Treatment Of Intussusception In Children Research Articles

Does the COVID‐19 pandemic change clinic features and treatment of intussusception in children?

Does the COVID‐19 pandemic change clinic features and treatment of intussusception in children?

Intussusception among Children Admitted in a Department of Pediatric Surgery of a Tertiary Care Centre: A Descriptive Cross-Sectional Study.

Intussusception is the second most common cause of acute abdominal pain in infants and preschool children. The aetiology for intussusception is idiopathic at this age. Hydrostatic reduction and exploratory laparotomy with proceed are the options for the management of intussusception. The aim of this study was to find out the prevalence of intussusception among patients admitted to the Department of Pediatric Surgery of a tertiary care centre. This is a descriptive cross-sectional study conducted among admitted patients in the Department of Pediatric Surgery of a tertiary care centre after ethical approval from the Ethical Committee (Reference number: A37-77/78). Data were collected from 1 January 2018 to 31 December 2020 from admitted children aged 6 months to 5 years of age. Data collection was done from the hospital record section using the convenience sampling method. Point estimate and 95% Confidence Interval were calculated. Among 1785 admitted patients, 267 (14.96%) (13.31-16.61, 95% Confidence Interval) were found to have intussusception. Among them, the hydrostatic reduction was successful in 246 (92.13%). Meanwhile, 21 (7.86%) of cases underwent laparotomy. The peak age of patients was seen in 148 (55.43%) in the age group of 1-3 years. Intussusception is one of the common surgical emergencies in children. Hydrostatic reduction of intussusception is a simple and effective method for the treatment of intussusception in children. intussusception; laparotomy; paediatrics; prevalence; ultrasound.

Clinical Application of Real-time Ultrasound-guided Warm Saline Enema in the Treatment of Intussusception in Children

Clinical Application of Real-time Ultrasound-guided Warm Saline Enema in the Treatment of Intussusception in Children

Factors associated with surgical treatment in pediatric intussusception.

The study aimed to identify factors related to the need for surgical treatment of intussusception in pediatric patients. The medical charts of 106patients diagnosed with intussusception and treated at the Imam Khomeini Medical Center in Ahvaz city between September 2019 and October 2020 were retrospectively reviewed. Patients were compared in terms of risk factor groups treated with surgery (12pediatric patients) and nonsurgical methods (92pediatric patients). Size of intussusception, free fluid in the abdomen, and currant jelly stool were compared between the groups. The mean age in the group treated with surgery was significantly higher (p = 0.01). The duration of symptoms in patients treated with surgery was significantly higher (p = 0.033). The size of intussusception in the surgical treatment group was significantly larger than in the nonsurgical recovery group (p = 0.042). The rates of presence of free fluid in the abdomen and currant jelly stool were significantly higher in patients treated with surgery (p = 0.001 and p = 0.004, respectively). Age > 1year, duration of symptoms > 24 h, currant jelly stool, intussusception > 3.5 cm, and free peritoneal fluid are factors associated with surgical treatment of intussusception in children.

Diagnosis and treatment of intussusception in children

Diagnosis and treatment of intussusception in children

Nonsurgical reduction of prolapsed colocolic intussusception in 2 puppies.

To describe the nonsurgical management of prolapsed colocolic intussusception in 2 puppies. Two 3-month-old male intact puppies (Pug and Labrador Retriever) developed intussusceptions that had prolapsed from the anus after they had suffered from tenesmus with soft feces or diarrhea. Reduction of the prolapsed tissue was performed and colocolic intussusception was diagnosed ultrasonographically in 1 dog. Rectal manipulation and saline enema were performed in both dogs, and reduction of the intussusception was confirmed endoscopically or ultrasonographically. Bupivacaine and prednisolone foam enemas were administered to reduce tenesmus. Abdominal ultrasonography the following day in 1 dog confirmed a normal appearing colon. No further tenesmus was noted in 1 dog; the other had a brief rectal prolapse after an episode of tenesmus that was manually reduced. Intussusception had not recurred 4 months and 1 year following manual reduction procedures. This is the first report of successful nonsurgical management of colocolic intussusception in a companion animal. Nonsurgical management is a first-line treatment of intussusception in children and could be considered in dogs with colocolic intussusception. Further investigation is required to define specific aspects, including rectal manipulation, saline enema, or anesthesia, that aid in resolution of this type of intussusception.

