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Management of pediatric intussusception in general hospitals: diagnosis, treatment, and differences based on age
Shant Shekherdimian1, Steven L Lee
1Department of General Surgery, Division of Pediatric Surgery, Kaiser Permanente, Los Angeles Medical Center 4760 Sunset Blvd, 3rd Floor, Los Angeles, CA 90027, USA.
Insights
Age impacts pediatric ileocolic intussusception management. Infants under 6 months and older children (>4 years) have higher surgery rates, with lower enema reduction success in infants.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Outcomes Research
Background:
- Age-related differences in pediatric ileocolic intussusception management and outcomes are not well-documented.
- Understanding these differences is crucial for optimizing care in general hospitals.
Purpose of the Study:
- To compare the diagnosis and treatment of pediatric ileocolic intussusception across different age groups in general hospitals.
- To identify age-specific challenges and successes in managing this condition.
Main Methods:
- Retrospective review of 188 pediatric patients treated for ileocolic intussusception across 11 hospitals (1996-2007).
- Patients categorized into three age groups: <6 months (Group A), 6 months to 4 years (Group B), and >4 years (Group C).
- Analysis of diagnostic modalities, operative reports, and hospital records.
Main Results:
- Contrast enema was the primary initial treatment (80.3%), but less common in older children.
- Successful reduction rates were lowest in infants (<6 months) and higher in older children.
- Operative intervention was more frequent in the youngest (<6 months) and oldest (>4 years) age groups.
Conclusions:
- Enema reduction for ileocolic intussusception is moderately successful in general hospitals, with lower rates than in specialized children's hospitals.
- Infants (<6 months) exhibit the lowest successful reduction rates and higher operative rates.
- Diagnosis in older children is less frequently made by contrast enema, and they also have higher operative rates.
Background:
age related differences in the management and outcomes of children with ileocolic intussusception have not been previously published. The purpose of this study is to compare the differences in diagnosis and treatment of pediatric ileocolic intussusception based upon age in general hospitals.
Methods:
a review was made of pediatric patients treated for intussusception at 11 hospitals between 1996 and 2007. The patients were divided into 3 groups based on age: group A: <6 months (n=37), group B: 6 months to 4 years (n=126), group C: >4 years (n=25). Diagnostic modality, operative reports, and hospital records were reviewed.
Results:
altogether 188 patients were treated for ileocolic intussusception. Contrast enema was performed in 80.3% of the patients. Initial treatment for the patients included contrast enema in 80.3%, immediate operation in 3.2%, and others in 16.5%. Older patients were less likely to undergo a contrast enema (P<0.05) but more likely to be successfully reduced. Patients in group A had the lowest rate of successful reduction (P<0.05). Overall, 3.2% of the patients were taken to the operating room without any diagnostic evaluations, but 65% of the patients ultimately required operative intervention. Patients in groups A and C were more likely to undergo an operation (P<0.05). Rates of bowel resection and length of hospital stay were similar among the three groups.
Conclusions:
enema reduction for ileocolic intussusception is moderately successful in general hospitals and lower than that reported in children's hospitals. The lowest reduction rate occurs in patients of less than 6 months old and the diagnosis of intussusception in older children is rarely made by contrast enema. There is a higher operative rate in children of less than 6 months or older than 4 years and the rate of intestinal resection is higher than that in children's hospitals.
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