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Nguyen QT, Pham HD, Tran QA, Ly DB, Nguyen LV, Dang TT, Nguyen LT. Modified Pneumatic Reduction Protocol for Intussusception: A Retrospective Cohort Study in an Ultrahigh Volume Center. J Pediatr Surg 2024:S0022-3468(24)00431-7. [PMID: 39117538 DOI: 10.1016/j.jpedsurg.2024.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/03/2024] [Accepted: 07/14/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND This study aims to assess the long-term outcomes of a modified pneumatic reduction protocol for intussusception at the Vietnam National Hospital of Pediatrics, an institution with a significant patient load in a lower-middle-income country. PATIENTS AND METHODS A single center, retrospective cohort observational study was conducted to examine patients who underwent modified fluoroscopic-guided air-enema reduction (FGAR) for intussusception from January 2016 to December 2017. Data on patient demographics, complication rates, and the incidence of long-term recurrence was collected. RESULTS Between January 2016 and December 2017, a total of 3562 patients underwent modified FGAR at our institution, including 2313 males (64.9%) and 1249 females (35.1%). The median age was 19 months (range: 1-170), and the median FGAR procedure duration was 4 min (range: 2-24). The median hospital stay was 1 day (range: 1-31). Successful reduction was achieved in 98.7% of cases, with 43 unsuccessful cases and 4 cases of perforated bowel requiring surgery. Twenty patients, presenting with severe symptoms due to delayed treatment seeking, were admitted to the pediatric intensive care unit (ICU) post-FGAR. No mortality or severe morbidity was reported. Over a median 6-year follow-up, intussusception recurred in 198 patients, accounting for 5.6% of the cohort, with 97% of recurrences occurring within the first year post-reduction. Infants and children under 12 months of age had the highest complication rates, including failed FGAR, complicated intussusception, ICU admission, or recurrence, compared to other age groups, and this difference was statistically significant (p < 0.05). CONCLUSION The modified FGAR protocol has been demonstrated to be safe and feasible, with a very high success rate, low complication rate, and low recurrence rate. Although further comparative studies are needed to confirm its reproducibility, it should be considered a promising approach for children in low-to middle-income countries. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Quang T Nguyen
- Department of Pediatric Surgery, The National Hospital of Pediatrics, Hanoi, Viet Nam; College of Health Science, VinUniversity, Hanoi, Viet Nam
| | - Hien D Pham
- Department of Pediatric Surgery, The National Hospital of Pediatrics, Hanoi, Viet Nam
| | - Quynh A Tran
- Department of Pediatric Surgery, The National Hospital of Pediatrics, Hanoi, Viet Nam
| | - Dung B Ly
- College of Health Science, VinUniversity, Hanoi, Viet Nam
| | - Luan Vm Nguyen
- College of Health Science, VinUniversity, Hanoi, Viet Nam
| | - Trang T Dang
- College of Health Science, VinUniversity, Hanoi, Viet Nam
| | - Liem T Nguyen
- Vinmec Research Institute of Stem Cell and Gene Technology, Vinmec Health Care System, Hanoi, Viet Nam.
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Chang CY, Chen YY, Lin CH, Sheen JM, Shih WT, Chen KJ, Yang YH. Recurrence of pediatric intussusception: A nationwide population-based descriptive study in Taiwan. Medicine (Baltimore) 2023; 102:e34727. [PMID: 37657043 PMCID: PMC10476760 DOI: 10.1097/md.0000000000034727] [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: 04/26/2023] [Accepted: 07/21/2023] [Indexed: 09/03/2023] Open
Abstract
Intussusception is frequently observed pediatric emergency that is often followed by recurrent intussusception after initial treatment. This study investigated the risk factors associated with recurrent intussusception in children aged ≤ 3 years. Between January 2007 and December 2015, a cohort study was conducted by linking the Taiwan Maternal and Child Health Database to the Birth Certificate Application database and the National Health Insurance Research Database in Taiwan. Patients aged ≤ 3 years with intussusception diagnosis and related treatment were included in our study. Multivariable logistic regression was used to analyze the risk factors associated with recurrent intussusception. In total, 5341 children with intussusception aged ≤ 3 years were enrolled in our cohort. The adjusted odds ratio (aOR) for recurrent intussusception in children aged 2 to 3 years was 0.62 (95% confidence interval [CI]: 0.47-0.82) compared with children aged < 1 year, and surgery decreased the risk of recurrent intussusception (aOR = 0.64, 95% CI: 0.46-0.88). Male patients had higher risk of recurrent intussusception than female patients had (aOR = 1.41, 95% CI: 1.13-1.75). Higher birth weight may increase the risk of recurrent intussusception, but this association was not statistically significant. Furthermore, gestational age did not seem to affect the risk of recurrent intussusception. Surgical treatment and delayed onset of intussusception are associated with a reduced risk of recurrent intussusception; males are associated with increased risk of recurrent intussusception. In addition, we suggest that in early infancy, patients who received non-surgical treatment as the initial treatment for intussusception should be closely followed up for potential recurrence of intussusception.
