Risk Factors For Intussusception Research Articles

Multiple Small Bowel Intussusceptions in the Setting of Anabolic Steroid Use

AbstractAdult intussusception is a rare phenomenon and often provides a unique diagnostic challenge, typically involving extensive investigation to rule out sinister pathology. We present the case of a healthy 28-year-old male, who presented with symptoms suggestive of small bowel obstruction. Computed tomography displayed evidence of a small bowel intussusception; however, thorough investigation was unremarkable, besides a marked polycythemia. The patient represented several months later with another bowel obstruction, at which time he disclosed the regular use of androgenous anabolic steroids (AAS), which are recognized to induce polycythemia. AAS increase the risk of thromboembolic events and have more recently been implicated as a risk factor for intussusception. This case aims to highlight the increasing prevalence of AAS use, and the importance of its consideration in diagnostic dilemmas, particularly in otherwise healthy adults presenting with intussusception.

Risk factors for intussusception in children with Henoch-Schönlein purpura: A case-control study

BACKGROUNDThe etiology of Henoch-Schönlein purpura (HSP) with intussusception remains undefined.AIMTo investigate the risk factors for intussusception in children with HSP and gastrointestinal (GI) involvement.METHODSSixty children with HSP and concomitant intussusception admitted to the Beijing Children’s Hospital of Capital Medical University between January 2006 and December 2018 were enrolled in this study. One hundred pediatric patients with HSP and GI involvement but without intussusception, admitted to the same hospital during the same period, were randomly selected as a control group. The baseline clinical characteristics of all patients, including sex, age of onset, duration of disease, clinical manifestations, laboratory test results, and treatments provided, were assessed. Univariate and multiple logistic regression analyses were performed to identify possible risk factors.RESULTSThe 60 children in the intussusception group comprised 27 girls (45%) and 33 boys (55%) and the 100 children in the non-intussusception group comprised 62 girls (62%) and 38 boys (38%). The median age of all patients were 6 years and 5 mo. Univariate and multiple regression analyses revealed age at onset, not receiving glucocorticoid therapy within 72 h of emergence of GI symptoms, hematochezia, and D-dimer levels as independent risk factors for intussusception in children with HSP (P < 0.05).CONCLUSIONThe four independent risk factors for intussusception in pediatric HSP with GI involvement would be a reference for early prevention and treatment of this potentially fatal disease.

Retrospective multicenter matched case–control study on the risk factors for intussusception in infants less than 1 year of age with a special focus on rotavirus vaccines – the German Intussusception Study

ABSTRACT Studies associate rotavirus vaccination with intussusception. In Germany, a retrospective multicenter matched case–control study was performed to identify risk factors for intussusception with a special focus on rotavirus vaccines. Children with place of birth and residence in Germany who had been treated for intussusception from 2010 to 2014 and who had been less than 1 year old at the time of intussusception were recruited. Case report forms were independently validated by two pediatricians according to the criteria of intussusception defined by the Brighton Collaboration (BC). Cases with the highest diagnostic certainty (level 1) were matched with population-based controls by age, gender, federal state, and place of residence. Information on vaccine exposures originated from vaccination certificates. One hundred and sixteen cases were matched with 272 controls. A significantly increased adjusted odds ratio (aOR) for intussusception (5.74, 95% CI: 1.51–21.79) was detected in individuals immunized with rotavirus vaccine dose 1 prior to symptom onset as compared to non-exposed individuals. Age at the start of the rotavirus immunization series did not modify the risk of intussusception. The odds for intussusception were not increased postdose 2 and 3 as well as any dose. One further risk factor for intussusception, family history of intussusception (aOR 3.26, 95% CI 1.09 − 9.77) was identified. Breastfeeding was found to have a protective effect (aOR 0.54, 95% CI 0.33 − 0.88). Rotavirus vaccine dose 1 was associated with a 5.7-fold increased risk to develop intussusception regardless of age at immunization whereas the overall risk for intussusception in the first year of life was not increased.

A case-control study of risk factors for intussusception among infants in eastern France after the introduction of the rotavirus vaccine

