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Intussusception: current management in infants and children
K W West1, B Stephens, D W Vane
1Department of Surgery, Indiana University Medical Center, Indianapolis.
Insights
Intussusception, a common cause of bowel obstruction in children, had a 42% success rate with barium enema reduction. Prompt surgical intervention is crucial for survival and preventing recurrence.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Background:
- Intussusception is a primary cause of bowel obstruction in infants and children.
- Recurrences were noted, with most occurring during initial hospitalization.
Purpose of the Study:
- To analyze treatment outcomes for intussusception over a 15-year period.
- To evaluate the effectiveness of diagnostic and therapeutic interventions.
Main Methods:
- Retrospective review of 83 pediatric intussusception cases (1970-1985).
- Diagnosis via barium enema or plain abdominal X-rays.
- Hydrostatic reduction attempts and surgical interventions were analyzed.
Main Results:
- Barium enema achieved hydrostatic reduction in 42% of cases.
- Delayed symptoms (>48 hours) correlated with reduction failure.
- Surgical reduction resulted in no recurrences, with prompt intervention ensuring 100% survival.
Conclusions:
- Delayed diagnosis significantly increases morbidity.
- Prompt surgical intervention is vital for favorable outcomes in intussusception.
- Surgical reduction eliminates recurrence risk.
Abstract:
Intussusception remains a leading cause of bowel obstruction in early infancy and childhood. From 1970 to 1985, 83 patients with intussusception were treated. There were 51 boys and 32 girls ranging in age from 2 months to 22 years. Ten patients had a total of 14 separate recurrences; nine occurred during the initial hospitalization. Symptoms on presentation included abdominal pain (80%), palpable mass (60%), rectal bleeding (53%), and lethargy or sepsis (45%). Fifteen children underwent exploration without contrast studies based on duration of symptoms (greater than 5 days) and evidence of severe obstruction on plain abdominal x-ray films. In the remaining children, diagnosis was confirmed by barium enema and hydrostatic reduction was achieved in only 34 patients (42% success rate). Symptoms were present more than 48 hours in 55% of the reduction failures. At operation, five children had spontaneously reduced and an appendectomy was performed. Manual reduction was possible in 32 patients. The intussusception was irreducible in 26 patients, and 18 required temporary stomas. Pathologic lead points were found in 11 patients. Average length of hospitalization was 1.5 days after barium enema reduction, 9.6 days after manual reduction, and 13.8 days after bowel resection. There were no recurrences of intussusception after surgical reduction. A significant morbidity rate was observed with a delay in diagnosis. Adequate preoperative preparation and prompt surgical intervention are associated with 100% survival.