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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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Vakaki M, Sfakiotaki R, Liasi S, Hountala A, Koutrouveli E, Vraka I, Zouridaki C, Koumanidou C. Ultrasound-guided pneumatic reduction of intussusception in children: 15-year experience in a tertiary children's hospital. Pediatr Radiol 2023; 53:2436-2445. [PMID: 37665367 DOI: 10.1007/s00247-023-05730-6] [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: 05/25/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND International practice regarding the method used to nonoperatively reduce pediatric intussusception is variable. OBJECTIVE To provide an overview of ultrasound-guided pneumatic intussusception reduction and assess its safety and effectiveness. MATERIALS AND METHODS A single-center prospective study was conducted in a tertiary referral pediatric hospital during the 15-year period between January 2008 and February 2023. All patients with ileocolic intussusception underwent abdominal sonographic examination for diagnosis. An ultrasound-guided pneumatic reduction of intussusception was then attempted. Children who were hemodynamically unstable, with signs of peritonitis or bowel perforation and those with sonographically detected pathologic lead points were excluded. RESULTS A total of 131 children (age range 2 months to 6 years) were enrolled in this study. Pneumatic intussusception reduction was successful in 128 patients (overall success rate 97.7%). In 117 patients, the intussusception was reduced on the first attempt and in the remaining on the second. In three cases, after three consecutive attempts, the intussusception was only partially reduced. As subsequently surgically proven, two of them were idiopathic and the third was secondary to an ileal polyp. No bowel perforation occurred during the reduction attempts. There was recurrence of intussusception in three patients within 24 h after initial reduction which were again reduced by the same method. CONCLUSION Ultrasound-guided pneumatic intussusception reduction is a well-tolerated, simple, safe and effective technique with a high success rate, no complications and no ionizing radiation exposure. It may be adopted as the first-line nonsurgical treatment of pediatric intussusception.
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Affiliation(s)
- Marina Vakaki
- Radiology Department, Children's Hospital P. & A. Kyriakou, Thivon & Livadias, Ampelokipi, 11527, Athens, Greece.
| | - Rodanthi Sfakiotaki
- Radiology Department, Children's Hospital P. & A. Kyriakou, Thivon & Livadias, Ampelokipi, 11527, Athens, Greece
| | - Sergia Liasi
- Radiology Department, Children's Hospital P. & A. Kyriakou, Thivon & Livadias, Ampelokipi, 11527, Athens, Greece
| | - Anna Hountala
- Radiology Department, Children's Hospital P. & A. Kyriakou, Thivon & Livadias, Ampelokipi, 11527, Athens, Greece
| | - Eleni Koutrouveli
- Radiology Department, Children's Hospital P. & A. Kyriakou, Thivon & Livadias, Ampelokipi, 11527, Athens, Greece
| | - Irene Vraka
- Radiology Department, Children's Hospital P. & A. Kyriakou, Thivon & Livadias, Ampelokipi, 11527, Athens, Greece
| | - Christina Zouridaki
- Radiology Department, Children's Hospital P. & A. Kyriakou, Thivon & Livadias, Ampelokipi, 11527, Athens, Greece
| | - Chrysoula Koumanidou
- Radiology Department, Children's Hospital P. & A. Kyriakou, Thivon & Livadias, Ampelokipi, 11527, Athens, Greece
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Takamoto N, Konishi T, Fujiogi M, Kutsukake M, Morita K, Hashimoto Y, Matsui H, Fushimi K, Yasunaga H, Fujishiro J. Outcomes Following Laparoscopic Versus Open Surgery for Pediatric Intussusception: Analysis Using a National Inpatient Database in Japan. J Pediatr Surg 2023; 58:2255-2261. [PMID: 37507337 DOI: 10.1016/j.jpedsurg.2023.07.004] [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: 02/20/2023] [Revised: 06/25/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Laparoscopic surgery for pediatric intussusception has recently become more common as an alternative to open surgery. However, the differences in outcomes between laparoscopic and open surgery remain unclear. Thus, this study aimed to compare short-term surgical outcomes and recurrence rates between patients treated with laparoscopic and open surgery for pediatric intussusception. METHODS Patients aged <18 years who underwent laparoscopic (n = 192) and open (n = 416) surgery for intussusception between April 2016 and March 2021 were retrospectively identified using a Japanese nationwide inpatient database. Propensity-score overlap weighting analyses were conducted to compare the outcomes between the laparoscopic and open surgery groups. The outcomes included in-hospital morbidity, reoperation, readmission for intussusception, bowel resection, the diagnosis of Meckel's diverticulum, duration of anesthesia, postoperative length of hospital stay, and total hospitalization costs. RESULTS The laparoscopic surgery group was older, heavier, and had fewer congenital malformations and emergency admissions than the open surgery group did. Overlap weighting analyses showed no significant differences in in-hospital morbidity (odds ratio [95% confidence interval], 0.88 [0.35-2.23]), reoperation (1.88 [0.24-14.9]), readmission for intussusception within 30 days (0.80 [0.12-5.30]) and 1 year (0.90 [0.28-2.93]), bowel resection (0.69 [0.46-1.02]), the diagnosis of Meckel's diverticulum (0.97 [0.50-1.90]), duration of anesthesia (difference, 11 [-1-24] minutes), postoperative length of stay (difference, -1.9 [-4.2-0.4] days), or total hospitalization costs (difference, 612 [ -746-1970] US dollars) between the groups. CONCLUSIONS In this large nationwide cohort, no significant differences in outcomes were observed between laparoscopic and open surgery. Laparoscopic surgery is an acceptable treatment option for pediatric intussusception. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Naohiro Takamoto