Effectiveness of ultrasound-guided hydrostatic reduction of intussusception in children

Aim: To review the effectiveness of ultrasound- guided hydrostatic reduction of intussusception in children.
 Methods: This prospective interventional study was done during one year period from January 2014 to December 2014 in the department of Radiology and Imaging of Dhaka Medical College and Hospital, Dhaka and included 30 children clinically and radiologically diagnosed as intussusception with symptoms d” 48 hours. They underwent ultrasound-guided hydrostatic reduction using normal saline and the effectiveness of this technique was reviewed.
 Results: Majority of the study population were in the age group of 7-24 months with mean age of 9.04± 2.48 months. 100% patients who presented within 24 hours of their symptoms achieved successful reduction whereas success rate of reduction were 95% and 0% respectively in patients presented within 24-36 hours and after 36 hours of their symptoms. 60% cases required 5-10 minutes for successful reduction, 20% cases required 3-5 minutes and 10% patients needed > 10 minutes. Within 3 attempts, reduction happened in 90% cases whereas 10% cases failed to reduce. No case was tried for reduction after 3 attempts in consideration of the bowel pathology and complications. Only 10% patients developed negligible complications. No case showed recurrence.
 Conclusion: Ultrasound guided hydrostatic reduction of intussusception is an effective nonoperative treatment of intussusception in children because of its high success rate, less complications and recurrence rate.
 J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 134-140

Pneumatic versus hydrostatic reduction in the treatment of intussusception in children

BackgroundThe aim of this study was to compare pneumatic reduction under guidance of fluoroscopy and hydrostatic saline enema reduction under guidance of ultrasound in treatment of intussusception in pediatric patients.MethodsThe study included 80 patients with intussusception in the time period fro

A 30-Year Experience in Treatment of Intestinal Intussusception in Children by Own Technique

The issues on objectification and selection of indications for conservative treatment of intestinal intussusception in children remain to be disputable.Materials and methods. The experience of treating 249 pediatric patients (172 boys and 77 girls) with intestinal intussusception at the age of 2 months - 13 years was analyzed. There were 265 cases of intestinal intussusception including 16 cases of the recurrence in 11 children. Conservative treatment was performed in 178 (71.5%) children, 71 (28.5%) children were operated on. To make the analysis, children were divided into 3 groups according to three ten-year periods.Results and discussion. The statistical analysis demonstrated the decrease in the number of patients with the increase in the number of children over 1 year of age over the past decade. The 1st decade was characterized by the introduction and experimental substantiation of flow-through pneumatic insufflation developed by the author with following refusal of X-Ray control. The methods of objectification of the criteria for non-surgical reduction of intussusception using flow-through pneumatic insufflation were developed experimentally. In the 2nd decade the algorithm for treatment of intestinal intussusception was developed; the indications for non-surgical reduction of intussusception were extended. 5 (22.7%) children out of 22 with disease duration of more than 24 hours and 6 (46.2%) children out of 13 over 1 year of age underwent non-surgical reduction of intussusception. In the 3rd decade the indications for non-surgical reduction of intussusception were extended. 11 (57.9%) children out of 19 with disease duration of more than 24 hours and 20 (74.1%) children out of 27 over 1 year of age underwent non-surgical reduction of intussusception. Only in 4 (28.5%) children out of 14 over 1 year of age who were operated on, we found out anatomical cause of the condition. We have analized the experience in treating 11 children with 16 recurrences of intestinal intussusception. In 7 cases non-surgical reduction was performed, 4 children were operated on. During surgeries there were observed no anatomical causes or predispositions to intussusception. Lethal outcomes were not registered.Conclusions. Thus, flow-through pneumatic insufflation is an effective and objective technique of non-surgical reduction of intestinal intussusception in infants. Non-surgical reduction of intestinal intussusception can be performed in the majority of patients without the signs of peritonitis. The duration of the condition, age of patients and the presence of recurrence should not be considered as absolute criteria in choosing treatment tactics in intestinal intussusception.

