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The clinical implications of non-idiopathic intussusception
1Department of Paediatric Surgery, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand.
Insights
A pathological lesion is the cause of intussusception in 6% of cases, increasing with age, especially in children over five. These lesions often prevent enema reduction and may be identified during or after the procedure.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Background:
- Intussusception, a common cause of bowel obstruction, can be idiopathic or associated with a pathological lead point.
- While clinical features often lack etiological clues, certain conditions like Peutz-Jeghers syndrome may present with characteristic manifestations.
- Neonatal intussusception may stem from duplication cysts or Meckel's diverticulum, with increasing lesion association beyond 12 months of age.
Purpose of the Study:
- To investigate the incidence and characteristics of pathological lesions at the lead point of intussusception.
- To determine the age-related prevalence of identifiable lesions causing intussusception.
- To explore the implications of pathological lead points on enema reduction and diagnostic imaging.
Main Methods:
- Review of intussusception cases, analyzing the presence and nature of lead point lesions.
- Age-stratified analysis of lesion incidence.
- Correlation of lesion presence with enema reducibility and diagnostic findings (fluoroscopy, ultrasonography).
Main Results:
- Pathological lesions are identified at the lead point in approximately 6% of intussusception episodes.
- The proportion of intussusceptions with an identifiable lesion increases significantly with age, particularly in children over five years old.
- Intussusceptions caused by pathological lead points are typically irreducible by enema and may be visualized during or after reduction via imaging.
Conclusions:
- A pathological lead point is a significant, age-dependent factor in intussusception etiology.
- The presence of a lead point lesion impacts treatment options, often contraindicating enema reduction.
- Diagnostic imaging plays a crucial role in identifying lead point lesions, especially when enema reduction is unsuccessful.
Abstract:
A pathological lesion can be identified at the leadpoint of intussusception in about 6% of episodes. Occasionally, general manifestations of an underlying disease indicate the specific cause of an intussusception (e.g., perioral pigmentation in Peutz-Jeghers syndrome), but usually the clinical features provide no clues as to the aetiology. Neonatal intussusception may be caused by a duplication cyst or Meckel's diverticulum. Beyond 12 months, the proportion of intussusceptions due to a pathological lesion at the leadpoint increases with age. There is an identifiable lesion in the majority of children over 5 years of age. Postoperative intussusception accounts for between 0.5% and 16% of intussusceptions, although it has a variety of causes; it typically follows retroperitoneal dissection. It is unusual for an intussusception due to a pathological lesion at the leadpoint to be reduced by enema. If it is reduced, the lesion may be seen at the time of reduction or fluoroscopy, or subsequently on ultrasonography.