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Perinatal intussusception in premature infants
D P Mooney1, G Steinthorsson, N A Shorter
1Department of Surgery, Children's Hospital at Dartmouth, Lebanon, NH, USA.
Insights
Intussusception is rare in premature infants, often misdiagnosed as necrotizing enterocolitis. Early diagnosis and surgical intervention are crucial for better outcomes in these high-risk neonates.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
Background:
- Intussusception is a common pediatric surgical emergency, typically affecting infants aged 5-18 months.
- Reports of intussusception in premature infants are exceptionally rare, with only 12 documented cases prior to this review.
Observation:
- This review examines 9 prior cases and 1 new case of intussusception in premature infants.
- Common clinical signs included bilious emesis, bloody stool, and intestinal dilation, often leading to misdiagnosis as necrotizing enterocolitis.
- Diagnostic challenges were evident, with contrast enema identifying intussusception in only 1 of 7 cases.
Findings:
- The average delay between symptom onset and surgery was 12 days due to misdiagnosis.
- Most cases required surgical diagnosis and successful primary anastomosis, with no reported recurrences.
- A pathological lead point was identified in 20% of the cases.
Implications:
- These rare cases may represent intrauterine development of intussusception, potentially leading to small bowel atresia if not for premature delivery.
- The high mortality rate (23%) underscores the severity and complexity of intussusception in premature neonates.
- Successful surgical management, primarily through anastomosis, is feasible, but hydrostatic reduction should be avoided.
Abstract:
Intussusception is common in infants aged 5 to 18 months, but there have been only 12 reports of its occurrence among premature infants. Nine of these previously reported cases with adequate data and one new case are reviewed. Many of the infants were believed to have necrotizing enterocolitis, leading to an average 12-day interval between the onset of signs and the operation. Bilious emesis or nasogastric contents, bloody stool, and intestinal dilation without pneumatosis intestinalis were common. A contrast enema showed the intussusception in only 1 of 7 cases. Most cases were diagnosed in the operating room and underwent successful primary anastomosis, with no recurrences. A pathological lead point was identified in 2 of the 10 cases. The overall mortality rate was 23%; the one death since 1970 was secondary to attempted hydrostatic reduction. These cases may represent what, in the absence of premature delivery, would have been the intrauterine development of intussusception likely leading to small bowel atresia.