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Affiliation(s)
- Chao-Yang Chang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Ying Chen
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chih-Hsuan Lin
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jiunn-Ming Sheen
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan
| | - Wei-Tai Shih
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ko-Jung Chen
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Zhang J, Dong Q, Su X, Long J. Factors associated with in-hospital recurrence of intestinal intussusception in children. BMC Pediatr 2023; 23:428. [PMID: 37633888 PMCID: PMC10464288 DOI: 10.1186/s12887-023-04267-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND A minority of children experience in-hospital recurrence of intestinal intussusception after treatment. This study investigated the factors associated with in-hospital recurrence of intussusception in pediatric patients in China. METHODS This retrospective study included patients aged 0-18 years-old with intestinal intussusception treated at Hainan Women and Children's Medical Center between January 2019 and December 2019. Demographic and clinical characteristics were extracted from the medical records. Factors associated with in-hospital recurrence of intussusception were identified by logistic regression analysis. RESULTS The analysis included 624 children (400 boys) with a median age of 1.8 years (range, 2 months and 6 days to 9 years). Seventy-three children (11.7%) had in-hospital recurrence of intussusception after successful reduction with air enema. Multivariate logistic regression analysis identified age > 1 year-old (odds ratio [OR]: 7.65; 95% confidence interval [95%CI]: 2.70-21.71; P < 0.001), secondary intestinal intussusception (OR: 14.40; 95%CI: 4.31-48.14; P < 0.001) and mesenteric lymph node enlargement (OR: 1.90; 95%CI: 1.13-3.18; P = 0.015) as factors independently associated with in-hospital recurrence of intussusception. CONCLUSIONS Age > 1 year-old, secondary intussusception and mesenteric lymph node enlargement were independently associated with increased odds of in-hospital recurrence of intussusception after successful reduction with air enema.
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Affiliation(s)
- Jing Zhang
- Department of General Surgery, Hainan Women and Children's Medical Center, Haikou, 570100, China
| | - Qi Dong
- Department of General Surgery, Hainan Women and Children's Medical Center, Haikou, 570100, China.
| | - Xiaoxia Su
- Department of General Surgery, Hainan Women and Children's Medical Center, Haikou, 570100, China
| | - Junshan Long
- Department of General Surgery, Hainan Women and Children's Medical Center, Haikou, 570100, China
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Hwang J, Yoon HM, Kim PH, Jung AY, Lee JS, Cho YA. Current diagnosis and image-guided reduction for intussusception in children. Clin Exp Pediatr 2023; 66:12-21. [PMID: 35798026 PMCID: PMC9815940 DOI: 10.3345/cep.2021.01816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 06/02/2022] [Indexed: 02/04/2023] Open
Abstract
Intussusception involves an invagination of the proximal bowel into the distal bowel, with ileocolic intussusception being the most common type. However, a diagnostic delay can lead to intestinal ischemia, bowel infarction, or even death; therefore, its early diagnosis and management are important. The primary role of abdominal radiography is to detect pneumoperitoneum or high-grade bowel obstruction in cases of suspected intussusception, and ultrasonography is the modality of choice for its diagnosis. Nonoperative enema reduction, the treatment of choice for childhood intussusception in cases without signs of perforation or peritonitis, can be safely performed with a success rate of 82%. Enema reduction can be performed in various ways according to image guidance method (fluoroscopy or ultrasonography) and reduction medium (liquid or air). Successful enema reduction is less likely to be achieved in children with a longer symptom duration, younger age, lethargy, fever, bloody diarrhea, unfavorable radiologic findings (small bowel obstruction, trapped fluid, ascites, absence of flow in the intussusception, intussusception in the left-sided colon), and pathological lead points. This review highlights the current concepts of intussusception diagnosis, nonsurgical enema reduction, success rates, predictors of failed enema reduction, complications, and recurrence to guide general pediatricians in the management of childhood intussusception.
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Affiliation(s)
- Jisun Hwang
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Predicting recurrent cases of intussusception in children after air enema reduction with machine learning models. Pediatr Surg Int 2022; 39:9. [PMID: 36441257 DOI: 10.1007/s00383-022-05309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop a model to identify risk factors and predict recurrent cases of intussusception in children. METHODS Consecutive cases and recurrent cases of intussusception in children from January 2016 to April 2022 were screened. The cohort was divided randomly at a 4:1 ratio to a training dataset and a validation dataset. Three parallel models were developed using extreme gradient boosting (XGBoost), logistic regression (LR), and support vector machine (SVM). Model performance was assessed by the area under the receiver operating characteristic curves (AUC). RESULTS A total of 2469 cases of intussusception were included, where 225 were recurrent cases. The XGBoost (AUC = 0.718) models showed the best performance in the validation dataset, followed by the LR model (AUC = 0.652), while the SVM model (AUC = 0.613) performed worst among the three models. Based on the Shapley Additive exPlanation values, the most important variables in the XGBoost models were air enema pressure, mass size, age, duration of symptoms, and absence of vomiting. CONCLUSIONS Machine learning models, especially XGBoost, could be used to predict recurrent cases of intussusception in children. The most important contributing factors to the models are air enema pressure, mass size, age, duration of symptoms and absence of vomiting.
