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Xia B, Chen G, Liu Q, Yan C, Lu P, Guo C. A comprehensive scoring system for the better prediction of bowel resection in pediatric intussusception. BMC Gastroenterol 2024; 24:180. [PMID: 38778288 PMCID: PMC11110355 DOI: 10.1186/s12876-024-03243-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Intussusception presents a significant emergency that often necessitates bowel resection, leading to severe complications and management challenges. This study aims to investigate and establish a scoring system to enhance the prediction of bowel resection necessity in pediatric intussusception patients. METHODS This retrospective study analyzed 660 hospitalized patients with intussusception who underwent surgical management at a pediatric hospital in Southwest China from April 2008 to December 2020. The necessity of bowel resection was assessed and categorized in this cohort. Variables associated with bowel resection were examined using univariate and multivariate logistic regression analyses. Based on these analyses, a scoring system was developed, grounded on the summation of the coefficients (β). RESULTS Among the 660 patients meeting the inclusion criteria, 218 required bowel resection during surgery. Bowel resection occurrence was linked to an extended duration of symptoms (Odds Ratio [OR] = 2.14; 95% Confidence Interval [CI], 1.03-5.23; P = 0.0015), the presence of gross bloody stool (OR = 8.98; 95% CI, 1.76-48.75, P < 0.001), elevated C-reactive protein levels (OR = 4.79; 95% CI, 1.12-28.31, P = 0.0072), lactate clearance rate (LCR) (OR = 17.25; 95% CI, 2.36-80.35; P < 0.001), and the intussusception location (OR = 12.65; 95% CI, 1.46-62.67, P < 0.001), as determined by multivariate logistic regression analysis. A scoring system (totaling 14.02 points) was developed from the cumulative β coefficients, with a threshold of 5.22 effectively differentiating infants requiring surgical intervention from others with necrotizing enterocolitis (NEC), exhibiting a sensitivity of 78.3% and a specificity of 71.9%. CONCLUSIONS This study successfully identified multiple risk factors for bowel resection and effectively used a scoring system to identify patients for optimal clinical management.
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Affiliation(s)
- Bingshan Xia
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, P.R. China
- Department of Pediatrics, Yongchuan maternal and Child Health Hospital, Chongqing, P.R. China
- Department of Pediatrics, Chongqing health center for women and children, Chongqing, P.R. China
| | - Guoqiang Chen
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, P.R. China
- Department of Pediatrics, Chongqing health center for women and children, Chongqing, P.R. China
| | - Qianyang Liu
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, P.R. China
- Department of Pediatrics, Chongqing health center for women and children, Chongqing, P.R. China
| | - Chengwei Yan
- Department of Pediatric General Surgery, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
| | - Peng Lu
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, P.R. China.
- Department of Pediatrics, Chongqing health center for women and children, Chongqing, P.R. China.
- Department of Pediatric General Surgery, Chongqing maternal and Child Health Hospital, Chongqing Medical University, Chongqing, P.R. China.
| | - Chunbao Guo
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, P.R. China.
- Department of Pediatrics, Chongqing health center for women and children, Chongqing, P.R. China.
- Department of Pediatric General Surgery, Chongqing maternal and Child Health Hospital, Chongqing Medical University, Chongqing, P.R. China.
