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Management and Outcome of Pediatric Patients With Transient Small Bowel-Small Bowel Intussusception
Jennifer E Melvin, Noel S Zuckerbraun1, Chijindu R Nworgu2
1Division of Pediatric Emergency Medicine, Department of Pediatrics.
Insights
Transient and benign small bowel-small bowel intussusception (SB-SBI) in healthy children are often incidental findings. These benign cases rarely require surgery and are unlikely to have a pathologic lead point.
Area of Science:
- Pediatric Radiology
- Gastroenterology
- Surgical Outcomes
Background:
- Small bowel-small bowel intussusception (SB-SBI) can occur in children.
- Distinguishing benign from pathologic SB-SBI is crucial for appropriate management.
Purpose of the Study:
- To evaluate the management and outcomes of transient and benign SB-SBI in healthy pediatric patients.
- To determine the likelihood of associated pathologic lead points in these cases.
Main Methods:
- Retrospective cohort study of healthy children (0-18 years) with radiologically confirmed transient and benign SB-SBI.
- Review of demographics, clinical presentation, imaging, management, and 1-year follow-up for subsequent diagnoses.
- Inclusion criteria: spontaneous resolution, diameter <2.5 cm, no lead point, normal bowel wall, no proximal dilation, no colonic involvement.
Main Results:
- Eighty-seven episodes of transient and benign SB-SBI in 68 healthy pediatric patients were analyzed.
- 57% of patients were admitted, and 56% had surgical consultations.
- Extensive further imaging (CT, EGD, Meckel's scan, MRI) revealed no concerning pathology or lead points.
- No patients required surgery or experienced complications.
Conclusions:
- Transient and benign SB-SBIs in healthy children with reassuring features are likely incidental findings.
- These cases are associated with a low risk of underlying pathologic lead points.
- Conservative management is appropriate for such cases, avoiding unnecessary interventions.
Objective:
The aim of this study was to assess the management and outcomes of healthy pediatric patients diagnosed radiologically with transient and benign small bowel-small bowel intussusception (SB-SBI).
Methods:
Retrospective cohort study of healthy patients 0 to 18 years of age who presented to a children's hospital emergency department from January 1, 2005, to June 30, 2015, and had transient and benign SB-SBI characterized by spontaneous resolution (ie, transient), diameter of less than 2.5 cm, no lead point, normal bowel wall thickness, nondilated proximal small bowel, and no colonic involvement (ie, benign radiographic features). Charts were reviewed for demographics, clinical presentation, radiologic studies obtained, outcomes, and further management. Medical and radiologic records were also reviewed for 1 year after presentation for any subsequent pathologic diagnoses.
Results:
Sixty-eight patients were included in our study, with a total of 87 episodes of transient and benign SB-SBI on initial or follow-up examination. Overall, 39 patients (57%) were admitted to the hospital, and 38 patients (56%) had a surgical consultation. Twenty-four patients (35%) had further radiologic studies obtained, including computed tomography scans, esophagogastroduodenoscopy, Meckel's scan, barium swallow studies, and magnetic resonance imaging. All studies were negative for concerning pathology including apparent lead points. None of the patients required surgical intervention or had any complications.
Conclusions:
Transient and benign SB-SBIs with reassuring radiologic and clinical features diagnosed in healthy pediatric patients are likely incidentally found and are unlikely to be associated with a pathologic lead point.
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