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Cheikhrouhou T, Chtourou R, Ben Dhaou M, Mallouli M, Benkraiem N, Kallel R, Ammar S, Zitouni H, Boudawara TS, Mhiri R. Intestinal tumor lesions leading to intussusception in children: a report of four cases and literature review. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00213-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Abstract
Background
Intussusception is commonly idiopathic in children. Pathologic lead points (PLP) especially intestinal tumors (IT) are extremely rare. The diagnosis of intussusception secondary to pediatric IT is difficult due to the non-specific nature of symptoms. Its management remains a challenge. We report here four pediatric cases of intussusception secondary to IT lesions in order to analyze the clinical and therapeutic characteristics of this unusual condition.
Case presentations
Four children were diagnosed and operated in our center for intussusception secondary to IT during the period from February 2017 to February 2021. Patients’ demographics, clinical presentations, investigations, operative data, and postoperative outcome were recorded and analyzed. There were three girls and one boy. Ages ranged between 1 and 8 years (average of 5.5 years). Intermittent abdominal pain with acute exacerbation and vomiting were the main clinical signs. Radiologic investigations showed the intussusception in all cases but the tumor lead point was evident only during the surgical exploration in most cases. All patients underwent surgical treatment with intussusception reduction and mass removal. Pathological examination of these masses revealed: submucosal intestinal lipoma (1 case), hamartomatous polyposis (2 cases), and Burkitt’s lymphoma (1 case). For this last case, adjuvant chemotherapy was also needed. The postoperative period was uneventful in all cases.
Conclusion
Pediatric intussusception secondary to IT lesions is an unusual and challenging condition that requires high preoperative diagnostic suspicion, considerate intraoperative judgment, and appropriate postoperative follow-up for successful outcomes.
These tumors should be considered by the pediatric surgeons as possible PLP for recurrent intussusception, especially in older children. Surgeons should be familiar with the various treatment options, because the real cause of the intussusception is often accurately diagnosed by laparotomy.
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Zhang M, Jin L, Tang X, Zhou X, Hu Q, Huang S, Yu F, Yao Z, Xiao Y. Prediction of Outcomes of Ultrasound-Guided Saline Enema in the Treatment of Pediatric Intussusception: A Retrospective Case-Control Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2739-2746. [PMID: 35179255 DOI: 10.1002/jum.15958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/18/2022] [Accepted: 01/30/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Outcomes of ultrasound-guided saline enema include successful treatment, unsuccessful treatment, or recurrence. This study aimed to investigate the value of ultrasonic parameters of the ileocecal region during hydrostatic reduction to predict enema outcomes. METHODS Ultrasound images of patients diagnosed with ileocolic intussusception and treated with ultrasound-guided saline enema at two different institutions between January 2019 and April 2021 were retrospectively analyzed to assess ileocecal-valve diameter (ICVD), intussusceptum thickness (IT), and the ratio of IT to ICVD (I/I). Logistic regression analysis was used to explore correlations between ICVD, IT, I/I, and patient characteristics (sex, age, symptom duration, and enema outcome). RESULTS Of 291 patients with ileocolic intussusception (207 boys; mean ICVD, 8.6 [SD: 0.1] mm; mean IT, 26 [SD: 0.2] mm; mean I/I, 3.0 [SD: 0.01]), 268 had first successful reduction; 23, first failed reduction; 7, final failed reduction; and 41, early recurrence. Significant risk factors for failed reduction included symptom duration >24 hours (odds ratio [OR] = 10, P = .012), ICVD ≤ 8.5 mm (OR = 8, P = .01), and I/I > 3.25 (OR = 16, P < .001). Significant risk factors for early recurrence post-enema included age >1 year (OR = 10, P = .028), ICVD > 8.5 mm (OR = 4, P = .003), and I/I ≤ 2.95 (OR = 6, P < .001). CONCLUSIONS ICVD and IT measured during ultrasound-guided hydrostatic reduction can predict enema outcomes. The mismatch between IT and ICVD is the primary cause of poor outcomes.