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Peramsetty NR, Fung T, Zhang A, Saliba C, Blewett C, Miyata S, Herman R. Recurrent Ileocolic Intussusception With the Appendix as the Pathologic Lead Point in Children: A Report of Two Cases and Review of Literature. Cureus 2024; 16:e61120. [PMID: 38919204 PMCID: PMC11198737 DOI: 10.7759/cureus.61120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/27/2024] Open
Abstract
Ileocolic intussusception is a consideration in young pediatric patients with acute abdominal pain. Meckel's diverticulum is the most common pathologic lead point for intussusception in children and the appendix acting as the lead point is rare. In addition, management guidelines for recurrent ileocolic intussusception (RICI) are lacking. We present two cases of RICI in which the pathological lead point was the appendix. The first patient, a two-year-old with no medical history, had intermittent abdominal pain and non-bloody vomiting for a month. Ultrasound revealed ileocolic intussusception, successfully managed with pneumatic reduction. However, symptoms recurred and a repeat ultrasound showed partial intussusception of the appendix into the cecum. Laparoscopic reduction and appendectomy were then performed. Symptomatic intussusception recurred, and a second laparoscopic reduction with stump appendectomy resolved all symptoms. The second patient, a three-year-old with no medical history, had colicky abdominal pain for 24 hours. Ultrasound revealed ileocolic intussusception that was pneumatically reduced. As pain recurred, laparoscopic reduction and appendectomy were performed, revealing ileocolic intussusception with a dilated appendix as the pathologic lead point. Recurrent ileocolic intussusception (RICI) with the appendix as the lead point is common, but RICI with the appendix as the lead point is rare. These cases demonstrate the role of the appendix as a pathologic lead point, and a review of the literature supports the need for surgical reduction. While enema reduction is the first line for recurrent intussusception, surgical reduction is preferred when a pathological lead point is suspected.
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Affiliation(s)
- Nikita R Peramsetty
- Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, USA
| | - Tiffany Fung
- Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, USA
| | - Andi Zhang
- Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, USA
| | - Christian Saliba
- Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, USA
| | - Christopher Blewett
- Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, USA
| | - Shin Miyata
- Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, USA
| | - Richard Herman
- Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, USA
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Delgado-Miguel C, García A, Delgado B, Muñoz-Serrano AJ, Miguel-Ferrero M, Barrena S, López-Santamaría M, Martínez L. Intussusception Management in Children: A 15-Year Experience in a Referral Center. Indian J Pediatr 2023; 90:1198-1203. [PMID: 35821554 DOI: 10.1007/s12098-022-04248-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 02/26/2022] [Accepted: 04/05/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To report a 15-y, single-center experience in the management and outcomes of ileocolic intussusception (ICI) episodes. METHODS A retrospective study was performed in patients with ICI episodes, who were treated at a single quaternary referral center from 2005 to 2019. Data evaluated included patient demographics, clinical presentation, treatment modalities, hospital stay, complications, and outcomes. RESULTS A total of 546 ICI episodes (66.1% males) were included, with a median age at diagnosis of 15 mo. Enema reduction was performed in 478 patients (87.6%), with an overall success rate of 85.8%. Hydrostatic saline enema was the most effective method (89.3%) when compared to pneumatic (80.6%) or barium enema (79.8%), this difference being statistically significant (p = 0.031). No associated complications were observed during nonoperative reduction. Surgical treatment was performed in 101 patients, in whom 36 bowel resections were performed. Postoperative complications were reported in 6 patients (5.9%). Hospital stay was significantly longer in patients with operative management (median 5 d vs. 1 d; p < 0.001). CONCLUSIONS Nonoperative management has a high overall success rate and low complication and recurrence rates. Saline enema reduction presents the highest effectiveness, and should be considered the first-line treatment.
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Affiliation(s)
- Carlos Delgado-Miguel
- Department of Pediatric Surgery, La Paz Children's Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain.