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Michimasa Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Mai Kutsukake
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kaori Morita
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yohei Hashimoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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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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Li Y, Zhou Q, Liu C, Sun C, Sun H, Li X, Zhang L. Epidemiology, clinical characteristics, and treatment of children with acute intussusception: a case series. BMC Pediatr 2023; 23:143. [PMID: 36997992 PMCID: PMC10061978 DOI: 10.1186/s12887-023-03961-y] [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: 10/18/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND To summarize the clinical and epidemiological characteristics of acute intussusception. METHODS This retrospective study included pediatric patients with acute intussusception admitted to the Department of Pediatric Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, from January 2014 to December 2019. RESULTS A total of 402 infants/children were included (301 males and 101 females) with a mean age of 2.4 ± 1.5 years (2 months to 9 years). Thirty patients (7.5%) had a history of cold food intake, diarrhea, and upper respiratory infection before disease onset. Paroxysmal abdominal pain and crying occurred in 338 patients (84.1%). Eight patients (2.0%) had the typical triad, 167 (41.5%) had vomiting, 24 (6.0%) had bloody stools, and 273 (67.9%) had palpable abdominal mass. The average intussusception depth was 4.0 ± 1.4 cm. Air enema reduction was performed in 344 cases: 335 (97.3%) were successful. Fifty-eight patients were treated with intravenous phloroglucinol (2 mg/kg), and 53 (91.4%) were successful. Sixty-five patients suffered relapses, with a relapse rate of 16.8%. CONCLUSIONS Pediatric acute intussusception is common. There was no obvious etiology. The clinical manifestations are mostly atypical. Abdominal pain is the most common complaint. Air enema reduction is an effective treatment. The recurrence rate is high.
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Affiliation(s)
- Yan Li
- Department of Scientific Research, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China
| | - Qi Zhou
- Department of Pediatric Surgery, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China
| | - Chao Liu
- Department of Pediatric Surgery, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China
| | - Chao Sun
- Department of Pediatric Surgery, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China
| | - Hao Sun
- Department of Pediatric Surgery, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China
| | - Xiang Li
- Department of Pediatric Surgery, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China
| | - Lei Zhang
- Department of Pediatric Surgery, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China.
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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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Zhu D, Xu X, Zhang M, Wang T, Zhu H. Significance of MCP-1 in predicting the short-term recurrence of primary intussusception in children: An observational study. Medicine (Baltimore) 2022; 101:e30743. [PMID: 36197260 PMCID: PMC9509185 DOI: 10.1097/md.0000000000030743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To evaluate the relationship between the expression level of (MCP-1) in peripheral blood and the short-term recurrence of primary intussusception in children, a retrospective analysis of children with primary intussusception under ultrasound-guided hydrostatic reduction in our hospital from June 2019 to June 2021, a total of 412 cases, 37 cases of short-term recurrence. Enzyme-linked immunosorbent assay was used to detect the expression of MCP-1 in peripheral venous blood; receiver operating curve (ROC) was utilized to evaluate the diagnostic efficacy of MCP-1 in predicting short-term recurrence; logistic regression analysis of risk factors for recurrence. MCP-1 increased in the peripheral blood of children with short-term recurrence (P < .05). Logistic regression analysis found that increased MCP-1 was a risk factor for recurrence; ROC showed that 23.24 ng/mL was used as a cut-off value. The sensitivity of MCP-1 for predicting the recurrence of intussusception in children is 82.14%, and the specificity is 75.67%. In primary intussusception, the expression of MCP-1 in the peripheral blood of children with short-term recurrence is raised. Elevated expression of MCP-1 is a risk factor for predicting short-term intussusception recurrence and has certain clinical significance.
