Radiographic and Clinical Factors in Pediatric Patients With Surgical Small-bowel Intussusception

Liberal surgical laparoscopy reduction for acute intussusception: experience from a tertiary pediatric institute

The optimal treatment for acute intussusception has not yet been defined. In this study, we explored whether employing a liberal laparoscopic intervention for intussusception could lead to favorable outcomes. We performed a historical control analysis to evaluate the outcomes associated with this liberal surgical management protocol. This liberal surgical management protocol were revised to incorporate a new protocol centered around the laparoscopic approach. In some cases of acute intussusception, liberal laparoscopic exploration and intervention were undertaken without initial hydrostatic or pneumatic reduction. During the study interval, a retrospective review was conducted on a total of 3086 patients. These were categorized into two groups: 1338 cases before May 2019 (pre-protocol group) and 1748 cases after May 2019 (post-protocol group). Surgical intervention rates in the pre-protoco and post-protocol period were 10.2% and 27.4% respectively (odds ratio [OR] = 0.30 [95% CI 0.25-0.37]; p < 0.001). No significant differences were observed in baseline clinical characteristics or demographic features between the two groups. The duration from admission to operation was longer for the pre-protocol group (p = 0.008) than for the post-protocol group. The post-protocol group demonstrated decreases in both intestinal resection (OR = 1.50 [95% CI 0.96-2.35]; p = 0.048) and total recurrent events (OR = 1.27 [95% CI 1.04-1.55]; p = 0.012) compared to the pre-protocol group. Liberal laparoscopic intervention for intussusception may effectively reduce the risk of intestinal resection and total recurrent events, thereby exhibiting promising outcomes for patients with intussusception.

İnvajinasyonda Tedavi Yaklaşımı: Takip mi Cerrahi mı?

Objective: In this study, we describe the management and outcome of children with intussusception and analyze the sonographic findings that can be used to differentiate transient, self-limited small bowel intussusception from the cases with an indication for surgery. Material and Methods: We retrospectively reviewed the medical records of pediatric patients with the diagnosis of invagination who had been followed up in the pediatric surgery service between 2012-2017. Results: The median age was 39.5±35.9 (range 2-171) months. Among these patients, 57 (64%) had been followed up without surgery, and the remaining patients (n= 32, 36%) had undergone surgery. The median age of patients who had not undergone surgery was significantly greater than that of the patients who had undergone surgery (52.2±38.4 vs. 16.75±12.6; p

Shear wave elastography evaluation in predicting the success of ultrasound-guided saline enema hydrostatic reduction technique in ileocolic intussusception

BACKGROUND

Intussusception is the invagination of the proximal intestinal segment into the distal portion. Reduction procedures with fluid or air have been used as the primary treatment of choice in clinically stable children.

PURPOSE

To evaluate the role of intestinal wall elasticity measurements by shear wave elastography (SWE) to predict the success of ultrasound-guided saline enema (USGSE) reduction.

METHODS

USGSE was performed, if not contraindicated otherwise, after the diagnosis of ileocecal intussusception via the ultrasound (US). The length and diameter of the intussusception and the median stiffness of the intestine were measured before USGSE.

RESULTS

Seventeen children were diagnosed with ileocolic intussusception via grayscale US assessment. Two children whose SWE images became artifacts due to inadaptability were excluded from the study. Thus, the study involved 15 patients (9 boys, 6 girls; age range = 11-48 months). There was no statistically significant association between age and median stiffness measurement in kilopascal (kPa). (P > 0.05). A moderate positive correlation was observed between the median stiffness measurement (kPa) and the length of intussusception (r = 0.547; P = 0.035). There was no statistically significant relationship between median stiffness measurement (kPa) and short-axis diameter of intussusception (P > 0.05).

CONCLUSIONS

Stiffness assessment of the intestinal wall in ileocolic intussusception during the US examination, which is the gold standard in the intussusception assessment, can be used as a new criterion for predicting the performance of the USGSE technique and might be useful in making decisions regarding the clinical management of ileocolic intussusception.