Postoperative intussusception in infants and children: a report of seven cases

An interesting and rare cause of post-operative intussusception: Roux limb intussusception

Intussusception is a common disease in children. Most intussusception is idiopathic and approximately 1% develops postoperatively. We present a case of a 6-year-old male patient who underwent surgery for a type 1 common bile duct cyst. In his post-operative 2nd month, the patient presented with a complaint of abdominal pain after eating, but his pain was not accompanied by nausea or vomiting. No pathological findings were evident in the examination or an abdominal X-ray of the patient. Intussusception was detected by ultrasonography and computed tomography. We wanted to introduce this interesting intussusception that originated from the Roux limb that was not seen before.

Abdominal catheter-induced intussusception following renal transplantation in two pediatric recipients: 2 cases report and literature review

BACKGROUND

Intussusception is a frequent abdominal emergency in the pediatric population when the proximal bowel invaginates into the distal bowel. However, catheter-induced intussusception has not previously been described in pediatric renal transplant recipients, and the risk factors need to be investigated.

CASE DESCRIPTION

We report 2 cases of post-transplant intussusception which were caused by abdominal catheters. Case 1 experienced ileocolonic intussusception 3 months after renal transplantation and presented with intermittent abdominal pain; the intussusception was successfully managed using air enema. However, this child experienced a total of 3 episodes of intussusception within 4 days, which discontinued only after removal of the peritoneal dialysis catheter. No further intussusception recurrence was observed and the patient's intermittent pain disappeared during the follow-up. Case 2 developed ileocolonic intussusception 2 days after renal transplantation and presented currant jelly stools. The intussusception was completely irreducible until the intraperitoneal drainage catheter was eliminated; the patient discharged normal feces during the following days. A search in the databases of PubMed, Web of Science, and Embase yielded 8 similar cases. Our 2 cases had a younger age at disease onset than those retrieved in the search, and abdominal catheter was revealed as a lead point. Possible leading points of the 8 previously reported cases included post-transplant lymphoproliferative disorder (PTLD), acute appendicitis, tuberculosis, lymphocele, and firm adhesions. We noted that our cases were managed successfully with nonoperative treatment, whereas the 8 reported cases underwent surgical intervention. All of the 10 cases of intussusception occurred after renal transplantation and showed that intussusception had been induced by a lead point.

CONCLUSIONS

Our 2 cases implied that abdominal catheter could be a lead point to induce intussusception, especially in pediatric recipients with abdominal disorder. This experience may be applicable to other surgeries involving indwelling abdominal catheters in children. Health practitioners should consider this pathologic lead point and avoid serious consequences when intussusception occurs.

Factors associated with surgical treatment in pediatric intussusception

BACKGROUND

The study aimed to identify factors related to the need for surgical treatment of intussusception in pediatric patients.

METHODS

The medical charts of 106 patients diagnosed with intussusception and treated at the Imam Khomeini Medical Center in Ahvaz city between September 2019 and October 2020 were retrospectively reviewed. Patients were compared in terms of risk factor groups treated with surgery (12 pediatric patients) and nonsurgical methods (92 pediatric patients). Size of intussusception, free fluid in the abdomen, and currant jelly stool were compared between the groups.

RESULTS

The mean age in the group treated with surgery was significantly higher (p = 0.01). The duration of symptoms in patients treated with surgery was significantly higher (p = 0.033). The size of intussusception in the surgical treatment group was significantly larger than in the nonsurgical recovery group (p = 0.042). The rates of presence of free fluid in the abdomen and currant jelly stool were significantly higher in patients treated with surgery (p = 0.001 and p = 0.004, respectively).

CONCLUSION

Age > 1 year, duration of symptoms > 24 h, currant jelly stool, intussusception > 3.5 cm, and free peritoneal fluid are factors associated with surgical treatment of intussusception in children.