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Affiliation(s)
- Dongsheng Zhu
- Department of Pediatric Surgery, The First People’s Hospital of Lianyungang, Lianyungang Hospital Affiliated to Xuzhou Medical University, The Affiliated Hospital of Kangda College, Nanjing Medical University, Lianyungang, Jiangsu, China
| | - Xiangfei Xu
- Department of Pediatric Surgery, The First People’s Hospital of Lianyungang, Lianyungang Hospital Affiliated to Xuzhou Medical University, The Affiliated Hospital of Kangda College, Nanjing Medical University, Lianyungang, Jiangsu, China
| | - Ming Zhang
- Department of Pediatric Surgery, The First People’s Hospital of Lianyungang, Lianyungang Hospital Affiliated to Xuzhou Medical University, The Affiliated Hospital of Kangda College, Nanjing Medical University, Lianyungang, Jiangsu, China
| | - Tong Wang
- Department of Pediatric Surgery, The First People’s Hospital of Lianyungang, Lianyungang Hospital Affiliated to Xuzhou Medical University, The Affiliated Hospital of Kangda College, Nanjing Medical University, Lianyungang, Jiangsu, China
| | - Hongqi Zhu
- Department of Pediatric Surgery, The First People’s Hospital of Lianyungang, Lianyungang Hospital Affiliated to Xuzhou Medical University, The Affiliated Hospital of Kangda College, Nanjing Medical University, Lianyungang, Jiangsu, China
- * Correspondence: Hongqi Zhu, Department of Pediatric Surgery, The First People’s Hospital of Lianyungang, Lianyungang Hospital Affiliated to Xuzhou Medical University, The Affiliated Hospital of Kangda College, Nanjing Medical University, Lianyungang, Jiangsu 222061, China (e-mail: )
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Zhao J, Sun J, Li D, Xu WJ. Laparoscopic versus open reduction of idiopathic intussusception in children: an updated institutional experience. BMC Pediatr 2022; 22:44. [PMID: 35038989 PMCID: PMC8762853 DOI: 10.1186/s12887-022-03112-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background In the reduction of intussusception, due to the lack of randomized, controlled, and prospective clinical trials to confirm the superiority of the laparoscopic approach over open surgery, more evidence was needed. This study aimed to compare the results of laparoscopy and open reduction of idiopathic intussusception in children as well as to illustrate some skills for the reduction of intussusception laparoscopically. Methods A retrospective review was performed to evaluate outcomes for patients with idiopathic intussusception who were treated laparoscopically (LAP group) from January 2015 to December 2019 and to compare the outcomes with laparotomy (OPEN group) during the same period. Results During the period studied, there were 162 patients treated surgically for intussusception: 62 LAP and 100 OPEN. No statistical differences were found in demographic data, clinical symptoms and signs, duration of symptoms, location and types of intussusception between the two groups. Conversion to open procedure was required for 11 patients in the LAP group. The operation time and time to oral intake were shorter in the LAP group while the difference was not significant. If the 11 conversion cases were excluded, the operation time and time to oral intake were significantly shorter (P < 0.05) in the LAP group. The length of stay was significantly shorter in the LAP group (P < 0.05). Intraoperative and postoperative complication rates between the two groups were comparable (P = 1.0). Conclusion Laparoscopy was safe and effective in the treatment of pediatric idiopathic intussusceptions. Pediatric surgeons with sophisticated minimally invasive skills should choose laparoscopy as the first choice in the treatment of idiopathic intussusceptions.
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Affiliation(s)
- Jian Zhao
- Department of Pediatric Surgery, Yangzhou Maternal and Child Health Hospital, Yangzhou, China
| | - Jun Sun
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, China.
| | - Deyu Li
- Department of Pediatric Surgery, Yangzhou Maternal and Child Health Hospital, Yangzhou, China
| | - Wei Jue Xu
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, China
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Kim S, Lim H, Park S, Koh H. Significance of Follow-Up Ultrasonography 24 Hours Post-Reduction in Detecting Intussusception Recurrence. Pediatr Gastroenterol Hepatol Nutr 2022; 25:21-29. [PMID: 35087730 PMCID: PMC8762597 DOI: 10.5223/pghn.2022.25.1.21] [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: 09/12/2021] [Revised: 10/28/2021] [Accepted: 12/17/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE The objective of this study was to identify the significance of 24-hour post-reduction ultrasonography (US) in pediatric patients with intussusception. METHODS A total of 229 patients with intussusception who were treated with saline reduction at Severance Children's Hospital between January 2014 and September 2020 were retrospectively reviewed. The 229 patients with successful saline reduction were divided into two groups: a recurrence at 24 hours group (R, n=41) and a non-recurrence group (NR, n=188). The full patient sample was divided into two groups: follow-up US (FU) or no follow-up US (NFU); the recurrence group was divided into follow-up (R-FU) and non-follow-up (R-NFU) subgroups, and stratified analyses were performed. RESULTS There were no significant differences in age, sex, laboratory findings, symptoms, and sonographic findings between the NR and R groups. In the R group, 24 patients underwent follow-up US, and 17 patients did not. Specific sonographic findings were statistically significant in the R-FU group compared to the R-NFU group (p=0.002). The R-FU group had fewer admissions (p=0.012) and longer mean hospitalization times (p<0.001) than the R-NFU group. The NFU group had a 12.2% recurrence rate, while the R-FU group recurrence rate was 25.8% (p=0.0099), suggesting that the omission of some recurrent events and follow-up US was a significant variable in the recurrence of intussusception. The median time to recurrence was 21 hours which supports the 24-hour follow-up protocol. CONCLUSION Twenty-four-hour follow-up US was shown to be valuable for detecting early recurrence of intussusception.
