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Rectal Bleeding and Abdominal Pain Following Vaccination in a 4-Month-Old Infant. Case Rep Pediatr 2017; 2017:9461315. [PMID: 28163948 PMCID: PMC5253479 DOI: 10.1155/2017/9461315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/21/2016] [Indexed: 11/17/2022] Open
Abstract
Intussusception is one of the most frequent causes of intestinal obstruction in infants. Rotavirus vaccination has been associated with intussusception in the medical literature. We report a case of a 4-month-old female with intussusception requiring hemicolectomy one week following rotavirus vaccination. We review the pathophysiology, presentation, and management of intussusception with a distinct focus on the history of rotavirus vaccination and risks of intussusception associated with timing of rotavirus vaccine administration. The discussion makes a strong case for rotavirus vaccine counseling regarding signs of intestinal obstruction and the importance of early recognition.
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Feldman O, Weiser G, Hanna M, Devir O, Balla U, Johnson DW, Kozer E, Shavit I. Success rate of pneumatic reduction of intussusception with and without sedation. Paediatr Anaesth 2017; 27:190-195. [PMID: 27901291 DOI: 10.1111/pan.13045] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pneumatic reduction of ileocolic intussusception is often performed without sedation. The aim of this study was to evaluate the success rate of pneumatic reduction of intussusception with and without sedation. METHODS We conducted a retrospective cohort study in Israel in two tertiary care centers using a similar protocol for pneumatic reduction of intussusception. In one center, patients had pneumatic reduction of intussusception under propofol-based sedation, while in the other, patients had pneumatic reduction of intussusception without any sedation. Children aged 3 months to 8 years who were diagnosed with ileocolic intussusception between January 1, 2008 and July 31, 2015 were included in the study. Multivariable regression was used to adjust for the possible confounders of age, gender, number of cases of intussusception prior to the study period, time period from the beginning of symptoms to emergency department admission (<12 h, >12 h), and time period from emergency department admission to the beginning of pneumatic reduction of intussusception. Secondary outcomes of the study included the proportion of bowel perforations during the procedure, and the proportion of early (within 48 h) recurrence of intussusception. RESULTS The sedation and nonsedation cohorts included 124 and 90 patients, respectively. The cohorts were comparable with regard to demographic characteristics, hemodynamic vital signs on admission to the emergency department, blood gases tests during emergency department stay, and time variables prior to reduction of intussusception. Multivariable regression revealed reduction of intussusception success rates of 89.5% and 83.3% for the sedation group and nonsedation group, respectively, with an adjusted odds ratio of 1.2, 95% CI 1.1-5.3. Three sedated patients and 0 nonsedated patients developed bowel perforations during the procedure. Rates of early recurrence of intussusception of sedated patients and nonsedated patients were 5.1% (6/117) and 1.3% (1/79), respectively (P = 0.15, RR = 3.9, 95% CI: 0.47 to 31.81). CONCLUSION The findings suggest that the pneumatic reduction of intussusception under propofol-based sedation had a slightly higher success rate than the pneumatic reduction of intussusception without sedation; however, the safety of this practice is yet to be determined.
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Affiliation(s)
- Oren Feldman
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
| | - Giora Weiser
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Mona Hanna
- Pediatric Department B, Rambam Health Care Campus, Haifa, Israel
| | - Ori Devir
- Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| | - Uri Balla
- Pediatric Emergency Department, Kaplan Medical Center, Rehovot, Israel
| | | | - Eran Kozer
- Pediatric Emergency Unit, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Itai Shavit
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
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Abstract
Abdominal pain is a common complaint that leads to pediatric patients seeking emergency care. The emergency care provider has the arduous task of determining which child likely has a benign cause and not missing the devastating condition that needs emergent attention. This article reviews common benign causes of abdominal pain as well as some of the cannot-miss emergent causes.
