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Recurrent intussusception: barium or surgery?
Insights
Recurrent intussusception in children is uncommon (4.4%). Recurrences often present with shorter symptom duration and fewer initial misdiagnoses, but specific cases warrant caution with barium reduction.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Intussusception is a common surgical emergency in infants and children.
- Recurrence rates and management strategies require further investigation.
Purpose of the Study:
- To review the incidence, clinical features, and management of recurrent intussusception in children.
- To identify factors influencing the success of non-operative and operative interventions for recurrent intussusception.
Main Methods:
- Retrospective review of pediatric intussusception cases over 16 years.
- Analysis of recurrence rates, clinical presentation, diagnostic methods, and treatment outcomes.
Main Results:
- 28 recurrences (4.4%) out of 630 intussusception episodes.
- Recurrent cases showed reduced symptom duration and initial misdiagnosis.
- Barium reduction success varied; surgery was required in some cases, including one for an inverted Meckel's diverticulum.
Conclusions:
- Recurrent intussusception has distinct clinical features compared to initial episodes.
- Caution is advised for barium reduction in specific recurrent intussusception cases, particularly in older children or those with multiple recurrences or polyposis.
Abstract:
A review was conducted of children with intussusception admitted to the Royal Children's Hospital over a 16 year period: of 630 episodes of intussusception, 28 represented recurrences (4.4%): 10 of these occurred in children aged 2 years or over. Duration of symptoms and the incidence of an incorrect initial diagnosis were markedly reduced with recurrence. The clinical presentation was similar to the first episode apart from rectal bleeding which was less common, reflecting the shorter history. Sixteen barium enemas were performed, of which 10 were successful. There were 18 operations with eight resections; seven for localized lesions and one for failure of manual reduction in a patient with an inverted Meckel's diverticulum. Barium reduction for recurrence should not be attempted in children over 2 years of age in whom no laparotomy was performed for their first episode, for most second recurrences, or in multiple polyposis.