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Affiliation(s)
- Min Zhang
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, P.R. China
| | - Linyuan Jin
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, P.R. China
| | - Xianpeng Tang
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, P.R. China
| | - Xiaohui Zhou
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, P.R. China
| | - Qiang Hu
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, P.R. China
| | - Shaobin Huang
- Department of Gastrointestinal Surgery, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, P.R. China
| | - Feng Yu
- Department of Ultrasound Diagnostics, Dongguan Eighth People's Hospital, Dongguan, P.R. China
| | - Zhiguang Yao
- Department of Pediatric Surgery, Dongguan Eighth People's Hospital, Dongguan, P.R. China
| | - Yaocheng Xiao
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, P.R. China
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Yu F, Chen H, Cao X, Mao W, Jiang S, Yao Z, Zhang M. A Technique to Reduce the Early Recurrence of Intussusception in Ultrasound-Guided Hydrostatic Reduction. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2467-2473. [PMID: 34952973 DOI: 10.1002/jum.15933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/03/2021] [Accepted: 12/12/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Ultrasound-guided saline enema is highly successful in treating pediatric intussusception; however, early recurrence-within 48 hours-is possible. This study aimed to explore effective methods of reducing early recurrence. METHODS This study included patients aged 0 to 14 years diagnosed with ileocolic intussusception with a symptom duration of <48 hours from January 2019 to March 2021. The patients were divided into control and intervention groups. All patients received successful treatment with ultrasound-guided saline enema; however, in patients treated before January 4, 2020 (control group), the intestinal fluid was drained immediately, and in patients treated after January 4, 2020 (intervention group), the intestinal fluid was drained after 15 minutes of intestinal pressure maintenance. Early recurrence rates of the groups were compared. RESULTS Ileocolic intussusception was treated successfully by ultrasound-guided saline enema in 231 patients (116, control group;115, intervention group). The early recurrence rate in the intervention group (10%; 95% CI: 4.9-16.5) was numerically lower than that in the control group (19%; 95% CI: 12.3-27.3). No significant difference was observed in the number of recurrences per person between the groups (P = .448). Patients without early recurrence were older (P = .004) and received enemas of a shorter duration (P < .001) and lower pressure (P < .001) than patients without early recurrence. CONCLUSIONS Maintaining reduction pressure for 15 minutes after a successful ultrasound-guided saline enema may reduce the early recurrence of intussusception. A randomized controlled trial is needed because the intervention and control cohorts were most probably incomparable (due to the COVID-19 pandemic).
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Affiliation(s)
- Feng Yu
- Department of Ultrasound Diagnostics, Dongguan Eighth People's Hospital, Dongguan, Guangdong, China
| | - Huanhua Chen
- Department of Ultrasound Diagnostics, Dongguan Eighth People's Hospital, Dongguan, Guangdong, China
| | - Xiaoqing Cao
- Department of Ultrasound Diagnostics, Dongguan Eighth People's Hospital, Dongguan, Guangdong, China
| | - Weihao Mao
- Department of Ultrasound Diagnostics, Dongguan Eighth People's Hospital, Dongguan, Guangdong, China
| | - Shuanglan Jiang
- Department of Ultrasound Diagnostics, Dongguan Eighth People's Hospital, Dongguan, Guangdong, China
| | - Zhiguang Yao
- Department of Pediatric Surgery, Dongguan Eighth People's Hospital, Dongguan, Guangdong, China
| | - Min Zhang
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, China
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Zhang Y, Shao CC, Wei XL, Ni PJ, Guan H, Zhao C, Li DG, Zhang FX. Ultrasound Findings to Predict Risk of Recurrence in Pediatric Intussusception After Air Enema Reduction. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1227-1235. [PMID: 34418137 DOI: 10.1002/jum.15814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/27/2021] [Accepted: 08/01/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Intussusception is one of the most common abdominal emergencies in early children. Intussusception recurs in 8-20% of children after successful nonoperative reduction. The aim of this study was to explore the ultrasound findings to predict risk of recurrence in pediatric intussusception after air enema reduction. METHODS A total of 336 intussusception children were followed up for 1 year after received successful air enema reduction. They were divided into the recurrent group and the non-recurrent group. The differences of clinical characteristics, ultrasonic features, and laboratory tests were analyzed by univariate analyses and the Cox proportional hazard model. RESULTS Sixty-five children with recurrent intussusception were identified. There were statistically significances in the diameter of the mass, in the presence or absence of enlarged lymph nodes out of the sleeve, and in the sleeve between recurrent and non-recurrent groups (P < .05). Other ultrasonic features, clinical characteristics, and blood parameters had no differences (P > .05). Multivariate Cox proportional hazard model showed that the diameter of the mass and abdominal lymph nodes may be the risk factors of intussusception recurrence (HR = 1.395, 95% CI: 1.045~1.863 and HR = 2.078, 95% CI: 1.118~3.865, P < .05). The cut-off value of mass diameter was 2.55 cm, above which recurrence is more likely. CONCLUSIONS Intussusception recurrence was prone with greater mass diameter (>2.55 cm) and enlarged abdominal lymph nodes. Although these ultrasound findings for recurrence do not necessarily reduce the rate of recurrence, it can predict the recurrent possibility, and help the emergency physicians to be more vigilant in these children and better counsel parents upon discharge.
