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Children with intussusception caused by a specific lesion often present with delayed diagnosis and worse outcomes. This study highlights common leading points and surgical needs in these challenging pediatric cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Medicine
Background:
- Intussusception in children can be idiopathic or caused by a specific pathologic lesion.
- Lesion-associated intussusception is often more difficult to diagnose and associated with higher morbidity.
- Over 500 cases of intussusception were reviewed, with 31 identified as lesion-associated.
Purpose of the Study:
- To analyze the clinical characteristics and outcomes of pediatric intussusception cases caused by specific pathologic lesions.
- To identify common leading points and management strategies in lesion-associated intussusception.
- To compare these cases with the idiopathic variety.
Main Methods:
- Retrospective analysis of 31 cases of lesion-associated intussusception within a larger series of over 500 cases.
- Evaluation of patient age, symptom duration, presenting signs, diagnostic methods (barium enema), and surgical interventions.
- Identification of common leading points such as Meckel's diverticula, polyps, and duplications.
Main Results:
- Children with lesion-associated intussusception were older on average, with longer symptom duration.
- Nearly 50% presented with advanced small bowel obstruction.
- Barium enemas were less frequently successful in reduction (0%), and ileo-ileal intussusceptions were more common.
- Meckel's diverticula, polyps, and duplications were the most frequent leading points.
- All patients required surgery, with three-fourths undergoing bowel resection.
Conclusions:
- Lesion-associated intussusception in children presents unique diagnostic and management challenges.
- Older children and those with recurrent intussusception do not always have identifiable leading points.
- Prompt surgical intervention is often necessary for lesion-associated intussusception, with a significant rate of bowel resection.
Abstract:
Children whose intussusception is caused by a specific pathologic lesion are harder to diagnose and have a higher morbidity than those with the idiopathic variety. We have collected and analyzed 31 such cases found in a series of over 500 intussusceptions. The average age of these children was greater than is usually found in most cases, and the duration of the signs and symptoms was also longer than is usually seen. Almost 50% presented with a picture of advanced small bowel obstruction. Fewer barium enemas were done (50%) and none was successful in reducing the intussusception. There was a higher number of ileo-ideal intussusceptions in this group. The commonest leading points were Meckel's diverticula, polyps, and duplications. All patients with leading points required operation; three-fourths had a bowel resection performed. This study of 569 cases suggests that older children with intussusception and children with recurrent intussusception do not necessarily have leading points causing their intussusceptions.