1 in predicting short-term recurrence; logistic regression analysis of risk factors for recurrence. MCP-1 increased in the peripheral blood of children with short-term recurrence (P < .05). Logistic regression analysis found that increased MCP-1 was a risk factor for recurrence; ROC showed that 23.24 ng/mL was used as a cut-off value. The sensitivity of MCP-1 for predicting the recurrence of intussusception in children is 82.14%, and the specificity is 75.67%. In primary intussusception, the expression of MCP-1 in the peripheral blood of children with short-term recurrence is raised. Elevated expression of MCP-1 is a risk factor for predicting short-term intussusception recurrence and has certain clinical significance.

Recurrent appendiceal intussusception mimicking ileocecal invagination in a 7-year-old girl

Appendiceal intussusception in children is a rare entity characterized by the invagination of the appendix into the cecum. The early diagnosis and optimal surgical management of appendiceal intussusception have not been achieved because of its rarity. Here, we report a case of a 7-year-old girl with appendiceal intussusception presenting with recurrent ileocecal invagination. She was treated by simple appendectomy without using a stapling device. The imaging findings in patients with appendiceal intussusception were reported, and the optimal surgical treatment for appendiceal intussusception was discussed.

How Does the COVID-19 Pandemic Affect Pediatric Patients with Intussusception Treated by Ultrasound-Guided Hydrostatic Enema Reduction?

Background: The pandemic of COVID-19 has significantly influenced the epidemiology of intussusception. Nevertheless, the effects of the COVID-19 pandemic on the operation of ultrasound-guided hydrostatic enema reduction (USGHER) for intussusception have been largely unknown. Methods: The data of pediatric patients with intussusception who were treated by USGHER from January to March of 2019 (Control Group), 2020 (Study Group 1), and 2021 (Study Group 2) in a large Chinese medical institution were retrospectively collected and analyzed. Results: We enrolled 246 patients, including 90 cases in Control Group, 70 in Study Group 1, and 86 in Study Group 2 (p = 0.042). The time from the onset of symptoms to the hospital visit and the time from the hospital visit to performing the ultrasound in Study Group 1 was significantly longer than that in Control Group and Study Group 2 (p = 0.036, p = 0.031, respectively). The number of patients with bloody stool and the longest invaginated length of intussusception in Study Group 1 increased significantly compared with patients in the other two groups (p = 0.007, p = 0.042, respectively). Comparisons of neither the pressure of enema nor the time of duration when performing USGHER present statistical significance among the three groups (p = 0.091, p = 0.085, respectively). For all enrolled pediatric patients, there was no perforation case involved, and recurrence of intussusception occurred in few cases. Conclusions: Besides the negative impacts on the incidence of intussusception, the COVID-19 pandemic might have led to the diagnostic delay of intussusception and the deterioration of patients’ clinical manifestations, but it did not significantly affect the operation of USGHER and patients’ clinical outcome.

Analysis of clinical characteristics of 126 children with recurrent intussusception

Objective: To analyze and summarize the clinical features in children with recurrent intussusception. Methods: This retrospective cohort study collected the clinical data of 126 children with recurrent intussusception who were admitted to the Children's Hospital of Zhejiang University School of Medicine due to "abdominal pain, paroxysmal crying, vomiting, bloody stools" from January 1, 2015 to November 30, 2019. The clinical manifestations of recurrent intussusception between ≤3 years old group and >3 years old group were compared, the etiology and age characteristics of pathologic lead points (PLP) were analyzed, and the clinical characteristics of PLP group and non-PLP group were also compared. The χ2 test and Mann-Whitney U test were used to compare the differences between groups. Results: A total of 126 children with recurrent intussusception were included, of whom 76 were males and 50 were females, with the age of 2.9 (1.7, 5.1) years. The proportion of children aged more than 1 year was 87.3% (110/126), and 48.4% (61/126) more than 3 years. Clinical manifestations mostly lacked the typical triad of symptoms. The percentage of paroxysmal crying in ≤ 3 years old group was significantly higher than that in >3 years old group (52.3% (34/65) vs. 24.6% (15/61), χ2=10.17, P=0.001), while the percentage of abdominal pain was significantly lower than that in the >3 years old group (46.1% (30/65) vs. 75.4% (46/61), χ2=11.25, P=0.001). The rate of positive ultrasound examination was 17.5% (22/126), and 63.6% (14/22) of them were diagnosed. The positive rate of CT examination was 4/13, of which 2 cases were diagnosed. In this study, 37 children were diagnosed with PLP by colonoscopy, laparoscopy or laparotomy, and 89 children were found without PLP. The positive rate of PLP in >3 years old group was significantly higher than that in ≤3 years old group (37.7% (23/61) vs. 21.5% (14/65), χ2=3.96, P=0.046). Meckel's diverticulum and juvenile polyp were the main contributors of PLP in ≤3 years old group, accounting for 7/14 and 3/14 respectively, while lymphoma and juvenile polyp accounted for 34.8% (8/23) and 26.1% (6/23), respectively in >3 years old group. Compared with non-PLP group, PLP group had higher age (5.2 (1.6, 6.7) vs. 2.7 (1.8, 4.2) years, Z=-2.26, P=0.01). However, there were no significant differences in gender and recurrence frequency between the two groups (both P>0.05). Conclusions: Recurrent intussusception is more common in children more than 1 year old, and has a wide spectrum of non-specific clinical presentations. Imaging examinations can be used to identify PLP. The most recurrent intussusception is idiopathic, but the presence of PLP should be alerted for, such as Meckel's diverticulum, lymphoma and juvenile polyp. Colonoscopy sometimes is necessary, surgical exploration and treatment should be carried out in time.