| | - Antonella García
- School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Bonifacio Delgado
- Department of Mathematics, Complutense University of Madrid, Madrid, Spain
| | - Antonio J Muñoz-Serrano
- Department of Pediatric Surgery, La Paz Children's Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Miriam Miguel-Ferrero
- Department of Pediatric Surgery, La Paz Children's Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Saturnino Barrena
- Department of Pediatric Surgery, La Paz Children's Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Manuel López-Santamaría
- Department of Pediatric Surgery, La Paz Children's Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Leopoldo Martínez
- Department of Pediatric Surgery, La Paz Children's Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
- Institute for Biomedical Resarch La Paz (IdiPaz), Network for Maternal and Children Health (SAMID), La Paz Children's Hospital, Madrid, Spain
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Delgado-Miguel C, García A, Delgado B, Muñoz-Serrano AJ, Miguel-Ferrero M, Camps J, Lopez-Santamaria M, Martinez L. Neutrophil-to-Lymphocyte Ratio as a Predictor of the Need for Surgical Treatment in Children's Intussusception. Eur J Pediatr Surg 2023; 33:422-427. [PMID: 35913089 DOI: 10.1055/a-1913-4280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Neutrophil-to-lymphocyte ratio (NLR) is an emerging inflammatory marker in abdominal pathologies. Ileocolic intussusception (ICI) involves a progressive intestinal inflammation, and the effectiveness of nonsurgical treatment (enema) might be related to the inflammation degree, although no previous studies have investigated this relationship. Our aim is to identify predictors of the need for surgical treatment in ICI. MATERIALS AND METHODS A single-center, retrospective, case-control study was performed in children with ICI, who were treated with initial nonsurgical management between 2005 and 2019. Patients were divided in two groups: A (effective enema) and B (need for surgery). Admission demographic and clinical and laboratory data were analyzed. Specificity and sensitivity of the different parameters as predictors of the need for surgical treatment were determined by receiver operating characteristic (ROC) curves. RESULTS A total of 511 patients were included (410: group A; 101: group B), without statistically significant demographic differences. Group B presented significantly higher frequency of vomiting, bloody stools, and longer median time since symptoms onset (24 vs. 8 hours; p < 0.001). Group B presented higher median laboratory inflammatory markers than group A: NLR (6.8 vs. 1.8; p < 0.001), neutrophils (10,148 vs. 7,468; p < 0.001), and C-reactive protein (CRP; 28.2 vs. 4.7; p < 0.001). In ROC curve analysis, NLR had an area under the curve of 0.925, higher than neutrophil count (0.776; p = 0.001), CRP (0.670; p = 0.001), and time since symptoms onset (0.673; p = 0.001). It was estimated a cut-off point of NLR greater than 4.52 (sensitivity: 73.2%; specificity: 94.5%). CONCLUSION High NLR values imply a high degree of bowel inflammation and might anticipate the need for surgical treatment in ICI in children. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Carlos Delgado-Miguel
- Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, South Carolina, United States
| | - Antonella García
- Department of Surgery, Faculty of Medicine, Autonomous University of Madrid, Madrid, Madrid, Spain
| | - Bonifacio Delgado
- Department of Mathematics, Complutense University of Madrid, Ringgold Standard Institution, Madrid, Comunidad de Madrid, Spain
| | - Antonio Jesus Muñoz-Serrano
- Department of Pediatric Surgery, La Paz University Hospital Children Hospital, Ringgold Standard Institution, Madrid, Comunidad de Madrid, Spain
| | - Miriam Miguel-Ferrero
- Department of Pediatric Surgery, La Paz University Hospital Children Hospital, Ringgold Standard Institution, Madrid, Comunidad de Madrid, Spain
| | - Juan Camps
- Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, South Carolina, United States
| | - Manuel Lopez-Santamaria
- Department of Pediatric Surgery, La Paz University Hospital Children Hospital, Ringgold Standard Institution, Madrid, Comunidad de Madrid, Spain
| | - Leopoldo Martinez
- Department of Pediatric Surgery, La Paz University Hospital Children Hospital, Ringgold Standard Institution, Madrid, Comunidad de Madrid, Spain
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Ting X, Xufei D, Jiangbin L, Weijue X, Zhibao L, Guogang Y. Development and Validation of a Nomogram for Predicting Pathological Intussusceptions in Children Prior to Surgical Intervention. Front Pediatr 2022; 10:877358. [PMID: 35923785 PMCID: PMC9339649 DOI: 10.3389/fped.2022.877358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Establish and validate a nomogram to help predict the preoperative risk of a pathological intussusception. METHODS A primary cohort of patients who underwent surgery for an intussusception were enrolled from one center, while a validation cohort consisted of patients from another center. Multivariate logistic regression analysis was used to identify the variables to build the nomogram. A calibration curve accompanied by the Hosmer-Lemeshow test was used to assess the calibration of the nomogram. To quantify the discrimination of the nomogram, Harrell's C-index was calculated. The performance of the validated nomogram was tested in the external validation cohort. The logistic regression formulae created during the analysis of the primary cohort was applied to all patients in the external validation cohort, and the total points for each patient were calculated. RESULTS The primary cohort consisted of 368 patients and the validation cohort included 74. The LASSO logistic algorithm identified three (recurrence episodes, mass size, and infection history) out of 11 potential clinical variables as significantly predictive of a pathologic intussusception. The C-index for the predictive nomogram was 0.922 (95% CI, 0.885-0.959) for the primary cohort and 0.886 (95% CI, 0.809-0.962) for the validation cohort. The decision curve showed that if the threshold probability of a patient in the validation cohort was > 7%, then the nomogram was more beneficial than either indiscriminately treating all or none of the patients. CONCLUSION We developed a nomogram based on clinical risk factors that could be used to individually predict pathological intussusceptions in children prior to surgical intervention.
