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Recurrent intussusception occurs in 5% of cases, with higher rates after barium enema reduction than surgery. Early recurrence is common, often with milder symptoms, and barium enema is effective unless a leading point is present.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Intussusception is a common surgical emergency in infants and children.
- Recurrent intussusception presents unique challenges in management and treatment strategies.
Purpose of the Study:
- To analyze the recurrence rate and outcomes of intussusception in a pediatric cohort.
- To evaluate the effectiveness of different reduction methods for recurrent intussusception.
Main Methods:
- Retrospective analysis of 600 intussusception cases over 17 years.
- Focus on 28 children with 35 recurrent intussusception events.
- Review of reduction methods (hydrostatic barium enema, operative) and outcomes.
Main Results:
- Overall recurrence rate was 5%; 11% after barium enema, 3% after surgery.
- Most recurrences (over two-thirds) occurred within 6 months.
- Barium enema successfully reduced 21 of 30 recurrences; surgery was required in 16 cases.
- Leading points were rare (2 cases) and necessitated resection.
Conclusions:
- While operative reduction decreases recurrence risk and ileocolic resection eliminates it, surgery is not indicated if barium enema reduction is successful.
- Hydrostatic reduction is not effective for intussusception caused by a leading point.
Abstract:
Twenty-eight children with 35 recurrent intussusceptions were collected and analyzed from a series of 600 intussusceptions over 17 yr. The overall recurrence rate in the entire series was 5% with 11% recurring after hydrostatic barium enema reduction, and 3% after operative reduction. Twenty-three children had one recurrence each, four children had two recurrences, and one child had four recurrent intussusceptions. More than two-thirds of the patients had a recurrence within 6 mo of their first intussusception, and half of these presented earlier and with fewer signs and symptoms than the previous attack had manifested. Twenty-one of 30 recurrences were reduced with barium enema. Sixteen were operated on, reducing nine manually and resecting four others. Only two leading points were found, and in both instances resection was required. All but two of the intussusceptions were ileocolic. The previous mode of reduction of each intussusception did not set a trend for future treatment of recurrent intussusceptions in the same child. While operative reduction diminishes the chances of a recurrent intussusception and ileocolic resection eliminates it, there does not seem to be any indication for surgery as long as barium enema reduction is successful. We have never observed the hydrostatic reduction of an intussusception caused by a leading point.