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Intussusception in infants and children: risk factors leading to surgical reduction
1Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan R.O.C.
Insights
Intussusception in children often presents with non-specific symptoms, but early identification of risk factors can guide surgical treatment decisions. This study analyzed 361 cases to improve outcomes for pediatric intestinal obstruction.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Pediatrics
Background:
- Intussusception is a leading cause of intestinal obstruction in infants and children.
- Understanding its demographic, clinical, and pathological features is crucial for effective management.
Purpose of the Study:
- To investigate the demographic data, clinicopathologic features, and therapeutic prognosis of intussusception in pediatric patients.
- To identify risk factors associated with surgical intervention and improve patient outcomes.
Main Methods:
- Retrospective review of 361 intussusception cases in 333 pediatric patients over an 11-year period.
- Analysis of clinical presentation, diagnostic methods (including sonography), treatment approaches (barium enema reduction, laparotomy), and outcomes.
Main Results:
- Most affected patients were under two years old, with a male predominance (1.6:1).
- The classic clinical triad was present in only one-third of cases. Ileo-colic intussusception was most common, with Meckel's diverticulum as the leading pathologic cause.
- Barium enema reduction success rate was 45%; 57% of patients required laparotomy. Risk factors for surgery included prolonged illness, classic triad, pathologic lead point, and radiologic obstruction. Overall mortality was 0.6%.
Conclusions:
- Clinical characteristics of pediatric intussusception remain consistent with previous reports.
- Early identification of risk factors is vital for optimizing surgical treatment and reducing the need for intestinal resection.
- While non-surgical reduction is preferred, prompt surgical intervention is necessary for severe or refractory cases.
Abstract:
Intussusception is commonly the etiology of intestinal obstruction in infants and children. To investigate demographic data, clinicopathologic features and therapeutic prognosis of patients with intussusception, we reviewed 361 intussusceptions in 333 patients over an 11-year period. Most patients were below two years of age and there was a male preponderance of 1.6:1. There was no seasonal difference between the number of cases. The clinical triad of vomiting, abdominal colicky pain and bloody stools was manifested in only one-third of our patients. Secondary intussusception contributed to 6.6% of cases and Meckel's diverticulum was the most common pathologic cause. Positive findings were recorded in 82% of 67 patients undergoing sonographic examination. Intussusception of the ileo-colic type was most frequently encountered. Most patients (79%) were diagnosed within 48 hours and almost all cases underwent primary barium enema reduction. The success rate was 45%. Laparotomy was performed in 207 patients (57%) refractory to enema reduction or with critical illness, and intestinal resection was required in 28 (14%). Long-standing duration of illness (> 24 hours), positive clinical triad, positive pathologic lead point, and radiologic finding of bowel obstruction were identified as risk factors leading patients to surgical reduction (p < 0.001). Postoperative complications and recurrent intussusception developed in some patients, and the overall mortality was 0.6%. The clinical characteristics of intussusception in children generally remained unchanged as compared to previous reports. Early identification of patients with risk factors for surgical treatment is important to decrease the need for intestinal resection.