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Affiliation(s)
- Yuan Zhang
- Clinical Epidemiology Unit, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Biostatistics, Clinical Research Center of Shandong University, Jinan, China
| | - Chun-Chun Shao
- Department of Evidence-Based Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiu-Liang Wei
- Department of Ultrasound, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ping-Juan Ni
- Department of Ultrasound, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hui Guan
- Department of Ultrasound, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chen Zhao
- Department of Ultrasound, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Dian-Guo Li
- Department of Pediatric Surgery, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fei-Xue Zhang
- Department of Ultrasound, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Chen X, Chen Q, Wang X, Gao Z. Clinical characteristics of recurrent intussusception: A single-center retrospective study. J Pediatr Surg 2021; 56:1831-1834. [PMID: 33896613 DOI: 10.1016/j.jpedsurg.2021.03.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE we attempted to summarize the clinical characteristics of recurrent intussusception through a large sample size retrospective study. METHODS 5778 patients who were diagnosed with intussusception and treated in our hospital between January 2014 and December 2018 were reviewed. RESULTS the overall recurrence rate was 20.0%, with the recurrence frequency ranged from 1 to 17 episodes and the recurrence interval ranged from 0 to 5 years. 80.0% (926/1158) patients had only 1 to 2 episodes of recurrence. Most of the patients (88.3%) relapsed within 1 year after successful reduction, among which 616 patients (53.2%) relapsed within 3 days. The recurrence rate of intussusception was the lowest when the age was less than 1 year, increased and kept high level in patients aged from 1 to 5 years old, then decreased after 5 years. The pathologic lead point (PLP) proportion of recurrence group was higher than that of non-recurrence group (2.2% VS 1.2%, P = 0.005). CONCLUSIONS the overall recurrence rate was 20.0%. Most of the patients had only 1 to 2 episodes of recurrence and relapsed within 1 year after successful reduction. Age and PLP were risk factors for intussusception recurrence.
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Affiliation(s)
- Xiaoli Chen
- Department of General Surgery, The Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, 57 Zhugan Street, Xiacheng District, Hangzhou, Zhejiang, China.
| | - Qingjiang Chen
- Department of General Surgery, The Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiang Wang
- Department of General Surgery, The Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhigang Gao
- Department of General Surgery, The Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Abstract
OBJECTIVE. Intussusception is the most common cause of intestinal obstruction in young children. Radiology has a key role in its diagnosis and treatment. This systematic review summarizes the currently available evidence for best practices in radiologic management of pediatric intussusception. CONCLUSION. High diagnostic accuracy and lack of ionizing radiation make ultrasound (US) the preferred imaging modality for diagnosing intussusception. For intussusception reduction, fluoroscopy-guided pneumatic enema and US-guided hydrostatic enema are equally dependable and safe techniques. The areas that warrant further research in this field include the efficacy and safety of the US-guided pneumatic enema, potential benefits of sedation and general anesthesia for the reduction procedure, and the optimal management of intussusceptions potentially involving pathologic lead points.
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Lee DH, Kim SJ, Lee HJ, Jang HJ. Identifying Predictive Factors for the Recurrence of Pediatric Intussusception. Pediatr Gastroenterol Hepatol Nutr 2019; 22:142-151. [PMID: 30899690 PMCID: PMC6416386 DOI: 10.5223/pghn.2019.22.2.142] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/23/2018] [Accepted: 09/27/2018] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The aim of the study was to identify factors related to the recurrence of intussusception in pediatric patients. METHODS The medical charts of patients diagnosed with intussusception and treated at Dongsan Medical Center, between March 2015 to June 2017, were retrospectively reviewed. Univariate and multivariate analyses were performed. RESULTS Among 137 patients, 23 patients (16.8%) had a recurrent intussusception and 8 of these patients (6%) had more than 2 episodes of recurrence. The age at diagnosis was significantly different between the non-recurrence and recurrence group (p=0.026), with age >1 year at the time of diagnosis associated with a greater rate of recurrence (p=0.002). The time interval from symptom onset to the initial reduction (<48 vs. ≥48 hours) was significantly longer in the recurrence group (p=0.034) and patients in the recurrence group had higher levels of C-reactive protein (CRP) (p=0.024). Bloody stools and a history of infection were significantly more frequent in the non-recurrence group (p=0.001 and p<0.001, respectively). On stepwise regression analysis, age >1 year at the time of presentation (odds ratio [OR], 4.79; 95% confidence interval [CI], 1.56-14.06; p=0.016) and no history of infection (OR, 0.18; 95% CI, 0.06-0.58; p=0.004) were retained as predictors of recurrence. CONCLUSION Patients with intussusception who are older than 1 year at diagnosis, have an elevated CRP level, a delay of ≥48 hours between symptom onset and the initial reduction, an absence of bloody stools, and no history of infection should be closely monitoring for symptoms and signs of a possible recurrence.
