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Patterns of recurrence of intussusception in children: a 17-year review
1Department of Diagnostic Imaging, Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
Insights
Recurrence rates and patterns in intussusception (INT) did not change with different management strategies. Radiological reduction is recommended for recurrent INT due to high success and favorable outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Background:
- Intussusception (INT) is a common surgical emergency in infants and children.
- Recurrence of INT can occur, necessitating careful management and follow-up.
- Understanding recurrence patterns is crucial for optimizing treatment strategies.
Purpose of the Study:
- To analyze recurrence rates and patterns in children with multiple intussusceptions.
- To determine if changes in management (barium vs. air enema) affected recurrence.
- To evaluate the long-term outcomes of children with recurrent intussusception.
Main Methods:
- Retrospective review of 763 children with 876 intussusceptions.
- Analysis of recurrence rates, patterns, reducibility, and pathologic lead points (PLP).
- Comparison of outcomes between barium enema (1979-1985) and air enema (1985-1996) management.
Main Results:
- Overall recurrence rate was 9% (11% barium, 8% air enema).
- Sixty-nine patients experienced 113 recurrences; 32% had multiple recurrences.
- Reducibility was high (100% initial, 95% recurrent) with no perforations; PLP found in 8%.
Conclusions:
- Management changes did not alter intussusception recurrence rates or patterns.
- Radiological reduction is recommended for recurrent INT due to high success and safety.
- Multiple recurrences are not a contraindication; careful PLP search is mandatory, surgery reserved for irreducible cases.
Purpose:
Patterns of recurrence of intussusception (INT) were reviewed to determine whether changes in management have affected the rate and patterns of recurrence as well as long-term outcome in children with multiple (i. e., 2 or more) recurrences.
Materials And Methods:
Review was done of 763 children with 876 intussusceptions, including (1) recurrence rate, (2) patterns of recurrence (number of and interval between recurrences), (3) reducibility, (4) pathologic lead points (PLP), (5) operative findings and (6) long-term follow-up in those with multiple recurrences.
Results:
Above features (1)-(6) were the same in those managed with barium enema (1979-1985) and those managed with air enema (1985-1996). Overall recurrence rate was 9 %; 11 % with barium enema and 8 % with air enema. Sixty-nine patients had 113 recurrences: 47/69 (68 %) and 1 recurrence and 22/69 (32 %) had multiple recurrences. Multiple recurrences presented as isolated episodes or in clusters up to 8 years. Reducibility was 100 % for initial INT and 95 % for recurrent episodes; there were no perforations. Surgery, in 4 with irreducible recurrence, revealed no PLP. PLP were present in 5 (8 %): 2 (4 %) with 1 recurrence and 3 (14 %) with multiple recurrences. No pattern of recurrence was predictive for PLP. Long-term follow-up (up to 15 years) available in 11 with multiple recurrences revealed a favourable outcome.
Conclusions:
Rates and patterns of recurrence did not change with altered management. Because of the high reduction rate of recurrences, lack of perforation and favourable long-term follow-up, we recommend radiological reduction for recurrent INT. Multiple recurrences are not a contraindication. A careful search for PLP is mandatory. Surgery should be reserved for irreducible recurrences or for demonstrated PLP.