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Risk factors for surgery in pediatric intussusception in the era of pneumatic reduction
Sara C Fallon1, Monica E Lopez, Wei Zhang
1Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
Insights
Early identification of intussusception patients needing surgery is crucial. Factors like prolonged symptoms, young age, and ultrasound findings predict operative intervention, improving patient outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Background:
- Intussusception management often requires surgical intervention despite advances in non-operative reduction techniques.
- Early identification of patients necessitating surgery can significantly improve clinical outcomes.
Purpose of the Study:
- To identify predictors of surgical intervention in intussusception cases.
- To determine factors associated with the need for intestinal resection in intussusception.
Main Methods:
- Retrospective review of medical records for patients treated for intussusception between 2006 and 2011.
- Univariate and multivariate analyses, including stepwise logistic regression, were employed to identify significant predictors.
Main Results:
- Of 379 patients, 101 (26%) required surgery, with 34 undergoing intestinal resection. Post-operative complication rate was 8%.
- Predictors for surgery included failed initial reduction, presence of a lead point, free fluid, bowel wall thickening on ultrasound, age under 1 year, and symptoms lasting over 2 days.
- Predictors for intestinal resection included a lead point, free/interloop fluid on ultrasound, and fever.
Conclusions:
- Prolonged abdominal symptoms (>2 days), young age (<1 year), specific ultrasound findings, and failed enema reduction are significant predictors of operative treatment for intussusception.
- Patients presenting with these indicators warrant consideration for early surgical consultation or transfer to specialized pediatric surgical centers.
Introduction:
Surgical treatment is still necessary for intussusception management in a subgroup of patients, despite advances in enema reduction techniques. Early identification of these patients should improve outcomes.
Methods:
The medical records of patients treated for intussusception at our institution from 2006 to 2011 were reviewed. Univariate and multivariate analyses, including stepwise logistic regression, were performed.
Results:
Overall, 379 patients were treated for intussusception, and 101 (26%) patients required operative management, with 34 undergoing intestinal resection. The post-operative complication rate was 8%. On multivariate analysis, failure of initial reduction (OR 9.9,p=0.001 95% CI, 4.6-21.2), a lead point (OR 18.5,p=0.001 95% CI, 6.6-51.8) or free/interloop fluid (OR 3.3,p=0.001 95% CI, 1.6-6.7) or bowel wall thickening on ultrasound (OR 3.3,p=0.001 95% CI, 1.1-10.1), age <1 year at reduction (OR 2.7,p=0.004, 95% CI, 1.4-5.9), and abdominal symptoms>2 days (OR 2.9,p=0.003, 95% CI, 1.4-5.9) were significantly associated with a requirement for surgery. Similarly, a lead point (OR 14.5, p=0.005 95% CI, 2.3-90.9) or free/interloop fluid on ultrasound (OR 19.8, p=0.001 95% CI, 3.4-117) and fever (OR 7.2, p=0.023 95% CI, 1.1-46) were significantly associated with the need for intestinal resection.
Conclusion:
Abdominal symptoms>2 days, age<1 year, multiple ultrasound findings, and failure of initial enema reduction are significant predictors of operative treatment for intussusception. Patients with these findings should be considered for early surgical consultation or transfer to a hospital with pediatric surgical capabilities.
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