Experience of Diagnosis and Treatment of Intussusception in Children

The objective of the research was to establish the causes of complications of intestinal intussusception in children as well as to determine the optimal diagnostic and treatment strategy.Materials and methods. The analysis of medical records and examinations of 100 children with intestinal intussusception at the age of 1 month to 17 years who were treated at the clinic of pediatric surgery of the Ivano-Frankivsk National Medical University was made. Ileocecal intussusception was diagnosed in 77 children; 13 patients had small intestinal intussusception; there were no patients with colonic intussusception; in 10 patients the localization of intussusception was not established. Treatment of intestinal intussusception was performed urgently immediately after the diagnosis. High priority was given to conservative treatment (74 patients); it was effective in 64 (86.5%) patients. The remaining 36 patients underwent surgery, 9 (25%) of them underwent a laparoscopic disinvagination. In 27 cases open surgery – disinvagination – was used.Results and discussion. The typical age (4-12 months) was observed in 50% of patients only, however, 38% of patients were over 1 year of age, and 20% of children were older than 3 years. All children with intestinal intussusception recovered. The complications of intestinal intussusception were observed in 7 patients, most of them were admitted to the clinic 24 hours after the onset of the disease. Re-laparotomy was used in three cases; two patients underwent elective (programmed re-laparotomy) and one patient underwent urgent re-laparotomy due to the presence of signs of peritonitis. Recurrent intussusception was observed in 5 patients; 4 patients developed this condition after conservative disinvagination, one child - after surgery.Conclusions. The complications of intussusception in children are usually associated with untimely diagnosis and treatment.Diagnostic laparoscopy is a highly informative method of diagnosis in the absence of typical symptoms of intussusception being also an effective minimally invasive treatment.When selecting the method of intussusception treatment you should be guided by the duration of rectal bleeding and Doppler data being the most important criteria for determining the degree of the impairment of hemomicrocirculation in the invaginated intestine.Conservative disinvagination is the priority method of treating intussusception.

Meta-analysis of Air Versus Liquid Enema for Intussusception Reduction in Children.

The purpose of this study was to assess the effectiveness and safety of air versus liquid enema reduction in the treatment of intussusception in children. Literature searches of the PubMed, Embase, and Cochrane Library databases were conducted from January 1, 1966, through May 31, 2013. Articles on the use of air or liquid enema in children with a confirmed diagnosis of intussusception and reporting either a success rate for enema reduction of intussusception or a perforation rate were selected. Enema reduction success rate, perforation rate, and recurrence rate were the main outcomes and were calculated by random effects modeling. One hundred two articles (101 reporting success rate, 71 reporting perforation rate) were included that presented results for 32,451 children (age range, 1 day-22 years; boys, 66%; girls, 34%). In 44 studies (16,187 children), the combined estimate for success rate of air enema was 82.7% (95% CI, 79.9-85.6%; inconsistency index [I(2)] = 97%), and in 52 studies (13,081 children) of liquid enema, it was 69.6% (95% CI, 65.0-74.1%; I(2) = 98%). In 38 studies (15,752 children), the combined estimate of perforation rate for air enema was 0.39% (95% CI, 0.23- 0.55%; I(2) = 40%), and in 30 studies (9429 children) of liquid enema, it was 0.43% (95% CI, 0.24- 0.62%; I(2) = 9%). Among 10,494 children (26 studies) undergoing air enema reduction, the rate of first intussusception recurrence was 6% (95% CI, 4.5-7.5%; I(2) = 89%), similar to the 7.3% (95% CI, 5.8-8.8%; I(2) = 71%) found for 4004 children (24 studies) undergoing liquid enema reduction. Air enema was superior to liquid enema for intussusception reduction. The success rate was higher without a difference in perforation rate. Limitations included heterogeneity and publication bias.

Laparoscopic diagnosis and treatment of enteric intussusception in children

Laparoscopic diagnosis and treatment of enteric intussusception in children

Risk Factors Associated with the Need for Operative Treatment of Intussusception in Children

The aim of this study was to identify the risk factor related to the need for operative treatment and avoid unnecessary non-operative management for intussusception in children. We retrospectively reviewed medical records of patient treated for intussusception at our institution between January 2006 and January 2013. Clinical features such as gender, age, seasonal variation, symptoms and signs, treatment results were analyzed. Univariate and multivariate analyses including a chi-square test for categorical variables and logistic regression analysis were performed. During the study period, 356 patients were treated for intussusception. 328 (92.1%) was treated successfully by the non-operative pneumoreduction, and 28 (7.9%) required operative management. On univariate analysis, risk factors which were related to the need for operative treatment were age, vomiting, bloody stool, lethargy, and symptoms duration. A logistic regression analysis in order to assess for independent predictors of operative treatment was performed. Age (＜6 vs ≥12 months) (OR 4.713, 95% CI 1.198∼18.539, p=0.027) and symptoms duration longer than 48 hours (OR 4.534, 95% CI 1.846∼11.137, p=0.001) were significantly associated with a requirement for operative treatment. We conclude that younger age and a longer duration of symptoms (≥ 48 hours) are the independent risk factor related to the need for operative treatment for intussusception. Early surgical intervention or transfer to a hospital with pediatric surgical capabilities should be considered for patients with these findings.

