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Yang J, Wang G, Gao J, Zhong X, Gao K, Liu Q, Nan G, Yan C, Chen G, Lu P, Guo C. Liberal surgical laparoscopy reduction for acute intussusception: experience from a tertiary pediatric institute. Sci Rep 2024; 14:457. [PMID: 38172223 PMCID: PMC10764731 DOI: 10.1038/s41598-023-50493-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
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.
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Affiliation(s)
- Jian Yang
- Department of Pediatric General Surgery, Yongchuan Maternal and Child Health Hospital, Chongqing, People's Republic of China
- Department of Pediatric General Surgery, Chongqing Health Center for Women and Children, Chongqing Medical University, Chongqing, People's Republic of China
| | - Guoyong Wang
- Department of Pediatric General Surgery, Chongqing Health Center for Women and Children, Chongqing Medical University, Chongqing, People's Republic of China
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd, Chongqing, 401147, People's Republic of China
| | - Jia Gao
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd, Chongqing, 401147, People's Republic of China
- Department of Pediatrics, Hechuan Maternal and Child Health Hospital, Chongqing, People's Republic of China
| | - Xiaotong Zhong
- Department of Pediatric General Surgery, Chongqing Health Center for Women and Children, Chongqing Medical University, Chongqing, People's Republic of China
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd, Chongqing, 401147, People's Republic of China
| | - Kai Gao
- Department of Pediatric General Surgery, Chongqing Health Center for Women and Children, Chongqing Medical University, Chongqing, People's Republic of China
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd, Chongqing, 401147, People's Republic of China
| | - Qianyang Liu
- Department of Pediatric General Surgery, Chongqing Health Center for Women and Children, Chongqing Medical University, Chongqing, People's Republic of China
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd, Chongqing, 401147, People's Republic of China
| | - Guoxin Nan
- Department of Pediatric General Surgery, Chongqing Health Center for Women and Children, Chongqing Medical University, Chongqing, People's Republic of China
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd, Chongqing, 401147, People's Republic of China
| | - Chengwei Yan
- Department of Pediatrics, Three Gorges Hospital, Chongqing University, Chongqing, People's Republic of China
| | - Gongli Chen
- Department of Pediatric General Surgery, Chongqing Health Center for Women and Children, Chongqing Medical University, Chongqing, People's Republic of China
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd, Chongqing, 401147, People's Republic of China
| | - Peng Lu
- Department of Pediatric General Surgery, Chongqing Health Center for Women and Children, Chongqing Medical University, Chongqing, People's Republic of China.
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd, Chongqing, 401147, People's Republic of China.
| | - Chunbao Guo
- Department of Pediatric General Surgery, Chongqing Health Center for Women and Children, Chongqing Medical University, Chongqing, People's Republic of China.
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd, Chongqing, 401147, People's Republic of China.
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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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Radu S, Lin S, Le LD, Fialkowski E, Zigman A. Delayed Repeat Contrast Enema for Treatment of Pediatric Intussusception. J Surg Res 2022; 275:109-114. [DOI: 10.1016/j.jss.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 01/02/2022] [Accepted: 01/20/2022] [Indexed: 11/28/2022]
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Fakhry T, Fawzy AN, Mahdy AT. The efficacy of delayed, repeated reduction enema in management of intussusception. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00072-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Management of intussusception varies according to the case, time of presentation, cause, and symptoms. In this study, we focus on describing the demographic and sonographic characteristics of children with intussusception with failed initial enema reduction who were managed by delayed repeated enema attempts and identify predictors associated with successful repeated reduction.
Results
This study was conducted in the period from December 2018 to April 2020 at university hospitals (pediatric surgery unit). This study included 40 patients with intussusceptions; 27 are males, and 13 of them are females. Their ages ranged from 5 months to 3 years old. Patients in this study had failed initial enema reduction attempts under sonographic guidance and had subsequent delayed (≥ 2 h from the initial attempt) repeated enemas made up the study population.
