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Surgical approach to intussusception in older children: influence of lead points
Pooya Banapour1, Roman M Sydorak1, Donald Shaul1
1Kaiser Los Angeles Medical Center, Department of Surgery, 4760 Sunset Blvd., 3rd fl, Los Angeles, CA 90027.
Insights
Older children with ileocolic intussusception are more likely to have a lead point. Early surgery is recommended for patients over 5 years old, as enema reduction is less effective in this group.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Intussusception
Background:
- The incidence of lead points in ileocolic intussusception increases with age.
- Older children may require different management strategies for intussusception.
Purpose of the Study:
- To evaluate the association between age and lead points in ileocolic intussusception.
- To determine the optimal management strategy for older children with intussusception.
Main Methods:
- Retrospective multi-institutional study of 153 patients aged <12 years with ileocolic intussusception.
- Analysis of clinical data, including stool characteristics, reduction methods, and presence of lead points.
- Comparison of outcomes between age groups (0-5 years vs. 6-12 years).
Main Results:
- Lead points were found in 5/10 children aged 6-12 years, significantly higher than in younger children (p<0.001).
- Enema reduction was successful in only 1 patient over age 5, while surgical resection was required in 29 patients.
- Common lead points included Meckel's diverticula and other pathologies.
Conclusions:
- Children over 5 years with ileocolic intussusception have a higher likelihood of a pathologic lead point.
- Early surgical intervention should be considered for older children with intussusception.
- Enema reduction is safe but minimally beneficial in children over 5 years old.
Background:
The likelihood of a lead point as the cause of ileocolic intussusception increases as children get older. This study looks at whether a different management strategy should be employed in older patients.
Methods:
7 year multi-institutional retrospective study of intussusception in patients aged <12 years.
Results:
Ileocolic intussusception with complete data was found in 153 patients: 109 0-2 years, 34 3-5 years, and 10 6-12 years, respectively. Bloody stools occurred in 42/143 of 0-5 years and 0/10 of 6-12 years, p<0.001. Combined hydrostatic and/or surgical reduction was successful in 113/143 0-5 year olds vs 5/10 6-12 year olds, p<0.001. Enemas were safe but reduced only 1 patient over age 5. Resections were required in 29 patients (15 idiopathic, 14 lead points). Lead points were found in 4/109 children under 3 years, in 5/34 aged 3-5 years and 5/10 aged 6-12 years (p=0.04 vs 3-5 years and p <0.001 vs 0-5 years). Lead points consisted of 7 Meckel's diverticula and 7 others.
Conclusion:
Children older than 5 years are much more likely to have a pathologic lead point and early surgical intervention should be considered. In this study, enema reduction was safe but minimally beneficial in this age group.
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