Unusual Presentation of Postoperative Intussusception in Two Infants

We present two infants with postoperative intussusception following stoma formation for stricture bowel due to necrotizing enterocolitis. They had unusual clinical features which need a high index of suspicion to diagnose.

Postoperative intestinal intussusception in children, an easily missed culprit of postoperative intestinal obstruction: Case series and literature review

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Most of our patients presented in the first two weeks after the primary operation and managed successfully with operative manual reduction with no postoperative complications.

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Postoperative intestinal intussusception secondary to surgical reduction of ileocolic intussusception is an exceedingly rare cause of postoperative intestinal obstruction.

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Usually, postoperative intestinal intussusception is misdiagnosed as postoperative adhesive obstruction.

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Postoperative intestinal intussusception is challenging in diagnosis and needs a very high index of suspicion.

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By keeping the possibility of POI in mind, one can easily diagnose it and prevent its consequences.

Background

Postoperative intestinal intussusception (POI) is a rare cause of intestinal obstruction with POI after surgical reduction of ileocolic intussusception being an extremely rare variant. POI was reported to follow many abdominal and non-abdominal operations. A late diagnosis can risk ischemia and necrosis. POI also increases the morbidity and mortality, rendering an early diagnosis and prompt management as lifesaving.

Methods

We reviewed the medical charts retrospectively for the last ten years for patients with POI at Palestine Red Crescent Society Hospital, Hebron, Palestine. We reviewed the literature and presented the characteristics of the most reported cases of POI following surgical reduction of ileocolic intussusception.

Results

We presented three cases of ileoileal POI and one case of ileocolic POI followed different primary operations. All but one patient presented in the first two weeks. The delayed presentation came two months after revision of a prolapsed colostomy. All patients managed successfully with operative manual reduction with no postoperative complications. Initially, we had struggles in the diagnosis of POI largely due to a low suspicion for this rare entity, but thereafter we kept POI in mind and managed the after-coming cases in an expeditious manner.

Conclusion

Frequently, POI is misdiagnosed as postoperative adhesive obstruction. POI is challenging in diagnosis and needs a very high index of suspicion, mainly due to its rarity and atypical presentation. By keeping the possibility of POI in mind, one can easily diagnose it and prevent its consequences.

Postoperative intussusceptions in children and infants: a systematic review

BACKGROUND

Postoperative intussusception (POI) is an unusual complication in children and infants who underwent various kinds of surgery. The early recognition was difficult for its rarity and atypical presentations. This study evaluates the clinical features of POI through a literature review.

METHODS

MEDLINE database was searched for relevant articles that reported the children and infants with POI since 1990 in English-language using the key word "postoperative intussusception". All published studies containing clinical data for POI in children and infants were included. Reference lists of retrieved articles were reviewed for additional cases. Detailed data of the included cases were extracted and analyzed.

RESULTS

Twenty-six studies with total 127 cases of POI were included. According to the extracted data, the median age was 19 months with the male-to-female ratio 1.5:1. There were 65 operations (51.2 %) that involved gastrointestinal system, 26 cases (20.5 %) of retroperitoneal tumor resection, 12 operations (9.4 %) involved diaphragm, 8 operations (6.3 %) involved urinary system, 5 cases (3.9 %) of partial pancreatectomy, 11 cases (8.7 %) of non-abdominal operations. 75.5 % presented symptoms in the first 7 days after surgery. The prominent symptom was bilious vomiting or increased nasogastric output (87.1 % of 101 patients), following abdominal distention (74.3 %), abdominal pain (35.6 %). Six cases (5.0 %) of ileocolic POI were reduced successfully by air enema. The small bowel intussusception attributed 85.6 % of POI (95 patients). Laparotomy and manual reduction were performed in 104 cases (86.0 %). Nine patients (7.4 %) underwent intestinal resection and anastomosis.

CONCLUSIONS

POI should be suspected in pediatric surgical patients who showed signs of intestinal obstruction in the early postoperative period. Early recognition and prompt management are important.