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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.
Insights
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.
- 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.
Abstract:
Intussusception is most often diagnosed in well-nourished 7- to 10-month-old infants, but may be overlooked in older children. From 1985 to 1991, we treated 118 boys and 62 girls ranging in age from 2 months to 15 years (average, 22.6 months). Thirty-seven percent were older than 2 years, significantly more than in earlier experience at this institution. Overall, children with intussusception had a less than average weight (P < .05). The majority of intussusceptions in all age groups were idiopathic. Seventy-three percent of the patients were treated successfully by barium enema. The presence of air-fluid levels on the plain radiograph decreased the success rate of barium enema reduction from 81% to 49%. Barium enema reduction should nevertheless be attempted regardless of the age of the patient or the duration of symptoms, and routine surgical exploration is never recommended.