ObjectiveThe objective of the present study was to investigate the risk factors for intussusception (IS) among infants, including vaccination against rotavirus. MethodsCase-control study with systematic inclusion of all infants aged <1 year with suspected IS admitted to emergency departments in the eastern region of France between 1 April 2008 and 31 March 2012. All cases classed level 1 according to the Brighton classification were matched to 4 hospital controls. Two exposure windows were examined; exposure to the first dose of rotavirus vaccine in the 7 and in the 14 days prior to the occurrence of IS. ResultsA total of 115 cases were matched with 457 controls. The average vaccination coverage rate over the 4 years of study was 8.6%. Rotavirus vaccine was not found to be significantly associated with the occurrence of IS in the 7 days (odds ratio (OR) not calculated; p = 0.99) and in the 14 days after administration of one dose vaccine (OR 1.33, 95% confidence interval (CI) 0.14–12.82). Infant formula alone or combined with breastfeeding was associated with an excess risk of IS (OR 2.74, 95% CI 1.10–6.79). A history of gastroenteritis within 2 weeks prior to hospitalisation was also associated with an increased risk (OR 2.24, 95% CI 1.07–4.67). ConclusionOur study indicates that infant formula alone or combined with breastfeeding is a risk factor for IS. A small, non-significant increase in the risk of IS was observed after rotavirus vaccination, although the low vaccine coverage rate likely precluded detection of a significant increase in risk.

Campylobacter jejuni-Induced Intussusception Recurrence Within a 30-hour Period

Intussusception represents the most common etiology for intestinal obstruction in early childhood. It represents telescoping of the small bowel potentially resulting in ischemia and perforation. It is recognized as potentially recurrent in up to 10% of cases. A mass lesion providing a lead point is a risk factor for recurrence. Symptoms include acute intermittent abdominal pain, and bloody stools. Campylobacter jejuni is a gram-negative bacterium that causes enteritis and is known to cause intussusception. However, there are no reported cases of Campylobacter causing recurrent intussusception within a 30 hr period. We report a previously healthy 2 year old male who presented with a 7 day history of diarrhea, fever, 3 day history of bloody stools, spasmodic abdominal pain, and 1 self-limited episode of rectal prolapse. He was seen on 3 occasions in an emergency department. At the first visit, he was sent home with a kit for stool study, as he was unable to produce a bowel movement. On final return, an abdominal ultrasound reported short segment intussusception in the right lower quadrant. He developed recurrent ileocolic intussusception (3 recurrences total within 30 hours). All 3 episodes were successfully reduced via barostatic enema. For suspected lead point, he underwent exploratory laparoscopy; none was identified. After exploratory laparoscopy, his parent developed bloody stools prompting stool studies from our patient for investigation of infectious etiologies which were positive for Campylobacter jejuni. He was treated with Azithromycin. Small bowel obstruction from intussusception can complicate several luminal processes resulting in bowel wall thickening or mass acting as a lead point. While infectious etiologies are a risk factor for intussusception, this is the first report of recurrent intussusception associated with Campylobacter jejuni enteritis. In this case, stool collection for studies was unsuccessful until his parent presented with similar symptoms. Despite there being no recommendations currently for stool studies in the evaluation of intussusception in society guidelines, the authors would speculate that stool studies for enteric pathogens should be routinely obtained in children presenting with intussusception and treated wherever identified, potentially impacting the risk of recurrence. Current treatment recommendations for complicated cases of bacterial enteritis secondary to Campylobacter jejuni include macrolide antibiotics.

Incidence and risk factors for intussusception among children in northern Israel from 1992 to 2009: a retrospective study.

BackgroundDetermining the background incidence of intussusception is important in countries implementing rotavirus immunization. Rotavirus immunization was introduced into the routine infant immunization program in Israel during late 2010. Incidence and risk factors for intussusception were examined in children aged less than five years between 1992 and 2009.MethodsData were collected from medical records of children hospitalized due to intussusception (N = 190), and from control children (N = 295), at Carmel and Hillel Yaffe hospitals in northern Israel.ResultsThe average annual incidence of intussusception in Jewish and Arab children aged less than five years was estimated at 36.1 (95% CI 17.0-76.5) vs. 23.2 per 100,000 (95% CI 9.3-57.9); for infants less than 12 months of age- 128.1 (95% CI 53.0-309.6) vs. 80.1 (95% CI 29.1-242.6) per 100,000. The risk of intussusception was higher in infants aged 3–5 months: OR 5.30 (95% CI 2.11-13.31) and 6–11 months: OR 2.53 (95% CI 1.13-5.62) when compared to infants aged less than 3 months; in those living in low vs high socioeconomic communities: OR 2.81 (95% CI 1.45-5.43), and in children with recent gastroenteritis: OR 19.90 (95% CI 2.35-168.32) vs children without recent gastroenteritis. Surgical reduction was required in 23.2%. The likelihood of surgery was significantly increased in patients presenting with bloody stool, in Arabs and those who were admitted to Hillel Yaffe Hospital.ConclusionsThe incidence of intussusception prior to universal rotavirus immunization was documented in northern Israel. Despite the lower incidence, Arab patients underwent surgery more often, suggesting delayed hospital admission of Arab as opposed to Jewish patients.

