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Radiographic and Clinical Factors in Pediatric Patients With Surgical Small-bowel Intussusception
Robert J Vandewalle1, Alexis K Bagwell1, Jared R Shields2
1Division of Pediatric Surgery, Department of General Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Insights
Small bowel-to-small bowel intussusception (SBI) in children presents a diagnostic challenge. Focal abdominal pain, prior surgery, and intussusception length predict the need for surgical intervention in SBI cases.
Area of Science:
- Pediatric Surgery
- Abdominal Imaging
- Gastrointestinal Radiology
Background:
- Small bowel-to-small bowel intussusception (SBI) in pediatric patients poses a diagnostic dilemma.
- The clinical significance and surgical necessity of SBI are highly variable.
- Most SBIs are considered clinically insignificant, complicating operative decisions.
Purpose of the Study:
- To identify clinical and radiologic factors guiding operative decisions in pediatric patients with SBI.
- To differentiate between clinically significant and insignificant SBIs.
- To aid clinicians in managing pediatric abdominal pain cases involving SBI.
Main Methods:
- Retrospective review of a pediatric tertiary hospital database (2011-2016).
- Inclusion of patients with radiologic evidence of SBI only (excluding ileocolic intussusception).
- Analysis of clinical presentation, operative intervention, and surgical findings; exclusion of SBI due to feeding tubes.
Main Results:
- 139 pediatric patients with SBI were identified.
- Multivariate analysis revealed key predictors for surgical intervention.
- Significant predictors included prior abdominal surgery (OR: 7.2), focal abdominal pain (OR: 22.1), and intussusception length (OR: 10.6).
Conclusions:
- Small bowel-to-small bowel intussusception (SBI) exhibits variable clinical significance.
- Focal abdominal pain, prior abdominal surgery, and intussusception length are primary predictors for operative intervention in SBI.
- These factors can guide surgical decision-making in pediatric SBI cases.
Background:
When evaluating a pediatric patient with abdominal pain, identification of a small bowel-to-small bowel intussusception (SBI) on radiologic imaging can create a diagnostic dilemma. The clinical significance and need for surgical exploration of SBI is highly variable, as most of them are considered clinically insignificant. We hypothesize that combination of clinical and radiologic factors in an exclusively SBI population will yield factors that guide the clinician in making operative decisions.
Methods:
A comprehensive database from a pediatric tertiary hospital was reviewed from January 1, 2011, to December 31, 2016, for any radiographic study mentioning intussusception. Results were reviewed for patients having only SBI (i.e., not ileocolic intussusception), and this comprised the study cohort. The electronic medical records for these patients were reviewed for clinical presentation variables, need for operative intervention, and identification of the intussusception during surgery. Patients with SBI due to enteral feeding tubes were excluded from the study.
Results:
Within the study period, 139 patients were identified with an SBI on radiologic imaging. Univariate analysis yielded numerous clinical and radiologic factors highly predictive of the need for surgical intervention. However, upon multivariate analysis, only a history of prior abdominal surgery (odds ratio [OR]: 7.2; CI: 1.1-46.3), the presence of focal abdominal pain (OR: 22.1; CI: 4.2-116.3), and the intussusception length (cm; OR: 10.6; CI: 10.3-10.8) were correlated with the need for surgical intervention.
Conclusions:
SBI is a disease process with a highly variable clinical significance. The presence of focal abdominal pain, a history of prior abdominal surgery, and the intussusception length are the greatest predictors of the need for operative intervention.
Level Of Evidence:
Level II.
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