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Changes in the presentation of intussusception.

F I Luks¹, S Yazbeck, G Perreault

¹Department of Surgery, Hôpital Sainte-Justine, University of Montréal, Quebec, Canada.

The American Journal of Emergency Medicine

|November 1, 1992

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Intussusception, a bowel obstruction, can be missed in older children. Barium enema is a successful treatment regardless of age or symptom duration, even with radiographic signs like air-fluid levels.

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.

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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.