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Pediatric ileocolic intussusception: new observations and unexpected implications
Larry A Binkovitz1, Amy B Kolbe2, Robert C Orth3
1Division of Pediatric Radiology, Mayo Clinic, 2107 Folwell Ridge St. SW, Rochester, MN, 55902, USA. binkovitz.larry@mayo.edu.
Insights
Ileocolic intussusception length is uniform regardless of colon location. Distal progression is due to right colon foreshortening, not increased telescoping, suggesting poor cecal fixation.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Background:
- Ileocolic intussusception involves the terminal ileum telescoping into the colon.
- Previous observations suggest intussusception length is consistent across different colon locations.
Purpose of the Study:
- To investigate the uniformity of ileocolic intussusception length.
- To analyze the relationship between intussusception length, colon location, symptom duration, and reducibility.
Main Methods:
- Retrospective review of ultrasound-diagnosed pediatric ileocolic intussusceptions.
- Data collected included demographics, imaging findings, symptom duration, intussusception location, and reducibility via pneumatic reduction.
Main Results:
- No significant relationship found between intussusception length and colon location or symptom duration.
- Intussusceptions were more distal with longer symptom duration.
- Successful reduction was more likely in proximal locations.
Conclusions:
- Ileocolic intussusception length is uniform, irrespective of its colon location.
- Apparent distal spread is attributed to right colon foreshortening and cecal displacement, not increased bowel telescoping.
- Reduction involves repositioning the cecum followed by bowel reduction.
Background:
Ileocolic intussusception occurs when the terminal ileum "telescopes" into the colon. We observed that ileocolic intussusception lengths are similar regardless of location in the colon.
Objective:
To examine the uniformity of ileocolic intussusception length and its relationship to colon location, symptom duration and reducibility.
Materials And Methods:
We retrospectively reviewed ultrasound-diagnosed pediatric ileocolic intussusceptions initially treated with pneumatic reduction at the Mayo Clinic or Texas Children's Hospital. We recorded demographic, imaging and surgical findings including age, gender, symptom duration, location of the ileocolic intussusception, reducibility with air enema and, if fluoroscopically irreducible, surgical findings.
Results:
We identified 119 ileocolic intussusceptions (64% boys), with 81% in the right colon. There was no significant relationship between ileocolic intussusception length and colon location (P=0.15), nor ileocolic intussusception length and symptom duration (P=0.36). Ileocolic intussusceptions were more distal with increasing symptom duration (P=0.016). Successful reductions were unrelated to symptom duration (P=0.84) but were more likely with proximal versus distal locations (P=0.02).
Conclusion:
Ileocolic intussusception lengths are relatively uniform regardless of location along the course of the colon where they present. Our findings suggest that most of the apparent distal propagation of ileocolic intussusceptions is not caused by increasing telescoping of small bowel across the ileocecal valve but rather by foreshortening of the right colon. This implies poor cecal fixation and confirms fluoroscopic and surgical observations of cecal displacement from the right lower quadrant with ileocolic intussusceptions. The movement of the leading edge of the ileocolic intussusception during reduction is first due to "relocating" the cecum into the right lower quadrant after which the reduction of small bowel back across the ileocecal valve then occurs.
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