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Affiliation(s)
- Jeremiah Smith
- Department of Emergency Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, MEB Floor 3, Charlotte, NC 28203, USA.
| | - Sean M Fox
- Emergency Medicine Residency Program, Department of Emergency Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, MEB Floor 3, Charlotte, NC 28203, USA
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Savoie KB, Thomas F, Nouer SS, Langham MR, Huang EY. Age at presentation and management of pediatric intussusception: A Pediatric Health Information System database study. Surgery 2016; 161:995-1003. [PMID: 27842915 DOI: 10.1016/j.surg.2016.09.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/23/2016] [Accepted: 09/16/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Intussusception is uncommon in children older than 3 years, and use of enema reduction in older children is controversial. We sought to determine whether older children are at greater risk of requiring operative intervention and/or having pathology causing lead points, such that enema reduction should not be attempted. METHODS The Pediatric Health Information System database was reviewed from January 1, 2009-June 30, 2014. Patients were followed for 6 months from initial presentation or until bowel resection occurred. Successful enema reduction was defined as having radiologic reduction without additional procedures. RESULTS A total of 7,412 patients were identified: 6,681 were <3 years old, 731 patients were >3 years old. In those >3 years old, 450 (62%) were treated successfully with enema reduction; the rate of patients with a tumor diagnosis was similar in patients <3 years old and patients >3 years old (5% vs 6%, P = .07). The rate of a Meckel's diagnosis was greater in patients >3 years old (2% vs 14%, P < .0001). In patients >3 years old, duration of stay between patients who underwent primary operative therapy versus those who underwent operative therapy after enema reduction was similar (4 days vs 4 days, P = .06). Older age was not associated with increased risk of recurrent admission for intussusception (P = .45). CONCLUSION Pediatric Health Information System data suggest that enema reduction may be safe and effective for a majority of children even if older than 3 years.
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Affiliation(s)
- Kate B Savoie
- Department of General Surgery, University of Tennessee Health Science Center, Memphis, TN; College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN
| | - Fridtjof Thomas
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Simonne S Nouer
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Max R Langham
- Department of General Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Eunice Y Huang
- Department of General Surgery, University of Tennessee Health Science Center, Memphis, TN.
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Trotta F, Da Cas R, Bella A, Santuccio C, Salmaso S. Intussusception hospitalizations incidence in the pediatric population in Italy: a nationwide cross-sectional study. Ital J Pediatr 2016; 42:89. [PMID: 27677340 PMCID: PMC5039877 DOI: 10.1186/s13052-016-0298-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/21/2016] [Indexed: 11/30/2022] Open
Abstract
Background Study to investigate the intussusception incidence background in the pediatric population and its temporal trend in Italy. Methods A cross-sectional study was conducted on the pediatric population aged 0 to 15 years, in the period 1 January 2002 to 31 December 2012. Intussusception cases were identified using the national hospital discharge database. The annual intussusception incidence, the incidence rate ratios (IRRs) and the related 95 % confidence Intervals (CI) were calculated. Results The overall intussusception incidence rate was 21 per 100,000 children aged ≤15 years, and was higher among boys than girls. The highest intussusception incidence rate occurred in infants <1 year of age (39 per 100,000 infants). Among infants, incidence varied with the geographical area, with higher rates in the central Italy (50 per 100,000 infants). The annual incidence rates in infants were stable since 2004 and up to 2012, ranging from 40.1 and 33.0 per 100,000 infants. Similar stable patterns were observed when conducting the analysis on children over 1 year of age. Conclusions This study provided the intussusception incidence background in Italy in different pediatric ages, including infants, over an 11-year period. This information is essential in post-marketing safety surveillance, to continuously monitor the benefit/risk profile of rotavirus vaccinations. Electronic supplementary material The online version of this article (doi:10.1186/s13052-016-0298-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francesco Trotta
- Pharmacovigilance Office, Italian Medicines Agency (AIFA), Via del Tritone 181, Rome, 00187, Italy. .,National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Viale Regina Elena 299, Rome, 00161, Italy.