Delayed Repeat Contrast Enema for Treatment of Pediatric Intussusception.

Ileocolic intussusception is a common cause of pediatric bowel obstruction. Contrast enema is successful in treating the majority of patients, and if initially unsuccessful, approximately one-third may be reduced with repeat enemas. We sought to study protocol implementation for delayed repeat enema in pediatric patients not reduced completely by an initial contrast enema. Our aims were to assess repeat enema success rates and outcome differences in preprotocol and postprotocol patients with respect to (1) intussusception recurrence, (2) surgical intervention and complication rates, and (3) length of stay. We performed a retrospective review of treatment and clinical outcomes prior to and following protocol implementation for repeat enema for intussusception at two tertiary pediatric referral hospitals. The preprotocol period was defined from 2/2013 to 2/2016, and the postprotocol period was from 8/2016 to 11/2019. There were 112 patients in the preprotocol group, with 74 (66%) having successful reduction following the first enema. Of the 38 patients without successful reduction, 16 (42%) patients underwent repeat enema, and five were successful (31%). The postprotocol group included 122 patients, with 84 (69%) having successful first reduction. Of the 38 patients that failed, 25 patients (66%) underwent repeat enema, of which 13 (52%) were successful. Compared to preprotocol patients, postprotocol patients had significantly more enemas repeated and a trend toward fewer surgical interventions. Protocol implementation of repeat delayed enemas was significantly associated with an increased rate of repeat enemas at our institutions and reduced need for operative intervention during the index stay.

Recurrent Recto-Sigmoid Intussusception due to Juvenile Polyp: A Case Report

Recurrent Recto-Sigmoid Intussusception due to Juvenile Polyp: A Case Report

Surgical treatment of recurrent intussusception induced by intestinal lymphoid hyperplasia in a child: is bowel resection always necessary? A case report

BackgroundIntussusception recurrence (IR) induced by intestinal lymphoid hyperplasia (ILH) in children is rare, and surgical treatment is the final resort if IR is refractory to medications and non-surgical interventions. To date, only a few case reports have described surgical management of ILH-induced IR in children, all involving bowel resection regardless of whether there are bowel necrosis and perforation.Case presentationA 2-year-old boy was transferred to our department due to IR. His main complaint was abdominal pain. Color Doppler ultrasound confirmed ileocecal intussusception while no other abnormalities were found. A final diagnosis of IR with unknown causes was made. Repeated saline enema reductions and dexamethasone failed to cure the IR. Laparotomy was eventually performed after almost 10 episodes of IR. Intraoperatively, distal ileum thickening with palpable masses without bowel necrosis and perforation was noted. ILH was suspected and a biopsy of the affected intestine was performed. Histopathological analysis confirmed ILH. The intussusception was manually reduced, the terminal ileum and the ileocecal junction were fixed to the paralleled ascending colon and the posterior peritoneum respectively, and no bowel resection was performed. The postoperative recovery was uneventful and no IR was observed during over 5 years of follow-up.ConclusionsAs far as we are aware, this is the first report of successful surgical treatment of ILH-induced pediatric IR without bowel resection in a child. Our experience suggests bowel resection may be unnecessary if bowel necrosis and perforation are absent.

