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Spontaneous reduction of intussusception: clinical spectrum, management and outcome
A Kornecki1, A Daneman, O Navarro
1University of Toronto, Toronto, Ontario, Canada.
Insights
Spontaneous reduction of intussusception (SROI) is more common than previously thought, often presenting as short-segment, small-bowel cases without a lead point. Asymptomatic children benefit from observation, while symptomatic cases require intervention based on clinical findings.
Area of Science:
- Pediatric Gastroenterology
- Abdominal Imaging
- Surgical Pediatrics
Background:
- Intussusception is a common cause of bowel obstruction in children.
- Spontaneous reduction of intussusception (SROI) is a recognized but infrequently reported phenomenon.
- Understanding the clinical spectrum of SROI is crucial for appropriate management.
Purpose of the Study:
- To analyze the clinical features, management strategies, and outcomes of pediatric patients with documented SROI.
- To determine the incidence and characteristics of SROI.
- To provide evidence-based recommendations for the management of SROI.
Main Methods:
- Retrospective review of medical records of 50 children diagnosed with SROI between 1992 and 1998.
- Initial diagnosis of intussusception was established using sonography (US), air enema, or computed tomography (CT).
- Clinical presentation, imaging findings, and treatment outcomes were analyzed.
Main Results:
- SROI occurred in both symptomatic (21 patients) and asymptomatic (29 patients) children.
- The majority of SROI cases involved the small bowel (43 patients) and lacked a pathologic lead point.
- Laparotomy was performed in only 4 patients, revealing no intussusception or lead point.
- All patients experienced favorable outcomes.
Conclusions:
- SROI is more prevalent than previously reported and can occur in symptomatic or asymptomatic children.
- Small-bowel intussusceptions without a lead point are typical in SROI.
- Conservative observation is recommended for asymptomatic SROI, while symptomatic cases warrant intervention guided by clinical assessment.
Background:
To analyze the spectrum of clinical features, management and outcome of children with documented spontaneous reduction of intussusception (SROI).
Materials And Methods:
Review of records of 50 children (33 boys, 17 girls; age range 11 days-15 years; mean age 4 years) with documented SROI, in whom intussusception was initially diagnosed by sonography (US) in 44, air enema in 2, and computed tomography in 4, in the 6-year period 1992-1998.
Results:
Symptoms suggestive of intussusception were present in 21 (3 of whom had Henoch-Schönlein purpura and 4 had previous ileocolic intussusception reduced by air enema). Intussusception was an incidental finding in the other 29, in 28 of whom the finding was in the small bowel. Intussusception was limited to the small bowel in 43 and was ileocolic in 7. SROI was usually documented on US. Laparotomy performed in only 4 showed no evidence of intussusception or pathologic lead point. Outcome in all patients was favorable.
Conclusions:
SROI may present in symptomatic or asymptomatic children and occurs more commonly than previously reported. These intussusceptions are usually short-segment, small-bowel intussusceptions with no recognizable lead point. In asymptomatic patients, conservative observation is warranted. Intervention should be dictated by the clinical findings in symptomatic patients.