Of the 40 patients, 34 patients (85%) were successfully reduced, and 6 patients (15%) failed reduction and required surgical intervention. There were no deaths, perforation, or resection of gangrenous bowel. Two cases showed recurrences, but required no surgical intervention. It is also noted that early presentation (< 12 h), stable, non-complicated, and with little or no bloody diarrhea are predictors of successful DRE.
Conclusion
Delayed repeated enema in the treatment of intussusception is a viable option in patients with unsuccessful initial enema reduction provided that early presentation, stable vitals, and no signs of perforation or peritonitis are present.
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Elzeneini WM. Effect of general anesthesia on delayed repeat enema in pediatric intussusception. Pediatr Int 2021; 63:699-703. [PMID: 33037743 DOI: 10.1111/ped.14502] [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: 12/05/2019] [Revised: 09/13/2020] [Accepted: 10/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The study aimed to assess the efficacy and safety of delayed repeated enema (DRE) and to evaluate the effect of general anesthesia (GA) on DRE. METHODS A retrospective analysis was conducted of all children below 3 years with primary intussusception who were offered DRE in our tertiary center, from 2014 until 2019. Following a standardized pneumatic enema protocol, those who showed a partially successful result were offered DRE 2 h later, either awake (Group A) or under GA (Group B). DRE under GA was our preferred procedure unless there were no pediatric anesthetists available at that time. Data collected for each group included age, sex, duration of symptoms, success rate of the DRE, and any complications noted. RESULTS The study included 57 children (32 males and 25 females). The median age in Group A (31 patients) was 10 months while in Group B (26 patients) it was 11 months. The number of patients with duration of symptoms < 24 h vs > 24 h was 12:19 and 9:17 in Group A and B patients respectively. DRE was successful in 14/31 (45.2%) of Group A patients with one complication and in 9/26 (34.6%) of Group B patients with no complications. There was no statistically significant difference between both groups' success rate and complication rate. Both groups were similar in age, sex, and duration of symptoms. CONCLUSIONS DRE can effectively increase the overall success rate of pneumatic enema in selected patients with pediatric intussusception. However, the current evidence does not justify the routine use of GA during attempts DRE attempts.
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Affiliation(s)
- Wael M Elzeneini
- Pediatric Surgery Department, Ain-Shams University Children's Hospital, Cairo, Egypt
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Kim PH, Hwang J, Yoon HM, Lee JY, Jung AY, Lee JS, Cho YA. Predictors of failed enema reduction in children with intussusception: a systematic review and meta-analysis. Eur Radiol 2021; 31:8081-8097. [PMID: 33974147 DOI: 10.1007/s00330-021-07935-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 02/25/2021] [Accepted: 03/24/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To identify predictors of failed enema reduction in children with intussusception. METHODS PubMed and EMBASE were searched for all studies published over a 20-year time frame, prior to March 25, 2020. Original articles that reported predictors of failed enema reduction were included. The pooled odds ratio (OR) for successful enema reduction according to various features was calculated. The combined estimates were meta-analytically pooled by random-effects modeling. The risk of bias was assessed using the National Institute of Health Quality Assessment Tool. This review was registered to the PROSPERO (CRD42020190178). RESULTS A total of 38 studies, comprising 40,133 cases, were included. The shorter duration of symptoms (< 24 h; combined OR, 3.812; 95% CI, 2.150-6.759) and abdominal pain (combined OR, 2.098; 95% CI, 1.405-3.133) were associated with the success (all p < 0.001). Age < 1 year (combined OR, 0.385; 95% CI, 0.166-0.893; p = 0.026), fever (combined OR, 0.519; 95% CI, 0.371-0.725; p < 0.001), rectal bleeding (combined OR, 0.252; 95% CI, 0.165-0.387; p < 0.001), and vomiting (combined OR, 0.497; 95% CI, 0.372-0.664; p < 0.001) were associated with the failed reduction. The ascites (combined OR, 0.127; 95% CI, 0.044-0.368; p = 0.001), left-sided intussusception (combined OR, 0.121; 95% CI, 0.058-0.252; p < 0.001), and trapped fluid (combined OR, 0.179; 95% CI, 0.061-0.525; p = 0.017) on US were associated with the failed reduction. CONCLUSIONS Successful predictors for intussusception reduction have been summarized. This evidence can help identify patients who are more likely to fail non-operative reduction and could be potential surgical candidates. KEY POINTS • A shorter duration of symptoms and presence of abdominal pain were associated with increased probability of success. • Age (less than 1 year), presence of fever, rectal bleeding, vomiting, and presence of ascites, left-sided intussusception, or trapped fluid on ultrasonography were associated with decreased probability of success. • This study suggests that various clinical and ultrasonography predictors would help identify patients who are more likely to fail nonoperative reduction and identify potential preoperative candidates.
