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Small bowel intussusception in symptomatic pediatric patients: experiences with 19 surgically proven cases
Sheung-Fat Ko1, Tze-Yu Lee, Shu-Hang Ng
1Department of Radiology, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung University, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan. sfatko@adm.cgmh.org.tw
Insights
Delayed diagnosis of pediatric small bowel intussusception (SBI) is common, leading to significant bowel complications. Early surgical intervention is crucial for better outcomes in children with symptomatic SBI.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Gastroenterology
Background:
- Small bowel intussusception (SBI) is a surgical emergency in children.
- Timely diagnosis and treatment are critical to prevent bowel complications.
Purpose of the Study:
- To review the clinical presentation, diagnostic methods, and outcomes of pediatric small bowel intussusception.
- To identify factors associated with delayed diagnosis and complications.
Main Methods:
- Retrospective review of 19 pediatric cases with surgically proven symptomatic SBI.
- Analysis of clinical data, imaging findings (sonography, CT), and surgical outcomes.
- Comparison of time to diagnosis and surgery between patients with and without bowel complications.
Main Results:
- Vomiting and abdominal pain were the most common symptoms.
- Sonography revealed target lesions suggestive of SBI in 13/17 patients.
- Delayed diagnosis and surgery occurred in 16 patients, with 42% experiencing bowel complications.
- Complications were significantly associated with longer delays from symptom onset to surgery (p=0.0026).
Conclusions:
- Delayed diagnosis and surgical treatment of pediatric SBI are frequent and lead to high rates of bowel complications.
- Sonographic findings of a target lesion are suggestive of SBI and may reduce the need for barium enema.
- Early surgical referral is strongly recommended for symptomatic pediatric SBI once diagnosed.
Abstract:
Nineteen cases of surgically proven symptomatic pediatric small bowel intussusceptions (SBI) were retrospectively reviewed. Clinical presentations included vomiting (89.5%), abdominal pain and/or irritable crying (89.5%), fever (52.6%), bloody stools (26.3%), palpable abdominal masses (15.8%), hematemesis (10.5%), jaundice (5.3%), and seizures (5.3%). The duration between symptom onset and hospitalization ranged between 20 and 336 hours (average 75.8 hours). Two patients with suspected appendicitis and small bowel obstruction were operated on promptly. Sonograms revealed target lesions (average diameter 2.9 cm) suggestive of intussusception in 13 out of 17 patients, with 10 lesions located in the paraumbilical or left abdominal regions. Barium enemas in 12 of these 13 patients demonstrated no colonic lesions. Diagnosis and surgery were delayed in 16 patients (average delay = 32 hours). The remaining 1 patient with positive sonographic findings underwent early surgery after computed tomographic (CT) confirmation of SBI. Surgery revealed ileoileal intussusceptions in 11 patients, jejunojejunal in 4, jejunoileal in 3, and duodenojejunal in 1. Eight patients had lead points. Bowel complications (ischemia, necrosis, or perforation) occurred in 8 patients. The duration between symptom onset and surgery in patients with bowel complications was significantly longer than for patients without complications (p = 0.0026). In conclusion, delayed diagnosis and surgical treatment in symptomatic pediatric patients with SBI were common, leading to a high rate (42%) of bowel complications. Sonographic demonstration of a 2-3 cm target lesion, especially if paraumbilical or left abdominal, is suggestive of SBI and may obviate the need for a barium enema; however, CT is helpful for confirming SBI. In symptomatic SBI, once diagnosed, early surgical referral is strongly recommended.