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Affiliation(s)
- Dong Hyun Lee
- Department of Pediatrics, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea
| | - Se Jin Kim
- Department of Pediatrics, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea
| | - Hee Jung Lee
- Department of Radiology, Keimyung University School of Medicine, Daegu, Korea
| | - Hyo-Jeong Jang
- Department of Pediatrics, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea
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Ye X, Tang R, Chen S, Lin Z, Zhu J. Risk Factors for Recurrent Intussusception in Children: A Systematic Review and Meta-Analysis. Front Pediatr 2019; 7:145. [PMID: 31041300 PMCID: PMC6476919 DOI: 10.3389/fped.2019.00145] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/26/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Intussusception is a common abdominal emergency in infancy and childhood, and the recurrence rate is reported to be up to 20%. Numerous potential risk factors for recurrence have been reported, although some of them are still controversial. Objective: The present study was conducted to identify the risk factors or predictive symptoms for recurrent intussusception in children who successfully recovered via enema reduction. Methods: The databases of PUBMED, EMBASE, and Cochrane were searched up to August 2018. The primary outcome was the odds ratio involving the following potential risk factors: sex, the presence of blood in stool, fever, abdominal pain, right abdominal mass, pathological lead point, and vomiting. Results: A total of 12,008 participants from 10 studies included in the abovementioned databases were enrolled in this meta-analysis. The correlation strength with each risk factor was as follows: Sex (OR = 0.87 [0.69, 1.09], P = 0.22); fever (OR = 1.85 [1.29, 2.65], P = 0.0008); blood in stool (OR = 0.93 [0.52, 1.67], P = 0.25); abdominal pain (OR = 0.82 [0.49, 1.37], P = 0.46); vomiting (OR = 0.55 [0.37, 0.80], P = 0.002); pathological lead point (PLP) (OR = 7.71 [1.96,30.29], P = 0.003); location of the mass (OR = 0.51 [0.03, 8.28], P = 0.64). Besides, children who were relatively older (over 1-2 years of age) were seen to have a higher risk of recurrence. Conclusion: The main conclusion of this meta-analysis was that children with the presence of fever and PLP may have a higher risk of recurrence following enema reduction for intussusception. The prevalence of vomiting was found to be lower in RI (Recurrent Intussusception) patients than in the non-RI patients (control group).
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Affiliation(s)
- Xiaohua Ye
- Department of Pediatrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Rong Tang
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Shangqin Chen
- Department of Pediatrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhenlang Lin
- Department of Pediatrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jianghu Zhu
- Department of Pediatrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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Abstract
Objective Intussusception is a common paediatric abdominal emergency in infants. The first-line treatment of choice in uncomplicated paediatric intussusception is enema reduction. The study aim was to provide an overview of the current national practice of enema reduction of paediatric intussusception in China. Methods A questionnaire on enema reduction of paediatric intussusception was sent to respondents (members of the Pediatric Anorectal Group, the Neonatal Group, the Society of Pediatric Surgery and the China Medical Association). Results Data from 128 questionnaires were analysed. Of these, 78.1% (100/128) reported the use of fluoroscopy, 17.2% (22/128) use of ultrasound monitoring, 78.9% (101/128) use of air and 17.9% (23/128) use of normal saline. A total of 78.9% (101/128) reported a success rate of 90%, 25.8% (33/128) reported that a paediatric surgeon managed the reduction, 18.8% (24/128) that a radiologist managed the reduction and 44.5% (57/128) that a paediatric surgeon and radiologist jointly managed the reduction. Conclusions There is large variation in the techniques of enema reduction of intussusception in China. Fluoroscopy-guided air enema reduction is mainly used. Enema reduction of uncomplicated cases of paediatric intussusception in China lacks standardization of equipment and personnel involvement.