| | - Roberto Da Cas
- National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Viale Regina Elena 299, Rome, 00161, Italy
| | - Antonino Bella
- National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Viale Regina Elena 299, Rome, 00161, Italy
| | - Carmela Santuccio
- Pharmacovigilance Office, Italian Medicines Agency (AIFA), Via del Tritone 181, Rome, 00187, Italy
| | - Stefania Salmaso
- National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Viale Regina Elena 299, Rome, 00161, Italy
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Khorana J, Singhavejsakul J, Ukarapol N, Laohapensang M, Siriwongmongkol J, Patumanond J. Prognostic indicators for failed nonsurgical reduction of intussusception. Ther Clin Risk Manag 2016; 12:1231-7. [PMID: 27563245 PMCID: PMC4984823 DOI: 10.2147/tcrm.s109785] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To identify the risk factors for failure of nonsurgical reduction of intussusception. Methods Data from intussusception patients who were treated with nonsurgical reduction in Chiang Mai University Hospital and Siriraj Hospital between January 2006 and December 2012 were collected. Patients aged 0–15 years and without contraindications (peritonitis, abdominal X-ray signs of perforation, and/or hemodynamic instability) were included for nonsurgical reduction. The success and failure groups were divided according to the results of the reduction. Prognostic indicators for failed reduction were identified by using generalized linear model for exponential risk regression. The risk ratio (RR) was used to report each factor. Results One hundred and ninety cases of intussusception were enrolled. Twenty cases were excluded due to contraindications. A total of 170 cases of intussusception were included for the final analysis. The significant risk factors for reduction failure clustered by an age of 3 years were weight <12 kg (RR =1.48, P=0.004), symptom duration >3 days (RR =1.26, P<0.001), vomiting (RR =1.63, P<0.001), rectal bleeding (RR =1.50, P<0.001), abdominal distension (RR =1.60, P=0.003), temperature >37.8°C (RR =1.51, P<0.001), palpable abdominal mass (RR =1.26, P<0.001), location of mass (left over right side) (RR =1.48, P<0.001), poor prognostic signs on ultrasound scans (RR =1.35, P<0.001), and method of reduction (hydrostatic over pneumatic) (RR =1.34, P=0.023). The prediction ability of this model was 82.21% as assessed from the area under the receiver operating characteristic curve. Conclusion The identified prognostic factors for the nonsurgical reduction failure may help to predict the reduction outcome and provide information to the parents.
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Affiliation(s)
| | | | - Nuthapong Ukarapol
- Division of Gastroenterology, Department of Pediatrics, Chiang Mai University Hospital, Chiang Mai
| | - Mongkol Laohapensang
- Division of Pediatric Surgery, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok
| | | | - Jayanton Patumanond
- Center of Excellence in Applied Epidemiology, Thammasat University Hospital, Pathumthani, Thailand
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Puckett Y, Greenspon J, Fitzpatrick C, Vane D, Bansal S, Rice M, Chatoorgoon K. Utility of hospital admission for pediatric intussusceptions. Pediatr Surg Int 2016; 32:805-9. [PMID: 27350542 DOI: 10.1007/s00383-016-3924-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The standard practice in pediatric patients diagnosed with intussusception has been reduction via enema and admission for a period of nil per os and observation. Little data exists to support this practice. The objective of this study was to examine whether post-reduction admission to hospital is required. METHODS A retrospective chart review was performed on all patients aged 0-18 years old with intussusception over a span of 20 years. Study included children treated for intussusception on first encounter with enema and subsequently admitted for observation. Study excluded those readmitted for recurrence after 48 h, patients whose intussusception did not reduce on first try, those lost to follow-up, and those who went to the operating room. Early recurrence was defined as recurrence within 48 h post-reduction. RESULTS Out of 171 patients admitted, only one experienced an early recurrence (0.6 %). Median length of stay for all patients was 2 days. Average cost incurred per day for intussusception admission was $404. CONCLUSION Intussusception in a child that is successfully reduced via enema has a low recurrence rate and is usually followed by prompt resolution of symptoms. An abbreviated period of observation in the emergency department post-reduction may result in healthcare savings.
