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Lateral wall cecal filling defects following successful hydrostatic reduction of cecalcolic intussusceptions
Insights
A lateral wall filling defect after intussusception reduction in infants may resolve on its own. A "wait and see" approach is often appropriate for these cecal filling defects.
Area of Science:
- Pediatric Radiology
- Gastrointestinal Imaging
- Surgical Pediatrics
Background:
- Intussusception is a common cause of bowel obstruction in infants.
- Hydrostatic reduction is a primary treatment for cecalcolic intussusception.
- Post-reduction imaging may reveal residual filling defects.
Observation:
- Two infants (<1 year) presented with lateral wall filling defects post-hydrostatic reduction of cecalcolic intussusception.
- Defects were attributed to invagination of the lateral wall between tinea coli.
- One infant underwent surgery due to recurrent intussusception despite defect size reduction.
Findings:
- The filling defect in the second infant resolved spontaneously within three days of the barium enema.
- This suggests that some post-reduction filling defects are transient.
- Clinical recovery is a key indicator for conservative management.
Implications:
- A cautious 'wait and see' approach is recommended for typical cecal filling defects after successful intussusception reduction.
- Follow-up barium enema in three days can assess defect resolution or reduction.
- This conservative strategy may avoid unnecessary surgical exploration in select pediatric cases.
Abstract:
Two children less than 1 yr of age were found to have a lateral wall filling defect following successful hydrostatic reduction of cecalcolic intussusceptions. Both filling defects were thought to be due to invagination of the lateral wall between the tinea coli. One child was explored due to recurrence of the intussusception despite despite a decrease in size of the filling defect. In the second child the filling defect had disappeared three days after the initial barium enema reduction. When confronted with a typical cecal filling defect in an infant following successful reduction of a cecalcolic intussusception, we believe that one is justified in assuming a cautious "wait and see" attitude. If the child recovers clinically the barium enema may be repeated in three days to access reduction in size or disappearance of the filling defect.