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Affiliation(s)
- Xu Ting
- Department of General Surgery, School of Medicine, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Duan Xufei
- Department of General Surgery, Tongji Medical College, Wuhan Children's Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Liu Jiangbin
- Department of General Surgery, School of Medicine, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xu Weijue
- Department of General Surgery, School of Medicine, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lv Zhibao
- Department of General Surgery, School of Medicine, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ye Guogang
- Department of General Surgery, School of Medicine, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Management of recurrent ileocolic intussusception. J Pediatr Surg 2020; 55:2150-2153. [PMID: 31677825 DOI: 10.1016/j.jpedsurg.2019.09.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE The aims of this study were to evaluate the need for surgical intervention for patients with recurrent ileocolic intussusception (RICI), especially for multiple recurrences, and to investigate whether early and late recurrence patterns were associated with surgery. METHODS Patients with ileocolic intussusception (ICI) during the years 2007-2019 were included. Demographic data, recurrences, and outcomes were analyzed. Early RICI was defined as recurrence within 48 h. RESULTS Overall, 604 episodes of ICI were confirmed in 491 patients. The recurrence rate was 13.8%, with 113 episodes in 68 patients. There were no statistically significant differences in age, reduction success rate, operation, or pathological lead points (PLPs) between the recurrence and non-recurrence groups. There was no significant association between the number of recurrences and the presence of a PLP or between the number of recurrences and whether the recurrences were early or late. The presence of PLPs was not significantly associated with age or recurrence, but the reduction success rate was significantly lower (P < 0.001). CONCLUSIONS Each recurrence should be managed as a first episode, regardless of early or late recurrence. Operative reduction should be considered when nonoperative reduction fails, a PLP is suspected, or there are signs of peritonitis. TYPE OF STUDY Treatment Study. LEVEL OF EVIDENCE Level III.
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Lee JY, Byun YH, Park JS, Lee JS, Ryu JM, Choi SJ. Lactic acid level as an outcome predictor in pediatric patients with intussusception in the emergency department. BMC Pediatr 2020; 20:184. [PMID: 32331520 PMCID: PMC7181481 DOI: 10.1186/s12887-020-02095-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/20/2020] [Indexed: 12/14/2022] Open
Abstract
Background Intussusception decreases blood flow to the bowel, and tissue hypoperfusion results in increased lactic acid levels. We aimed to determine whether lactic acid levels are associated with pediatric intussusception outcomes. Methods The electronic medical records of our emergency department pediatric patients diagnosed with intussusception, between January 2015 and October 2018, were reviewed. An outcome was considered poor when intussusception recurred within 48 h of reduction or when surgical reduction was required due to air enema failure. Results A total of 249 patients were included in the study, including 39 who experienced intussusception recurrence and 11 who required surgical reductions; hence, 50 patients were included in the poor outcome group. The poor and good outcome groups showed significant differences in their respective blood gas analyses for pH (7.39 vs. 7.41, P = .001), lactic acid (1.70 vs. 1.30 mmol/L, P < .001), and bicarbonate (20.70 vs. 21.80 mmol/L, P = .036). Multivariable logistic regression analyses showed that pH and lactic acid levels were the two factors significantly associated with poor outcomes. When the lactic acid level cutoff values were ≥ 1.5, ≥2.0, ≥2.5, and ≥ 3.0 mmol/L, the positive predictive values for poor outcomes were 30.0, 34.6, 50.0, and 88.9%, respectively. Conclusion Lactic acid levels affect outcomes in pediatric patients with intussusception; higher lactic acid levels are associated with higher positive predictive values for poor outcomes.