Intussusception is another complication of acute bacterial enteric infection

In this issue of The Journal, Nylund et al describe a large cohort-based study that identifies an acute bacterial enteric infection in the preceding 6 months as a risk factor for the development of intestinal intussusception. This work extends previous studies reporting immunization with a specific rotavirus vaccine formulation as a risk factor for intussusception in infants. Nodular lymphoid hyperplasia occurring in response to either infection or vaccination could serve as a lead point for the intussusception and, thereby, provide a biological explanation underlying these observed associations. Post-infectious irritable bowel syndrome and chronic inflammatory bowel diseases are also increasingly recognized as long-term complications, which can develop months or even years after an acute, intercurrent bacterial (including Campylobacter and Salmonella infections) enterocolitis. In this issue of The Journal, Nylund et al describe a large cohort-based study that identifies an acute bacterial enteric infection in the preceding 6 months as a risk factor for the development of intestinal intussusception. This work extends previous studies reporting immunization with a specific rotavirus vaccine formulation as a risk factor for intussusception in infants. Nodular lymphoid hyperplasia occurring in response to either infection or vaccination could serve as a lead point for the intussusception and, thereby, provide a biological explanation underlying these observed associations. Post-infectious irritable bowel syndrome and chronic inflammatory bowel diseases are also increasingly recognized as long-term complications, which can develop months or even years after an acute, intercurrent bacterial (including Campylobacter and Salmonella infections) enterocolitis. Long-Term Treatment of Cystinosis in Children with Twice-Daily CysteamineThe Journal of PediatricsVol. 156Issue 5PreviewCystinosis causes renal and other organ failure. Treatment with 6-hourly cysteamine bitartrate (Cystagon, Mylan, Morgantown, West Virginia) reduces intracellular cystine and the rate of organ deterioration. A recent study showed that an enteric-release cysteamine required less frequent daily dosing. This report describes the long-term use of enteric-coated (EC) cysteamine bitartrate (Cystagon) in children with cystinosis. Full-Text PDF

経皮内視鏡的空腸瘻造設術(PEJ）による栄養療法中に小腸重積を発症した超高齢者非結核性抗酸菌症の1例

We report a 94-year-old woman, who underwent percutaneous endoscopic Jejunostomy (PEJ) tube feeding for enteral nutrition, developed the intussusception of the small intestine. She suffered from nontuberculous mycobacterium (NTM), and her lung inflammation deteriorated due to aspiration pneumonia and malnutrition. Because of old age, dysphagia, esophageal hiatus hernia, gastro-esophageal reflux and her bedridden condition due to severe osteoporosis, oral nutritional supplementation is nearly impossible. To reduce the aspiration risk, we chose PEJ instead of percutaneous endoscopic gastrostomy (PEG) as the route of tube feeding. Six months after the placement of a PEJ tube, aspiration pneumonia was diagnosed and she was readmitted to our hospital. During hospitalization, she had sudden diarrhea, vomiting, and lower abdominal pain. Abdominal CT scan and radiographs using contrast medium showed small intestinal intussusception related to the PEJ tube. We observed the clinical course without performing surgery, pulling it back towards the stomach and placing an ileus tube, because the small intestine was not completely obstructed. Two months later, although she suffered from aspiration pneumonia once more, she remained in a stable condition without further intervention so that she could move to aother hospital. Recently PEJ has been expected to prevent aspiration pneumonia, but we believe that it can be a risk factor for intussusception. Although the PEJ can be a good parenteral nutrition route for frail elderly with dysphagia, we need to consider possible complications including intussusception.

Risk factors for intussusception in infants in Vietnam and Australia: Adenovirus implicated, but not rotavirus

This study aimed to investigate risk factors for the development of intussusception in infants in a developing country with a suspected high incidence and in a developed country with a low incidence. A prospective case-control study of infants <2 years of age with idiopathic intussusception confirmed by air enema or surgery was conducted at the National Hospital of Paediatrics (NHP), Vietnam (n = 533) and the Royal Children's Hospital (RCH), Australia (n = 51). Diagnosis was validated in a subset (84% NHP; 67% RCH) by an independent blinded radiologist. Risk factor assessment was performed using a standardized questionnaire. Stool specimens were assayed for bacterial, viral, and parasitic agents. The incidence of intussusception in Vietnam was 302/100,000 in infants <1 year of age (95% CI: 258-352), substantially higher than in Australia (71/100,000). A strong association with adenovirus infection was observed at both sites (cases positive at NHP: 34%, OR 8.2; cases positive at RCH: 40%, OR 44). No association was identified between intussusception and rotavirus, other enteric pathogens, oral polio vaccine, feeding practices, or living conditions. The incidence of intussusception in infants was markedly higher in Vietnam than in Australia. A strong association between adenovirus infection and intussusception was identified at both sites suggesting that adenovirus may play a role in the etiology of intussusception.