Current success in the treatment of intussusception in children

Intussusception remains a common cause of bowel obstruction in young children and results in significant morbidity and mortality if not promptly treated. The goal of this study was to determine the current success rate of radiologic reduction, the requirements for operative intervention, and the effect of delay in presentation on outcome. Children treated for intussusception over a 15-year period were reviewed after treatment at a tertiary children's hospital. Records were reviewed for patient outcomes from radiologic evaluation and surgical intervention. Two hundred forty-four children with intussusception were identified. Median age was 8.2 months (range, 16 days to 12.7 years). Eighty-seven percent of patients had ileocolic or ileoileocolic intussusception. The most common presenting symptoms were emesis (81%), hematochezia (61%), and abdominal pain (59%). Contrasted enemas were performed in 190 children, with successful reduction in 46%. Air-contrasted enema reduction was more successful than liquid-contrasted techniques (54% vs 34%; P = .017). Success in reduction was greater if symptom duration was <24 hours compared with >24 hours (59% vs 36%; P = .001). Despite failed prior attempts at reduction, 48% were reduced on reattempted enema reduction. One hundred forty children required surgical intervention for intussusception with 50% requiring bowel resection. Children with symptom duration >24 hours had a greater risk of requiring surgery (73% vs 45%; P < .001) and bowel resection (39% vs 17%; P = .001) than those with symptoms for <24 hours. Pathologic lead points were encountered in 14%. There were 2 deaths and complications occurred in 19%. Length of stay after surgical reduction was 3.9 days, but 6.1 days if bowel resection was required. Success of intussusception reduction is improved with air-contrasted techniques and is not affected by previously failed, outside attempts. Delay in presentation decreases success in radiologic reduction and increases risk of operative intervention and bowel resection.

The Role of Ultrasound in the Diagnosis and Treatment of Intussusception in Children

The Role of Ultrasound in the Diagnosis and Treatment of Intussusception in Children

Treatment of Intussusception in Children

Treatment of Intussusception in Children

Ultrasound guided hydrostatic reduction in the management of intussusception

A case series study was conducted for two years from 01 June 2002 to 01 June 2004 to study the efficiency of ultrasound guided hydrostatic reduction in the management of intussusception in children. A total of 25 patients who underwent the procedure were evaluated. All the patients were diagnosed by High Resolution Ultrasonography (HRUSG). Continuous monitoring of the progress of reduction during the procedure was done by HRUSG. 500-1000 ml (average 600 ml) of normal saline was used. 24 out of 25 (96%) intussusceptions were successfully reduced. Average time taken was 15 minutes. All the patients were reviewed after 24 hrs for recurrence. None of them showed recurrence within 24 hrs. No complications were observed. The study concludes that ultrasound guided hydrostatic reduction is a safe, simple and effective method for treatment of intussusception in children.

Combination of different types of intestinal intussusception trauma in children

The issues of diagnosis and treatment of intestinal intussusception in children are still one of the most urgent in pediatric surgery. Often, intestinal intussusception is combined with various types of injuries.

Laparoscopy in the treatment of intussusception in children

Purpose: The technique and outcome of minimally invasive laparoscopic treatment of various forms of intussusception in children after ineffective attempt at conservative treatment are described. Methods: Ninety-eight patients from 2 months to 11 years of age were analyzed. Results: Suggested scheme of surgical treatment using laparoscopic technique was successful in 64 patients (65.3%), and conversion to open procedure occurred in 34 (34.7%). There was no mortality or intraoperative complications in our series. Conclusion: Practically every form of intussusception without bowel necrosis, including the most complex forms, can be reduced now using modern videolaparoscopic equipment and atraumatic instruments.

Errors in the diagnosis and treatment of intestinal intussusception in children

The analysis of errors in the diagnosis and treatment of 49 children with intestinal intussusception is carried out according to the case histories. The most common causes of diagnostic errors are incorrect assessment of bloody discharge from the rectum, insufficiently careful examination of the patient, poor use of additional research methods, neglect of preoperative preparation in a serious condition of the child, inappropriate choice of anesthesia method and improper postoperative management of patients.