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Affiliation(s)
- Xiao Bing Tang
- 1 Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, China.,*These authors contributed equally to this work
| | - Jia Yu Zhao
- 1 Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, China.,*These authors contributed equally to this work
| | - Yu Zuo Bai
- 1 Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, China.,2 The Pediatric Anorectal Group, Society of Pediatric Surgery, Chinese Medical Association, Shenyang, China
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Shen G, Zhang C, Li J, Zhang J, Liu Y, Guan Z, Hu Q. Risk factors for short-term recurrent intussusception and reduction failure after ultrasound-guided saline enema. Pediatr Surg Int 2018; 34:1225-1231. [PMID: 30151752 DOI: 10.1007/s00383-018-4340-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the safety and effectiveness of ultrasound-guided saline enema to treat intussusception and to analyze the risk factors affecting short-term recurrence and reduction failure. MATERIALS AND METHODS We selected patients who had undergone intussusception reduction via ultrasound-guided saline enema from January 2010 to December 2017. The overall success rate, overall pathologic intussusception rate, and pathologic intussusception rate were calculated in each group. All the patients were divided into two groups: the successfully reduced group and the failed reduction group. Then, the successfully reduced patients were divided into two groups: the short-term recurrence group and the short-term non-recurrence group. The differences between each of the two sets of groups were analyzed, and the risk factors affecting short-term recurrence and failure of intussusception were analyzed. RESULTS During the 8-year study period, a total of 1793 patients with intussusception were treated with ultrasound-guided saline enema reduction in our hospital. Among these patients, 1743 (97.2%) experienced successful reduction, 29 (1.6%) had pathologic intussusception, and 1 experienced perforation. After applying the univariate analysis and logistic regressive multivariate analysis, we found that age above 2 years and the absence of fever were risk factors for the early recurrence of intussusception. Pathologic intussusception was a risk factor for reduction failure. CONCLUSION The overall success rate of ultrasound-guided saline enemas was 97.2%, and the pathologic intussusception rate was 1.6%. Age above 2 years and the absence of fever were risk factors for short-term recurrence, and pathologic intussusception was a risk factor for the failure of reduction.
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Affiliation(s)
- Gang Shen
- Department of Pediatric Surgery, Weifang People's Hospital, Weifang, 261041, Shandong, China
| | - Chuanguang Zhang
- Department of Pediatric Surgery, Weifang People's Hospital, Weifang, 261041, Shandong, China
| | - Junfeng Li
- Department of Pediatric Surgery, Weifang People's Hospital, Weifang, 261041, Shandong, China
| | - Jing Zhang
- Department of Pediatric Surgery, Weifang People's Hospital, Weifang, 261041, Shandong, China
| | - Yongdong Liu
- Department of Pediatric Surgery, Weifang People's Hospital, Weifang, 261041, Shandong, China
| | - Zheming Guan
- Weifang Medical University, Weifang, Shandong, China
| | - Qiang Hu
- Department of Pediatric Surgery, Weifang People's Hospital, Weifang, 261041, Shandong, China.
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Xie X, Wu Y, Wang Q, Zhao Y, Xiang B. Risk factors for recurrence of intussusception in pediatric patients: A retrospective study. J Pediatr Surg 2018; 53:2307-2311. [PMID: 29685487 DOI: 10.1016/j.jpedsurg.2018.03.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aim of this study was to explore the risk factors associated with recurrence of intussusception after operative or nonoperative reduction in children. METHODS Between January 2004 and December 2012, patients with intussusception treated with nonoperative and operative reduction were retrospectively analyzed. We included the patients who were diagnosed with intussusception from the age of 0 year to 18 years who received nonoperative and operative reduction as an initial treatment. The data collected included demographic data (sex, age, and bodyweight), symptoms (vomiting, abdominal pain, rectal bleeding, diarrhea, distention, constipation, and duration of symptoms), signs (temperature, palpable mass, and location of the mass), investigations (ultrasound findings) and the method of reduction. RESULTS The risk factors for recurrence of idiopathic intussusception were analyzed by the univariable analysis and multivariable analysis. In the univariable model, the significant risk factors for recurrence of intussusception analyzed were age, bodyweight, duration of symptoms, rectal bleeding, poor prognosis signs on ultrasound scans, location of mass, and pathological lead point. After multivariable analysis was done, we found that the significant risk factors for recurrence of intussusception were age ≥ 2 years (OR = 5.597, P = 0.044), duration of symptoms ≥48 h (OR = 91.664, P < 0.001), rectal bleeding (OR = 4.758, P = 0.009), location of mass (left over right side) (OR = 0.038, P < 0.001), pathological lead point (OR = 0.002, P < 0.001). CONCLUSION Our study found that age ≥ 2 years, duration of symptoms≥48 h, rectal bleeding, location of mass (left over right side) and pathological lead point were risk factors for recurrence of intussusception. LEVEL OF EVIDENCE Prognosis study. TYPE OF STUDY Retrospective study.
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Affiliation(s)
| | | | | | | | - Bo Xiang
- Department of pediatric surgery, West China hospital, Sichuan University, China.