WHO informal consultation on quality, safety and efficacy specifications for live attenuated rotavirus vaccines: Mexico City, Mexico, 8–9 February 2005

Rotavirus vaccines are at an advanced stage of development but there are as yet no WHO recommendations on production and quality control to provide regulatory guidance. A meeting of experts was convened by WHO and PAHO/AMRO to review the scientific basis for production and quality control of rotavirus vaccines, and to discuss specific measures to assure the safety and efficacy of rotavirus vaccines. The meeting was attended by 25 experts from 14 countries, drawn from academia, public health, national regulatory authorities and vaccine producers. It was agreed that existing guidance for other live virus vaccines provides a very good basis for product characterization, especially for source materials and control of production. The basis for attenuation of current vaccines or vaccine candidates is not known but, at least for the vaccines based on the Jennerian approach of using animal (bovine) rotaviruses, is likely to be multigenic. The risk of intussusception in humans is influenced by genetic background and age. Recent analyzes of large vaccine safety trials found that certain strains of vaccine virus were not associated with intussusception, although in these trials the first dose of vaccine was not administered to children over 3 months of age. Since age is a risk factor for intussusception, this may suggest that early delivery of the first dose of vaccine is desirable. However, maternal antibodies may mitigate against early delivery of the first vaccine dose. Factors which could affect vaccine efficacy or safety include strain diversity, malnutrition, other enteric infections, parasitic infection or immune suppression. It was concluded that data from clinical trials conducted in one part of the world would not necessarily be predictive of vaccine efficacy in other places. It was agreed that in nonclinical evaluations there was a need to use oral dosing for toxicity studies and, because rotavirus is non-neurovirulent, that there was no need for an animal neurovirulence test. For clinical evaluations there was a need for a standard definition of severe disease as the clinical endpoint, a need for studies in diverse geographical regions, and the need to control for possible interference by factors such as other oral vaccinations, intercurrent infections and breast feeding. There is no accepted correlate of protection. Secretory IgA is the most satisfactory laboratory parameter currently available and for a period after vaccination much of the specific serum IgA is of this type, so that serum IgA levels can act as measure of seroconversion. The need for standardization of the potency assay for release of vaccine was identified, as was a need to develop guidance on standardized approaches to post-marketing surveillance for rotavirus vaccines.

Natural Rotavirus Infection Is Not Associated to Intussusception in Mexican Children

To determine whether natural rotavirus infection or infection by another enteropathogen is associated to intussusception (IS); and to describe the seasonality of IS compared with severe diarrhea (SD) and rotavirus SD in Mexican children. A prospective, observational, multicenter and case-control study was conducted in Mexico City from December 1999 to February 2001. Cases were children younger than 1 year old hospitalized for IS; diagnosis was made by clinical features, radiologic and/or surgery findings. Controls were children younger than 1 year old hospitalized for another disease than a gastrointestinal illness (NGI). Cases and controls were paired by age and date of admission (+/-3 months; for both), in a 1:2 ratio. A surveillance of IS cases, SD and rotavirus SD episodes was conducted during the study period. Stool samples collected soon after IS resolution or at admission were tested for rotavirus, adenovirus, astrovirus, bacteria and parasites. Thirty cases of IS and 60 controls with NGI were studied. Rotavirus was not detected in any case of IS. Adenovirus (17%) was the only enteropathogen detected in IS. Rotavirus (8%), adenovirus (2%), astrovirus (2%) and bacteria (2%) were detected in NGI. Rotavirus infection was not associated with IS (odds ratio, 0; 95% confidence interval, 0-2.9), whereas adenovirus infection was strongly associated as risk factor for IS (odds ratio undefined; P = 0.003), compared with NGI. Seasonal variation in admissions for IS was small, whereas admissions for SD and rotavirus SD showed a marked seasonal increase during fall-winter. In Mexican children, rotavirus infection was not associated to IS; whereas a significant association was observed between adenovirus and IS. Also there was no increase in IS cases during the sharply defined fall-winter rotavirus outbreak. Observations from this controlled study suggest that natural rotavirus infection is not a risk factor for IS. This information may have implications for development of a safer and effective rotavirus vaccine.

Infant feeding and idiopathic intussusception

A case-control study showed that, compared with infants who had never been fed human milk, breast-fed infants had a relative risk of intussusception of 6.0 (95% confidence interval, 1.8 to 20.4) when breast-feeding at admission was exclusive and of 2.3 (95% confidence interval, 0.8 to 6.6) when it was partial. Exclusive breast-feeding may be a risk factor for intussusception in infancy.