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Recurrent intussusception. Risks and features
A N Champoux1, M A Del Beccaro, V Nazar-Stewart
1Department of Pediatrics, University of Washington, Seattle.
Insights
Recurrent intussusception (RI) risk factors are not predictable by initial symptoms. Operative reduction of initial intussusception significantly lowers the risk of RI.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Intussusception is a common cause of bowel obstruction in infants.
- Recurrent intussusception (RI) presents unique challenges in diagnosis and management.
Purpose of the Study:
- To identify risk factors for recurrent intussusception (RI).
- To characterize the clinical features, timing, and complications associated with RI.
Main Methods:
- Retrospective chart review of pediatric patients treated for intussusception between 1979 and 1990.
- Comparison of patients with RI (cases) versus those with a single intussusception (controls).
Main Results:
- No significant differences in initial presentation (age, sex, symptoms) between case and control groups.
- Barium enema reduction of initial intussusception was associated with a significantly higher risk of RI (OR 13.50).
- Operative reduction of initial intussusception was rarely followed by RI (1 of 33 episodes).
- Recurrent episodes showed reduced lethargy and fewer instances of bloody stools compared to initial episodes, with shorter symptom duration.
Conclusions:
- Presenting features and symptoms do not predict recurrent intussusception (RI).
- Successful operative reduction for initial intussusception reduces the likelihood of RI.
- Patients experiencing RI may present with less severe symptoms and shorter symptom duration.
Objective:
To determine the risk factors associated with recurrent intussusception (RI) and to characterize the timing, features, and complications of RI.
Design:
Retrospective chart review.
Setting:
Children's Hospital and Medical Center, Seattle, Wash.
Participants:
All patients with a diagnosis of intussusception who underwent barium enema as treatment for reduction between October 1, 1979 and December 31, 1990. Children with RI (N = 23, seven with two or more recurrent episodes) were classified as the case group; children with a single intussusception (N = 234), controls.
Results:
There were no statistically significant differences in age, sex, race, symptoms, duration of symptoms, or results of the physical examination between the case group and controls. Reduction of the initial intussusception by a barium enema occurred in 96% of patients in the case group vs 62% of the controls (odds ratio, 13.50; 95% confidence intervals, 2.10 to 563.4; P = .003). Only one of 33 episodes of RI followed an operative reduction. In comparing the first recurrent episode with the initial episode, there was a significant reduction in the proportion of patients presenting with lethargy (0% vs 30%; Fisher Exact Test, P = .009) or blood in the stool (5% vs 52%; P < .002) and a drop in the median duration of symptoms from 20 to 6 hours.
Conclusions:
Recurrent intussusception cannot be predicted by presenting features or symptoms; operative reduction due to a failed reduction by a barium enema reduces the risk of RI; and patients with RI have fewer symptoms with a shorter duration.