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[Invagination in children: not always ileocaecal]

I Oros-Horjus1, D C van der Zee, D Vieira-Travassos

  • 1Universitair Medisch Centrum Utrecht, locatie Wilhelmina Kinderziekenhuis, afd. Kinderchirurgie, Utrecht.

Nederlands Tijdschrift Voor Geneeskunde
|August 30, 2007
PubMed

Insights

Secondary intussusception in children requires careful evaluation for a lead point, especially in those over 3. Prompt investigation, including laparoscopy, is crucial for accurate diagnosis and treatment.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology

Background:

  • Intussusception is a common surgical emergency in infants and young children.
  • Idiopathic intussusception is the most frequent type, typically resolving with hydrostatic reduction.

Observation:

  • Three pediatric cases of secondary intussusception are presented, two initially misdiagnosed as idiopathic.
  • Two cases involved ileo-ileal intussusception with lead points (malignant lymphoma, vasculitis), while one ileo-ileal intussusception resolved spontaneously (Meckel's diverticulum).

Findings:

  • Contrast enema can be misleading, appearing successful when only partially reducing the intussusception.
  • Recurrence or suspicion of a lead point necessitates further investigation, including diagnostic laparoscopy.
  • Lead points were identified in intussusceptions in children over 3 years old or with underlying conditions.

Implications:

  • Emphasizes the importance of identifying lead points in pediatric intussusception, particularly in older children or those with comorbidities.
  • Highlights the limitations of contrast enema in diagnosing and treating complex intussusception cases.
  • Advocates for a low threshold for advanced diagnostic procedures like laparoscopy to ensure definitive management.

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