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Intussusception in the older child- suspect lymphosarcoma
Insights
Intussusception in children can stem from Meckel's diverticulum or ileal lymphosarcoma. Older children with specific symptoms and radiographic findings should be suspected of having ileal lymphosarcoma.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Oncology
Background:
- Intussusception is a common surgical emergency in infants and children.
- Identifying the underlying cause is crucial for appropriate management.
Observation:
- A review of 378 children with intussusception identified 29 cases with an identifiable intestinal lesion.
- Meckel's diverticulum was the cause in 21 children, all under 2 years old.
- Ileal lymphosarcoma caused intussusception in six children, aged 6.5 to 9 years.
Findings:
- Children over 6 years with intussusception, abdominal pain, bloody stools, a palpable mass, and radiographic evidence should be suspected of having ileal lymphosarcoma.
- Extensive small bowel reflux during hydrostatic reduction is necessary to rule out small intestinal lesions.
Implications:
- Suspicion of malignancy necessitates surgical planning and potential wide excision of the lesion and regional lymph nodes.
- Early diagnosis and surgical intervention are critical for favorable outcomes in pediatric intussusception due to malignancy.
Abstract:
Examination of the records of 378 children with intussusception at our institution revealed that 29 cases were caused by an identifiable intestinal lesion. A Meckel's diverticulum was the causative agent in 21 children, all of whom were under 2 yr of age. A previously undiagnosed ileal lymphosarcoma produced the intussusception in six other children, all between 6 1/2 and 9 yr of age. Our experience indicates that any child over 6 yr of age with the clinical findings of colicky abdominal pain, bloody stools, and a palpable mass plus the radiographic evidence of intussusception must be considered to have ileal lymphosarcoma until proven otherwise. Hydrostatic reduction of the intussusception must be accompanied by extensive small bowel reflux of barium in order to effectively rule out a small intestinal lesion. If this is not accomplished, surgery should be planned with the suspicion that a malignancy may be present. If this suspicion is confirmed by frozen section, the operation procedure should include wide surgical excision of the lesion along with the regional lymph nodes.