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Pediatric Intussusception in Northern Iran: Comparison of Recurrent With Non-Recurrent Cases
Mohammad Reza Esmaeili-Dooki1, Leila Moslemi1, Abbas Hadipoor1
1Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR Iran.
Insights
Recurrent intussusception occurred in 16% of pediatric cases. Barium enema reduction, compared to operative reduction, increased recurrence risk fivefold, with most cases being idiopathic.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Abdominal Surgery
Background:
- Intussusception, the invagination of the intestine, is a common cause of intestinal obstruction in young children.
- It most frequently affects children aged 6 months to 3 years.
Purpose of the Study:
- To determine the recurrence rate of intussusception in children.
- To identify predisposing factors associated with recurrent intussusception.
Main Methods:
- Retrospective review of medical records for children under 13 with intussusception from 2001-2013.
- Analysis of 237 diagnosed cases, comparing recurrence rates and associated factors.
- Statistical comparison using chi-square, Fisher, Mann-Whitney, and t-tests.
Main Results:
- The overall recurrence rate was 16% (38 cases).
- Recurrence was significantly higher (P < 0.001) after initial barium enema (BE) reduction (23.5%) compared to operative reduction (5.7%).
- Pathological leading points (PLPs) were uncommon and not significantly associated with recurrence, with most cases appearing idiopathic.
Conclusions:
- The method of initial reduction is a key factor in intussusception recurrence.
- Barium enema reduction is associated with a higher risk of recurrence than operative reduction.
- Recurrent intussusception is often idiopathic, with PLPs being infrequent, particularly in younger children.
Background:
Intussusception represents as the invagination of a part of the intestine into itself and is the most common cause of intestinal obstruction in infants and children between 6 months to 3-years-old.
Objectives:
The objective of this study was to determine the recurrence rate and predisposing factors of recurrent intussusception.
Patients And Methods:
The medical records of children aged less than 13-years-old with confirmed intussusception who underwent reduction at a tertiary academic care in northern Iran (Mazandran), from 2001 to 2013 were reviewed. Data were extracted and recurrence rate was determined. The two groups were compared by chi square, Fisher, Mann-Whitney and t-test. Diagnosed cases of intussusception consisted of 237 children.
Results:
Average age of the patients was 19.57 ± 19.43 months with a peak of 3 to 30 months. Male to female ratio was 1.65 and this increased by aging. Recurrence rate was 16% (38 cases). 87 (36.7%) underwent surgery. These were mainly children under one year old. In 71% (40) of episodes recurrence occurred 1 to 7 times within 6 months. The recurrence occurred in 29 (23.5%) children in whom a first reduction was achieved with barium enema (BE) and 5 (5.7%) children who had an operative reduction (P < 0.001) in the first episode. Pathological leading points (PLPs) were observed in 5 cases; 2.6% in recurrence group versus 2% in non-recurrence group (P = 0.91). Three patients had intestinal polyp, 2 patient's lymphoma and Mackle's diverticulum. Age (P = 0.77) and sex (P = 0.38) showed no difference between the two groups. PLPs were observed in 1.4% of children aged 3 months to 5 years. This was 13.3%, in older children (P = 0.02).
Conclusions:
The recurrence of intussusception was related to the method of treatment in the first episode and it was 5-fold higher in children with BE than in operative reduction. Recurrent intussusceptions were not associated with PLPs, they were more idiopathic.
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