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Affiliation(s)
- Jeong-Yong Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Young-Hoon Byun
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jun-Sung Park
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jong Seung Lee
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jeong-Min Ryu
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Seung Jun Choi
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Zhao L, Feng S, Wu P, Lai XH, Lv C, Chen G. Clinical characteristics and surgical outcome in children with intussusceptions secondary to pathologic lead points: retrospective study in a single institution. Pediatr Surg Int 2019; 35:807-811. [PMID: 30874901 DOI: 10.1007/s00383-019-04471-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Intussusception secondary to pathologic lead points (PLPs) is a potential surgical emergency and almost all cases need surgery. The aim of this study was to evaluate the clinical manifestations, physical examinations and surgical outcomes of secondary intussusception (SI) caused by PLPs, as well as to improve the diagnosis and treatment of PLPs in children and infants. MATERIALS AND METHODS We retrospectively reviewed the records of 83 children and infants who were diagnosed with intussusception secondary to PLPs in our institution. The ultimate diagnosis was dependent on histopathological findings under a microscope by a pathologist. Patients were divided into a younger group (< 2 years old) and the older group (> 2 years old) according to age. Patient demographics, clinical manifestations, duration of symptoms, auxiliary examinations, and the presence of pathological lead point were recorded. RESULTS A total of 83 patients were found with intussusception secondary to PLPs in this study. Patients were aged from 4 days to 14 years, with a mean age of 3.8 years (median 1.5; range 0-14 years). There were 47 cases in the younger group and 36 cases in the older group. The main clinical symptoms were intermittent crying or abdominal pain. PLPs were observed in only ten patients on US (12%). Ten patients underwent enteroscopy examination for further diagnosis, and all the patients had positive findings including seven cases of Peutz-Jeghers syndrome and three cases of benign polyps. Technetium-99 m pertechnetate scans were performed in ten patients and five patients had positive results (50%). Based on the surgical findings, complex/compound is the most common type of intussusception, followed by small intestinal and ileo-colic type. The main types of PLPs were Meckel's diverticulum (n = 31), duplication cyst (n = 19) and benign polyps (n = 13). Meckel's diverticulum and intestinal duplication were the most common causes of secondary intussusception among children younger than 2 years, accounting for 81% (38/47) of the cases. The most common causes of secondary intussusception in children older than 2 years were intestinal polyps, Meckel's diverticulum and Peutz-Jeghers syndrome, accounting for 72% (26/36) of the cases. CONCLUSIONS The presence of a pathological lead point is more likely in older children. The most common types of intussusception secondary to PLPs are complex/compound and small intestinal. Meckel's diverticulum and intestinal duplication were the most common causes of secondary intussusception among younger children and Peutz-Jeghers syndrome and intestinal polyps were commonly seen in older children.
