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Clinical characteristics of intussusception secondary to pathologic lead points in children: a single-center
Xiao-Kun Lin1, Qiong-Zhang Xia2, Xiao-Zhong Huang2
1Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China. linxk2000@163.com.
Insights
Pediatric intussusception secondary to pathologic lead points (PLPs) often recurs and has diverse causes. Surgical reduction is the preferred treatment for this challenging condition.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Medicine
Background:
- Intussusception secondary to pathologic lead points (PLPs) presents a diagnostic and management challenge in pediatric surgery.
- Limited published data exists on the specific characteristics and outcomes of PLP-related intussusception in children.
Purpose of the Study:
- To review and analyze clinical data on the diagnosis and management of intussusception secondary to PLPs in pediatric patients.
- To identify common etiologies and recurrence patterns associated with PLP-induced intussusception.
Main Methods:
- Retrospective review of 65 pediatric patients diagnosed with intussusception secondary to PLPs between 2002 and 2016.
- Analysis of patient demographics, clinical manifestations, diagnostic methods (ultrasound), recurrence rates, surgical procedures, and PLP types.
Main Results:
- The study included 47 males and 18 females with an average age of 4.9 years.
- Fifty-one patients experienced recurrent intussusception, with various recurrence intervals. Common PLPs included Meckel diverticulum (32), intestinal duplication (14), and benign polyps (5).
- Surgical reduction was performed in all patients, with enterectomy being the most common procedure (55 patients). All patients recovered well, with one case of post-operative adhesion requiring conservative management.
Conclusions:
- Intussusception secondary to PLPs is characterized by a tendency for recurrence and diverse underlying etiologies.
- Improving auxiliary examinations is crucial for accurate etiological identification and to prevent intraoperative omissions.
- Surgical reduction of intussusception secondary to PLPs is the recommended and effective clinical management strategy.
Objective:
Intussusception secondary to pathologic lead points (PLPs) is a challenging condition for pediatric surgeons, and few studies have been published on this subject. The aim of this study was to review and analyze clinical data on the diagnosis and management of intussusception secondary to PLPs in children.
Methods:
Between 2002 and 2016, a total of 65 pediatric patients with a diagnosis of intussusception secondary to PLPs were retrospectively reviewed.
Results:
The series comprised 47 males and 18 females. The average age of the patients was 4.9 years old. All patients had typical clinical manifestations, and intussusception was proven by ultrasound. Fifty-one patients had recurrent intussusception, of whom 21 had one, 14 had two, 10 had three, and 6 had more than three. There were 20 episodes of recurrence within 24 h (39.2%), 15 episodes were found between 24 and 72 h (29.4%), and the remaining 31.4% (16/51) of recurrences occurred after 72 h. All patients received surgical intussusception reduction. Meanwhile, enterectomy was the procedure of choice in 55 patients, polypectomy in 5 patients, and cystectomy in 3 patients. The types of intussusception secondary to PLPs included small intestinal (n = 25), ileocolic (n = 19), ileocecal (n = 11), ileo-ileocolic (n = 9) and cecalcolic (n = 1). The types of PLPs included Meckel diverticulum (n = 32), intestinal duplication (n = 14), benign polyps (n = 5), malignant lymphoma (n = 4), Peutz-Jeghers syndrome (n = 3), mesenteric cyst (n = 3), intestinal wall hematoma of hemophilia (n = 2), allergic purpura (n = 1), and hamartoma (n = 1). All patients recovered well with no relapse during follow-up, except for one patient who had an intestinal obstruction from adhesions that occurred approximately 3 months after discharge and who was curable after conservative treatment.
Conclusions:
Intussusception secondary to PLPs tends to exhibit recurrence. There are various types of intussusception secondary to PLPs. It is necessary to improve auxiliary examinations to identify the etiology and avoid intraoperative omission. Surgical reduction of intussusception secondary to PLPs is the preferred clinical management.
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