Methicillin-resistant Staphylococcus aureus enterocolitis in a 16-month-old boy: a case report

BackgroundMethicillin-resistant Staphylococcus aureus enterocolitis is a rare disease that typically affects immunocompromised adults. Most cases of pediatric enterocolitis are caused by Gram-negative bacteria, Gram-positive Clostridiodes difficile, or viruses. This is the first published case report of a toddler with methicillin-resistant Staphylococcus aureus enterocolitis.Case presentationA 16-month-old non-Hispanic White boy with no past medical or psychosocial history initially presented to the emergency room with abdominal pain and emesis. Past family history was pertinent only for his father having a history of constipation. He was diagnosed with intussusception and underwent successful contrast reduction on hospital day 0. The following day, the patient had recurrent symptoms and a repeat contrast enema showed no evidence of recurrent intussusception. A computed tomography scan was obtained, which was concerning for possible recurrence with compromised bowel. He was taken to the operating room for operative reduction and underwent an ileocecetomy with primary handsewn end-to-end anastomosis. His postoperative course was complicated by an anastomotic leak on hospital day 6 necessitating reoperation and creation of an end ileostomy with mucous fistula. He received intravenous metronidazole, ceftriaxone, and ceftazidime antibiotics during his hospital course. On postoperative day 12, the patient developed a sudden increase in ileostomy output, and stool cultures were obtained. His symptoms persisted despite diet modifications, stopping antibiotics, and initiating loperamide. Three days later, stool cultures resulted negative for Escherichia coli, Salmonella, Shigella, Campylobacter species, and Clostridiodes difficile but were positive for methicillin-resistant Staphylococcus aureus. The patient was started on a 10-day course of oral vancomycin and discharged home in good condition 4 days later. After 12 weeks, the patient underwent reversal of the ostomy and is doing well at the 1 month postoperative follow-up, now 5 months from his initial surgery.ConclusionsTo our knowledge, this is the first published report of a toddler being diagnosed with methicillin-resistant Staphylococcus aureus enterocolitis. Because methicillin-resistant Staphylococcus aureus enterocolitis is rare and has overlapping symptoms with more common gastrointestinal pathologies, it is often misdiagnosed. When a patient presents with diarrhea or high ostomy output along with fecal cultures negative for Clostridiodes difficile and other common pathogenic agents, methicillin-resistant Staphylococcus aureus should be considered.

Risk factors for recurrent intussusception after successful reduction in pediatric patients in a tertiary care hospital of Nepal: A prospective study

BackgroundIntussusception is defined as the invagination of one segment of intestine into another segment of intestine. It may recur because of persistence or return of some factor responsible for the primary intussusception. Various risk factors have been reported but still not well elucidated. Materials and methodsThis is the prospective observational study. In this study, 78 patients, age <16 years with diagnosis of intussusception between June 2019 and April 2020 who had successful reduction with either hydrostatic reduction and/or operative reduction in Teaching Hospital were enrolled in the study. This is study of early recurrence as patients were followed up to a period of 1 month for recurrence of intussusception. The recurrent cases were thus identified and various variables were compared between recurrent and non-recurrent cases by univariable and multivariable analysis. ResultsAmong 78 patients, 13 patients (16.7%) had recurrent intussusception. In the univariable analysis model, the significant risk factors for recurrence of intussusception analyzed were duration of symptoms of 48 h or more, fever, blood in stool and palpable mass. While after multivariable analysis, we found that the significant risk factors for recurrence of intussusception were duration of symptoms ≥48 h (OR = 5.32, p-value = 0.047), Fever (OR = 17.32, p-value = 0.001), palpable mass (OR = 24.12, p-value = 0.017). ConclusionAttention and awareness among pediatricians about these sonographic and clinical risk factors especially symptoms for recurrence are needed to minimize pre-hospital delay and identify patients in risk of recurrence. This ultimately helps to improve care for pediatric patients with recurrent intussusception.

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.

Metastatic melanoma to the small bowel causing intussusception: A case report.

Introduction and importanceMelanoma is a malignant skin neoplasm with a high metastatic potential. Several reports have shown that metastatic melanoma has a predilection to metastasize to the GI tract; however, diagnosing metastatic melanoma as a cause of intussusception has been reported in only few cases with variable presentations.Case presentationWe present the case of a 48-year-old woman with a long history of metastatic melanoma who presented with recurrent enteric intussusception due to a melanoma lesion acting as a pathologic lead point despite immunotherapy treatment. We contribute the management plan, diagnostic modalities, and surgical approach of this rare form of adult intussusception in guidance of future management plans.Clinical discussionThe variability in presentation of adult intussusception makes diagnosis difficult and the lack of consensus on management and surgical strategies poses challenging hurdles. A diagnostic laparoscopy followed by reduction and resection of the intussuscepted lesion in a small surgical field is an effective and beneficial palliative procedure with favorable outcomes. Our patient developed intussusception despite receiving a trial of dual immunotherapy after chemotherapy.ConclusionIt may be insufficient to control disease even with dual immunotherapy after chemotherapy. Further studies are needed to determine the optimal surgical and oncological management in treating gastrointestinal metastasis of malignant melanoma.