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Affiliation(s)
- Sujin Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - HyeJi Lim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sowon Park
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hong Koh
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
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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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11
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Kelley-Quon LI, Arthur LG, Williams RF, Goldin AB, St. Peter SD, Beres AL, Hu YY, Renaud EJ, Ricca R, Slidell MB, Taylor A, Smith CA, Miniati D, Sola JE, Valusek P, Berman L, Raval MV, Gosain A, Dellinger MB, Sømme S, Downard CD, McAteer JP, Kawaguchi A. Management of intussusception in children: A systematic review. J Pediatr Surg 2021; 56:587-596. [PMID: 33158508 PMCID: PMC7920908 DOI: 10.1016/j.jpedsurg.2020.09.055] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/30/2020] [Accepted: 09/24/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to develop recommendations for the management of ileocolic intussusception in children. METHODS The ClinicalTrials.gov, Embase, PubMed, and Scopus databases were queried for literature from January 1988 through December 2018. Search terms were designed to address the following topics in intussusception: prophylactic antibiotic use, repeated enema reductions, outpatient management, and use of minimally invasive techniques for children with intussusception. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Consensus recommendations were derived based on the best available evidence. RESULTS A total of 83 articles were analyzed and included for review. Prophylactic antibiotic use does not decrease complications after radiologic reduction. Repeated enema reductions may be attempted when clinically appropriate. Patients can be safely observed in the emergency department following enema reduction of ileocolic intussusception, avoiding hospital admission. Laparoscopic reduction is often successful. CONCLUSIONS Regarding intussusception in hemodynamically stable children without critical illness, pre-reduction antibiotics are unnecessary, non-operative outpatient management should be maximized, and minimally invasive techniques may be used to avoid laparotomy. LEVEL OF EVIDENCE Level 3-5 (mainly level 3-4) TYPE OF STUDY: Systematic Review of level 1-4 studies.
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Affiliation(s)
- Lorraine I. Kelley-Quon
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California,Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - L. Grier Arthur
- Division of Pediatric Surgery, St. Christopher’s Hospital for Children, Philadelphia, PA
| | - Regan F. Williams
- Division of Pediatric Surgery, Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN
| | - Adam B. Goldin
- Division of Pediatric General and Thoracic Surgery, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA
| | | | - Alana L. Beres
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California, Davis, CA
| | - Yue-Yung Hu
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elizabeth J. Renaud
- Alpert Medical School at Brown University, Hasbro Children’s Hospital, Providence, RI
| | - Robert Ricca
- Division of Pediatric Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Mark B. Slidell
- Section of Pediatric Surgery, The University of Chicago Medicine, Comer Children’s Hospital, Chicago, Illinois
| | - Amy Taylor
- Texas Medical Center Library, Houston, TX
| | - Caitlin A. Smith
- Division of Pediatric General and Thoracic Surgery, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA
| | - Doug Miniati
- Division of Pediatric Surgery, Kaiser Permanente Roseville Women and Children’s Center, Roseville, California
| | - Juan E. Sola
- Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Patricia Valusek
- Pediatric Surgical Associates, Ltd., Children’s Minnesota, Minneapolis, MN
| | - Loren Berman
- Division of Pediatric surgery, Department of Surgery, Nemours-AI DuPont Hospital for Children and Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, DE
| | - Mehul V. Raval
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ankush Gosain
- Division of Pediatric Surgery, Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN,Children’s Foundation Research Institute, Le Bonheur Children’s Hospital, Memphis, TN
| | - Matthew B. Dellinger
- Division of Pediatric General and Thoracic Surgery, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA
| | - Stig Sømme
- Division of Pediatric Surgery, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Cynthia D. Downard
- Division of Pediatric Surgery, Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville, Louisville, KY
| | | | - Akemi Kawaguchi
- Department of Pediatric Surgery, University of Texas McGovern Medical School and Children’s Memorial Hermann Hospital, Houston, TX
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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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13
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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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