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Affiliation(s)
- Lingling Zhao
- Department of Pathology, Zhejiang Provincial Hospital of TCM, The First Affiliated Hospital of Zhejiang University of TCM, Hangzhou, 310006, China
| | - Shaoguang Feng
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, 310015, China
| | - Peng Wu
- Department of Pediatric Surgery, Northwest Women and Children's Hospital, Xi'an, China
| | - Xin-He Lai
- School of Biology and Food Science, Shangqiu Normal University, Shangqiu, Henan, China
| | - Chengjie Lv
- Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Guorong Chen
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Lin XK, Xia QZ, Huang XZ, Han YJ, He GR, Zheng N. Clinical characteristics of intussusception secondary to pathologic lead points in children: a single-center experience with 65 cases. Pediatr Surg Int 2017; 33:793-797. [PMID: 28584905 DOI: 10.1007/s00383-017-4101-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Intussusception secondary to pathologic lead points (PLPs) is a challenging condition for pediatric surgeons, and few studies have been published on this subject. The aim of this study was to review and analyze clinical data on the diagnosis and management of intussusception secondary to PLPs in children. METHODS Between 2002 and 2016, a total of 65 pediatric patients with a diagnosis of intussusception secondary to PLPs were retrospectively reviewed. RESULTS The series comprised 47 males and 18 females. The average age of the patients was 4.9 years old. All patients had typical clinical manifestations, and intussusception was proven by ultrasound. Fifty-one patients had recurrent intussusception, of whom 21 had one, 14 had two, 10 had three, and 6 had more than three. There were 20 episodes of recurrence within 24 h (39.2%), 15 episodes were found between 24 and 72 h (29.4%), and the remaining 31.4% (16/51) of recurrences occurred after 72 h. All patients received surgical intussusception reduction. Meanwhile, enterectomy was the procedure of choice in 55 patients, polypectomy in 5 patients, and cystectomy in 3 patients. The types of intussusception secondary to PLPs included small intestinal (n = 25), ileocolic (n = 19), ileocecal (n = 11), ileo-ileocolic (n = 9) and cecalcolic (n = 1). The types of PLPs included Meckel diverticulum (n = 32), intestinal duplication (n = 14), benign polyps (n = 5), malignant lymphoma (n = 4), Peutz-Jeghers syndrome (n = 3), mesenteric cyst (n = 3), intestinal wall hematoma of hemophilia (n = 2), allergic purpura (n = 1), and hamartoma (n = 1). All patients recovered well with no relapse during follow-up, except for one patient who had an intestinal obstruction from adhesions that occurred approximately 3 months after discharge and who was curable after conservative treatment. CONCLUSIONS Intussusception secondary to PLPs tends to exhibit recurrence. There are various types of intussusception secondary to PLPs. It is necessary to improve auxiliary examinations to identify the etiology and avoid intraoperative omission. Surgical reduction of intussusception secondary to PLPs is the preferred clinical management.
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Affiliation(s)
- Xiao-Kun Lin
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
| | - Qiong-Zhang Xia
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Xiao-Zhong Huang
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Yi-Jiang Han
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Guo-Rong He
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Na Zheng
- Department of Pediatric Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
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Wong CWY, Jin S, Chen J, Tam PKH, Wong KKY. Predictors for bowel resection and the presence of a pathological lead point for operated childhood intussusception: A multi-center study. J Pediatr Surg 2016; 51:1998-2000. [PMID: 27666006 DOI: 10.1016/j.jpedsurg.2016.09.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/12/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Intussusception may require bowel resection. Here, we aim to define factors that predict the need of bowel resection and the presence of pathological lead point. METHODS A retrospective review was taken from three tertiary centers for all operated intussusception patients from January 2010 to December 2014. Patient demographics were recorded. Statistical analysis was performed, and risk factors were derived by binary logistic regression. RESULTS Five thousand ninety-six patients were treated for intussusception with 73 (57 male, 16 female) operated. The median age was 23.2months, and median duration of symptoms was 2days. Twenty-eight patients (38.4%) required bowel resection. Logistic regression demonstrated that older age (p=0.018) and longer duration of symptoms (p=0.009) were associated with bowel resection. Furthermore, older age was a predictive factor for the presence of a pathological lead point (p=0.01). A palpable abdominal mass was also found to be associated with the need of bowel resection (risk ratio 2.3) and the presence of pathological lead point (risk ratio 2.3) independently. CONCLUSION Older age at presentation and a longer duration of symptoms are positive predictors for the need of bowel resection in intussusception. The presence of a pathological lead point is more likely in older children. LEVEL OF EVIDENCE Case series with no comparison group - Level IV.
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Affiliation(s)
- Carol W Y Wong
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Shuguang Jin
- Department of Surgery, West China Center of Medical Sciences of Sichuan University, Sichuan, China
| | - Jie Chen
- Department of Surgery, Xin Hau Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Paul K H Tam
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kenneth K Y Wong
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
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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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