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Simanovsky N, Issachar O, Koplewitz B, Lev-Cohain N, Rekhtman D, Hiller N. Early recurrence of ileocolic intussusception after successful air enema reduction: incidence and predisposing factors. Emerg Radiol 2018; 26:1-4. [DOI: 10.1007/s10140-018-1635-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/16/2018] [Indexed: 12/17/2022]
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Successful treatment of intussusception by hydrostatic reduction in pediatric patients: Is everything okay? JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.408972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
OBJECTIVE The aim of this study was to assess the frequency of clinical features and pathological lead points in recurrent intussusception, with a special focus on the risk factors that lead to recurrent intussusception. DESIGN This is a retrospective cohort study. A 5-year retrospective study was performed between January 2012 and July 2016 in the Children's Hospital of Soochow University, Suzhou, China, to determine the clinical features and pathological lead points of recurrent intussusception. SETTING This is a retrospective chart review of recurrent intussusception cases in a large university teaching hospital. PARTICIPANTS The medical records were obtained for 1007 cases with intussusception, including demographics, clinical signs and symptoms, imaging and recurrence times if available. INTERVENTIONS Univariate and multivariate logistic regression analyses were used to measure significant factors affecting recurrent intussusception and recurrent intussusception with pathological lead points. RESULTS There were 481 total episodes of recurrence in 191 patients. Among these, 87 had one recurrence and 104 had multiple recurrences. After comparing recurrent and non-recurrent intussusception cases using univariate analysis, it was determined that the factors associated with recurrent intussusception were age (>1 year), duration of symptoms (≤12 hours), the lack of bloody stool, paroxysmal crying or vomiting, the mass location (right abdomen) and pathological lead point (P<0.05). Age (>1 year), duration of symptoms (≤12 hours), the absence of vomiting, mass location (right abdomen) and pathological lead point were significantly independently predictive of recurrent intussusception. The factors associated with recurrent intussusception with lead points present were vomiting and mass location in the right abdomen (P<0.05). Vomiting and mass location (left abdomen) were significantly predictive of recurrent intussusception with lead points. CONCLUSIONS Age (>1 year), symptom duration (≤12 hours), the absence of vomiting, mass location (right abdomen) and pathological lead points were significantly predictive of recurrent intussusception. Vomiting and mass location (left abdomen) were significantly predictive of recurrent intussusception with lead points.
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Affiliation(s)
- Wan-liang Guo
- Department of Radiology, Children’s Hospital of Soochow University, Suzhou, China
| | - Zhang-chun Hu
- Department of Radiology, Children’s Hospital of Soochow University, Suzhou, China
| | - Ya-lan Tan
- Department of Radiology, Children’s Hospital of Soochow University, Suzhou, China
| | - Mao Sheng
- Department of Radiology, Children’s Hospital of Soochow University, Suzhou, China
| | - Jian Wang
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
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Efrati Y, Klin B, Kozer E, Abu-Kishk I. The role of dexamethasone in decreasing early recurrence of acute intussusception in children: A retrospective study. J Pediatr Surg 2017; 52:1141-1143. [PMID: 28065716 DOI: 10.1016/j.jpedsurg.2016.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/21/2016] [Accepted: 12/26/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Early recurrent intussusception (RI) is a concern after a successful pneumatic reduction. Steroids have been suggested as a treatment that decreases early RI. The purpose of this study was to examine the role of dexamethasone in decreasing early RI. METHODS A retrospective review of 174 pediatric patients that underwent successful pneumatic reduction was conducted. Two groups were identified: group 1 that received intravenous dexamethasone (0.5mg/kg/dose) on diagnosis or immediately after the reduction maneuver, and group 2 that were not given dexamethasone. RESULTS There were 113 boys and 61 girls ranging in age from 2 to 36months. There were no statistical differences between the groups except for younger age in the dexamethasone group (P=0.03). There was no significant difference (p=0.08) in the rate of early RI between the non-steroid group (5.4%, 4/74) and the steroid group 14% (14/100). Mean admission length was 30h. The majority of RIs occurred in the first 8h of admission. CONCLUSIONS We found that premedication of children with idiopathic intussusception with dexamethasone did not decrease early RI. LEVEL OF EVIDENCE Level III retrospective comparative study.
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Affiliation(s)
- Yigal Efrati
- Pediatric Division, Assaf Harofeh Medical Centre, Zerifin 70300, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Baruch Klin
- Pediatric Division, Assaf Harofeh Medical Centre, Zerifin 70300, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Eran Kozer
- Pediatric Division, Assaf Harofeh Medical Centre, Zerifin 70300, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Ibrahim Abu-Kishk
- Pediatric Division, Assaf Harofeh Medical Centre, Zerifin 70300, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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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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Jolley H, Gefen AM, Ginsburg H, Gold-von Simson G. Double Ileoileal Intussusception Following Surgical Reduction of Ileocolic Intussusception in an 8-Month-Old Female. J Pediatr 2017; 186:208-208.e1. [PMID: 28408127 DOI: 10.1016/j.jpeds.2017.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/09/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Hannah Jolley
- New York University School of Medicine, New York, New York
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