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Affiliation(s)
- Yana Puckett
- Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, 1465 South Grand Blvd, Saint Louis, MO, 63104, USA.
| | - Jose Greenspon
- Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, 1465 South Grand Blvd, Saint Louis, MO, 63104, USA
| | - Colleen Fitzpatrick
- Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, 1465 South Grand Blvd, Saint Louis, MO, 63104, USA
| | - Dennis Vane
- Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, 1465 South Grand Blvd, Saint Louis, MO, 63104, USA
| | - Samiksha Bansal
- Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, 1465 South Grand Blvd, Saint Louis, MO, 63104, USA
| | - Mandy Rice
- Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, 1465 South Grand Blvd, Saint Louis, MO, 63104, USA
| | - Kaveer Chatoorgoon
- Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, 1465 South Grand Blvd, Saint Louis, MO, 63104, USA
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Gfroerer S, Fiegel H, Rolle U. Ultrasound-guided reduction of intussusception: a safe and effective method performed by pediatric surgeons. Pediatr Surg Int 2016; 32:679-82. [PMID: 27154198 DOI: 10.1007/s00383-016-3898-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Ultrasound has developed as the method of choice for diagnosing intussusception. Ultrasound-guided enema reduction is the standard method for treating intussusception. This retrospective study evaluates the efficacy and safety of ultrasound in diagnosis and treatment of intussusception performed solely by pediatric surgeons. METHODS Charts were studied of all patients who were treatedfor intussusception in our unit from 2013 to 2015. Primary outcome measure was the completeness of reduction, and secondary outcome measure was the rate of complications and elapsed time until surgical treatment. RESULTS We included 38 patients in this retrospective study. The mean age was 16.7 months (±15), and the female to male ratio was 1:2. Diagnosis was established by abdominal ultrasound. Thirty-five of thirty-eight patients underwent ultrasound-guided enema reduction at our institution. Three of thirty-eight patients were scheduled for immediate surgery due to signs of peritonitis or prolonged bowel obstruction. The overall rate of successful ultrasound enema reduction was 28/35 (80 %) patients. Seven of thirty-five patients underwent surgery after an unsuccessful enema reduction; 6/7 patients had a prolonged history of symptoms, and 6/7 patients had a specific pathological lead point. The length of hospitalization was less than 2 days for patients after enema reduction. Recurrence was observed in three cases (8.5 %). We did not observe any complications during enema reduction. CONCLUSIONS Ultrasound-guided enema reduction for intussusception is safe and effective when performed by pediatric surgeons.
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Affiliation(s)
- Stefan Gfroerer
- Department of Paediatric Surgery and Paediatric Urology, University Hospital Frankfurt/M., Theodor-Stern-Kai 7, 60590, Frankfurt/M., Germany
| | - Henning Fiegel
- Department of Paediatric Surgery and Paediatric Urology, University Hospital Frankfurt/M., Theodor-Stern-Kai 7, 60590, Frankfurt/M., Germany
| | - Udo Rolle
- Department of Paediatric Surgery and Paediatric Urology, University Hospital Frankfurt/M., Theodor-Stern-Kai 7, 60590, Frankfurt/M., Germany.
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Abstract
We present a case series describing an infant and a child who presented with abdominal discomfort and their conditions were diagnosed with intussusception by point-of-care ultrasound. These cases illustrate how point-of-care ultrasound led to the expeditious diagnosis of intussusception.
