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Postoperative intussusception: experience with 36 cases in children
K W West1, B Stephens, F J Rescorla
1Department of Surgery, Indiana University School of Medicine, Indianapolis.
Insights
Postoperative intussusception (POI) is a rare but serious complication in children following abdominal surgery. Early recognition and surgical intervention are crucial to prevent intestinal necrosis.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Complications
Background:
- Intestinal obstruction is a common postoperative complication, often attributed to peritoneal adhesions.
- Postoperative intussusception (POI) is a less recognized but significant cause of obstruction in children.
Purpose of the Study:
- To analyze the incidence, clinical presentation, diagnostic methods, and management outcomes of postoperative intussusception in pediatric patients.
- To emphasize the importance of early diagnosis and intervention for POI.
Main Methods:
- Retrospective review of 36 pediatric cases of POI treated between 1970 and 1987.
- Analysis of initial surgical procedures, POI symptoms, diagnostic imaging (plain radiographs, barium contrast), and treatment strategies (manual reduction, surgical resection).
Main Results:
- POI occurred after various pediatric surgical procedures, with Nissen fundoplication being the most common initial surgery.
- Key symptoms included bilious vomiting and abdominal distension, typically appearing 8 days post-surgery.
- While contrast studies had limited value, prompt laparotomy allowed manual reduction in most cases; however, diagnostic delay led to intestinal necrosis in four patients.
Conclusions:
- Postoperative intussusception should be considered in children presenting with bowel dysfunction in the early postoperative period.
- A high index of suspicion and prompt surgical exploration are essential for successful management and to avoid complications like bowel necrosis.
Abstract:
Intestinal obstruction is a common postoperative complication and is usually related to peritoneal adhesion formation. A less well-recognized cause is postoperative intussusception (POI). Thirty-six instances of POI in children (aged 1 month to 18 years) were treated between 1970 and 1987. POI followed Nissen fundoplication in 9 patients, neuroblastoma resection in 5, small-bowel procedures in 4, inguinal herniorrhaphy in 3, pull-through procedures in 3, ureterostomy in 2, thoracic procedures in 2, ventral hernia in 1, nephrectomy in 1, hepatic resection in 1, Heller myotomy in 1, ventriculo-atrial shunt in 1, and gastrocystoplasty in 1. Initial symptoms included bilious vomiting or increased nasogastric drainage (after initial return of gut function) in 26 patients, abdominal distension in 24, irritability in 10, intermittent pain in 7, palpable abdominal mass in 2, rectal bleeding in 2, and lethargy in 1. The symptoms occurred 1 to 24 days (mean, 8 days) after the initial surgery. Plain abdominal radiographs revealed multiple air-fluid levels in 31 and an "adynamic ileus" in five patients. Barium contrast techniques could successfully reduce two ileocolic and one distal ileo-ileal lesions. The remainder necessitated operative management. Manual reduction was possible in 29 cases, and four children with diagnostic delay required bowel resection and an anastomosis for intestinal necrosis. The site of intussusception was ileo-ileal in 23 patients, jejunojejunal in 6, ileocolic in 5, and jejuno-ileal in 2. The diagnosis of POI should be considered in children with signs of bowel dysfunction in the early postoperative period. Contrast studies are of limited value, since most cases are confined to the small bowel. A high index of suspicion and prompt laparotomy will usually allow manual reduction of the lesion. Diagnostic delay may result in bowel necrosis.