Changes in the presentation of intussusception

Area of Science:

• Pediatric Gastroenterology
• Abdominal Radiology
• Surgical Pediatrics

Background:

• Intussusception is typically diagnosed in infants aged 7-10 months but is often overlooked in older children.
• A significant proportion of intussusception cases occur in children over 2 years of age.
• Children with intussusception tend to have a lower than average weight.

Purpose of the Study:

• To analyze the characteristics and treatment outcomes of intussusception in a pediatric population.
• To evaluate the efficacy of barium enema reduction in different age groups and radiographic presentations.
• To determine the optimal management strategy for pediatric intussusception.

Main Methods:

• Retrospective review of 180 pediatric patients (2 months to 15 years) treated for intussusception between 1985 and 1991.
• Analysis of patient demographics, nutritional status, and clinical presentation.
• Assessment of barium enema reduction success rates, considering factors like age and radiographic findings (air-fluid levels).

Main Results:

• 37% of patients were older than 2 years, indicating a higher incidence in older children than previously reported.
• Idiopathic intussusception was the most common diagnosis across all age groups.
• Barium enema achieved a 73% overall success rate; however, the presence of air-fluid levels on plain radiographs reduced success from 81% to 49%.

Conclusions:

• Barium enema reduction should be attempted for intussusception in all pediatric patients, irrespective of age or symptom duration.
• The presence of air-fluid levels on radiographs does not preclude successful barium enema reduction.
• Routine surgical exploration for pediatric intussusception is not recommended.