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Meta-analysis of Air Versus Liquid Enema for Intussusception Reduction in Children. AJR Am J Roentgenol 2016; 205:W542-9. [PMID: 26496576 DOI: 10.2214/ajr.14.14060] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the effectiveness and safety of air versus liquid enema reduction in the treatment of intussusception in children. MATERIALS AND METHODS Literature searches of the PubMed, Embase, and Cochrane Library databases were conducted from January 1, 1966, through May 31, 2013. Articles on the use of air or liquid enema in children with a confirmed diagnosis of intussusception and reporting either a success rate for enema reduction of intussusception or a perforation rate were selected. Enema reduction success rate, perforation rate, and recurrence rate were the main outcomes and were calculated by random effects modeling. RESULTS One hundred two articles (101 reporting success rate, 71 reporting perforation rate) were included that presented results for 32,451 children (age range, 1 day-22 years; boys, 66%; girls, 34%). In 44 studies (16,187 children), the combined estimate for success rate of air enema was 82.7% (95% CI, 79.9-85.6%; inconsistency index [I(2)] = 97%), and in 52 studies (13,081 children) of liquid enema, it was 69.6% (95% CI, 65.0-74.1%; I(2) = 98%). In 38 studies (15,752 children), the combined estimate of perforation rate for air enema was 0.39% (95% CI, 0.23- 0.55%; I(2) = 40%), and in 30 studies (9429 children) of liquid enema, it was 0.43% (95% CI, 0.24- 0.62%; I(2) = 9%). Among 10,494 children (26 studies) undergoing air enema reduction, the rate of first intussusception recurrence was 6% (95% CI, 4.5-7.5%; I(2) = 89%), similar to the 7.3% (95% CI, 5.8-8.8%; I(2) = 71%) found for 4004 children (24 studies) undergoing liquid enema reduction. CONCLUSION Air enema was superior to liquid enema for intussusception reduction. The success rate was higher without a difference in perforation rate. Limitations included heterogeneity and publication bias.
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Intussusception patients older than 1 year tend to have early recurrence after pneumatic enema reduction. Pediatr Surg Int 2015; 31:855-8. [PMID: 26169529 DOI: 10.1007/s00383-015-3726-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To identify age risk factors of early recurrent intussusception after pneumatic enema reduction. Management opinions are proposed. METHODS Two thousand two hundred and ninety-five intussusception patients' medical records from January 2009 to December 2011 were retrospectively reviewed and analyzed. RESULTS Of the 2295 patients, the intussusception of 1917 of them was initially reduced by pneumatic enema, with 127 cases recurring within 72 h. The early recurrence rate is 6.62%. The early recurrence rate of patients younger than 1 year old is 2.1% (22/1032), while the rate for those older than 1 year is 11.9% (105/885). The difference is significant (P = 0.0001). There were no significant differences between age groups older than 1 year. One hundred and seventeen cases of recurrence happened within 48 h, which accounted for 92.1% of all early recurrence. Recurrence patients were treated again with pneumatic enema, with a successful reduction in 93.7%. They were followed up for 2-4 years; the long-term recurrent rate was 11.8% (14/119). No patient had poor prognosis because of delayed treatment. CONCLUSION Intussusception patients older than 1 year tend to have greater early recurrence rate after pneumatic enema reduction; 92.1% of the early recurrent cases happened in 48 h. There is no need to hospitalize patients after pneumatic enema reduction. A repeat pneumatic enema is a good choice before surgical approach.
