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Risk factors associated with intestinal necrosis in children with failed non-surgical reduction for intussusception
Hui-Ya Huang1, Xiao-Zhong Huang2, Yi-Jiang Han2
1Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
Insights
Bloody stools and prolonged symptom duration are key indicators of intestinal necrosis in pediatric intussusception cases that fail non-surgical reduction. Early surgical intervention for prolonged symptoms may be warranted.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Research
Background:
- Intestinal necrosis is a severe complication of intussusception in children.
- Risk factors for intestinal necrosis in pediatric intussusception are not well-defined.
Purpose of the Study:
- To identify risk factors for intestinal necrosis in pediatric intussusception patients with failed non-surgical reduction.
- To inform clinical decision-making for surgical intervention.
Main Methods:
- Retrospective review of 728 pediatric intussusception cases undergoing surgery after failed air-enema reduction.
- Analysis of demographic and clinical features, including surgical findings.
- Univariate and multivariate logistic regression to identify risk factors for intestinal necrosis.
Main Results:
- 171 out of 728 patients (23.5%) developed intestinal necrosis.
- Intestinal necrosis was associated with longer symptom duration (P=0.000) and younger age (P=0.000).
- Grossly bloody stool (OR=2.12) and symptom duration (OR=1.07) were independent risk factors for intestinal necrosis.
Conclusions:
- Bloody stools and prolonged symptom duration at admission are significant risk factors for intestinal necrosis in pediatric intussusception.
- Duration of illness demonstrated high sensitivity and specificity for predicting intestinal necrosis.
- Consideration for immediate surgical reduction in cases with prolonged symptoms is suggested.
Background:
Intestinal necrosis is the most serious complication of intussusception. The risk factors associated with intestinal necrosis in pediatric patients with intussusception have not been well characterized.
Objective:
This study aimed to investigate the risk factors associated with intestinal necrosis in pediatric patients with failed non-surgical reduction for intussusception.
Methods:
Hospitalized patients who failed the air-enema reduction for intussusception in the outpatient department and subsequently underwent surgery were retrospectively reviewed. All cases were categorized into two groups: intestinal necrosis group and non-intestinal necrosis group based on the surgical findings. Demographic and clinical features including the findings from the surgery were recorded and analyzed. Factors associated with intestinal necrosis were analyzed using univariate and multivariate unconditional logistic regression analyses.
Results:
A total of 728 cases were included. Among them, 171 had intestinal necrosis at the time of surgery. The group with intestinal necrosis had a longer duration of symptom or length of illness (P = 0.000), and younger (P = 0.000) than the non-intestinal necrosis group. Complex/compound type of intussusceptions is more likely to have intestinal necrosis. Multivariate analysis showed that the presence of grossly bloody stool (OR = 2.12; 95% CI 1.19-3.76, P = 0.010) and duration of symptom (OR = 1.07; 95% CI 1.06-1.08, P = 0.000) were independent risk factors for intestinal necrosis in patients hospitalized for surgical reduction for intussusceptions.
Conclusion:
At time of admission, the presence of bloody stools and duration of symptom are the important risk factors for developing intestinal necrosis for those patients who failed non-surgical reduction. The length of illness has the highest sensitivity and specificity to correlate with intestinal necrosis. This finding may suggest that we should take the intussusception cases that have the longer duration of symptom directly to operation room for reduction.
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