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Lessenich EM, Kimia AA, Mandeville K, Li J, Landschaft A, Tsai A, Bachur RG. The Frequency of Postreduction Interventions After Successful Enema Reduction of Intussusception. Acad Emerg Med 2015; 22:1042-7. [PMID: 26292193 DOI: 10.1111/acem.12741] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/13/2015] [Accepted: 04/17/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective was to determine the frequency of postreduction, hospital-level interventions among children with successful reduction of ileocolic intussusception and identify factors that predict the need for such interventions. METHODS This was a retrospective cross-sectional study of children who underwent successful enema reduction for ileocolic intussusception at a single emergency department. Hospital-level interventions were included if they occurred within 24 hours of reduction and were further classified as either major (recurrence or possible perforation) or minor (imaging for suspected recurrence or administration of parenteral narcotics or antiemetics). Binary logistic regression was used to identify predictors for hospital-level interventions. RESULTS A total of 464 children underwent enema reduction. The median age was 1.7 years (interquartile range [IQR] = 0.8 to 2.5 years), and 66% were male. A total of 435 (94%) were hospitalized with a median hospital stay of 25 hours (IQR = 19 to 34 hours). Nineteen percent (95% confidence interval [CI] = 15% to 22%) needed postreduction interventions, including 6% (95% CI = 4% to 9%) who required major interventions. The median time to any hospital intervention was 9.9 hours (IQR = 6.3 to 16.4 hours). We identified two independent predictors for hospital-level interventions: duration of symptoms > 24 hours (adjusted odds ratio [OR] = 2.1, 95% CI = 1.3 to 3.4) and location of the intussusception tip at (or proximal to) the hepatic flexure (adjusted OR = 1.9, 95% CI = 1.1 to 3.3); the latter factor was also a predictor of a major intervention. None of the children (95% CI = 0 to 1.0%) had an acute decompensation after an initially successful enema reduction. CONCLUSIONS Clinical decompensation is rare and recurrence is relatively low after an uncomplicated reduction of ileocolic intussusception. However, one in five children required hospital-level interventions after reduction. Children with the intussusception tip at (or proximal to) the hepatic flexure, and those with symptoms for longer than 24 hours, are more likely to require subsequent interventions. Although outpatient management appears safe after a period of observation, caregivers should be counseled about the risk of ongoing symptoms and recurrence.
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Affiliation(s)
| | - Amir A. Kimia
- Division of Emergency Medicine; Department of Medicine; Children's Hospital Boston; Boston MA
| | - Katherine Mandeville
- Division of Emergency Medicine; Department of Medicine; Children's Hospital Boston; Boston MA
| | - Joyce Li
- Division of Emergency Medicine; Department of Medicine; Children's Hospital Boston; Boston MA
| | - Assaf Landschaft
- Division of Emergency Medicine; Department of Medicine; Children's Hospital Boston; Boston MA
| | - Andy Tsai
- Department of Radiology; Children's Hospital Boston; Boston MA
| | - Richard G. Bachur
- Division of Emergency Medicine; Department of Medicine; Children's Hospital Boston; Boston MA
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Puckett Y, Nathan J, Dissanaike S. Intussusception caused by dried apricot: A case report. Int J Surg Case Rep 2014; 5:1254-7. [PMID: 25437689 PMCID: PMC4276074 DOI: 10.1016/j.ijscr.2014.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 11/02/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION An unusual cause of intussusception due to small bowel obstruction secondary to dried apricot consumption was encountered. Phytobezoar small bowel obstruction is a rare, but interesting pathology that accounts for 2–4% of small bowel obstructions (18). Even rarer, is an intussusception caused by dried fruit ingestion. We present the case of a 56-year-old female that presented with an intussusception after she ingested a large amount of dried apricots. PRESENTATION OF CASE The patient is a 56-year-old female with a small bowel obstruction secondary to intussusception in the distal ileum. She was taken to the operating room for a celiotomy where an intussusception of the distal small bowel was found. An enterotomy was performed which revealed dried apricots as the lead point. The intussusception was successfully reduced and the apricots removed. DISCUSSION Small bowel obstruction due to intussusception can be caused secondary to malignancy, Meckel's Diverticulum, benign neoplasm, and strictures. A less common cause for small bowel obstruction due to intussusception in adults is secondary to mechanical obstruction by bezoars. Risk factors for bezoar formation include previous gastric surgery, diabetes, and mastication problems. CONCLUSION Bezoars are an extremely rare cause of intussusception in adults. A high level of suspicion needs to exist in the presence of a history of eating dried fruit, history of gastric surgery, diabetes mellitus, and problems with mastication. Various treatment modalities exist to treat obstructions secondary to bezoars, including open reduction and removal of bezoar via enterotomy.
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Affiliation(s)
- Yana Puckett
- Department of General Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, United States.
| | - Jon Nathan
- Department of General Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Sharmila Dissanaike
- Department of General Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, United States.
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