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Affiliation(s)
- Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jisun Hwang
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Jeong-Yong Lee
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
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Pathak P, Gross JA, Thapa M. Imaging of Pediatric Gastrointestinal Emergencies. Semin Roentgenol 2020; 55:170-179. [PMID: 32438978 DOI: 10.1053/j.ro.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Priya Pathak
- University of Washington, Seattle Children's, Seattle, WA
| | - Joel A Gross
- Department of Radiology, University of Washington, Harborview Medical Center, Seattle WA
| | - Mahesh Thapa
- University of Washington, Seattle Children's, Seattle, WA.
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Kanglie MMNP, de Graaf N, Beije F, Brouwers EMJ, Theuns-Valks SDM, Jansen FH, de Roy van Zuidewijn DBW, Verhoeven B, van Rijn RR, Bakx R. The incidence of negative intraoperative findings after unsuccessful hydrostatic reduction of ileocolic intussusception in children: A retrospective analysis. J Pediatr Surg 2019; 54:500-506. [PMID: 29866482 DOI: 10.1016/j.jpedsurg.2018.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/06/2018] [Accepted: 05/10/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is a lack of studies addressing the occurrence of negative intraoperative findings (that is the absence of intussusception) after an unsuccessful hydrostatic reduction of an ileocolic intussusception. The aim of this study is to determine the incidence of negative intraoperative findings after unsuccessful hydrostatic reduction of ileocolic intussusception. METHODS We conducted a multicentre retrospective study of all children aged 0-18 years treated for ileocolic intussusception from January 1, 2010 to December 31, 2015 in 9 Dutch hospitals. Primary outcome measure was the percentage of children without an intussusception during surgical exploration after unsuccessful hydrostatic reduction. RESULTS In the study period 436 patients were diagnosed with an ileocolic intussusception. Of these, 408 patients underwent hydrostatic reduction of an ileocolic intussusception. 112 patients (27.5%) underwent surgery after an unsuccessful hydrostatic reduction. In 13 (11.6%) patients no intraoperative evidence of intussusception was found. Patients who underwent surgical intervention after unsuccessful hydrostatic reduction were significantly younger than patients who had a successful hydrostatic reduction; there was no gender difference. CONCLUSION A substantial number of children (11.6%) underwent a laparotomy after unsuccessful hydrostatic reduction in whom no intussusception was found intraoperatively. We suggest initiating laparoscopy instead of laparotomy when surgery is necessary. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
| | - Nanko de Graaf
- Department of Paediatric Radiology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Femke Beije
- Department of Emergency Medicine, Isala hospital, Zwolle, The Netherlands
| | - Elise M J Brouwers
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Sabine D M Theuns-Valks
- Department of Paediatric Gastroenterology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Frits H Jansen
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Bas Verhoeven
- Department of Paediatric Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rick R van Rijn
- Department of Radiology, Emma Children's Hospital - Academic Medical Centre Amsterdam, The Netherlands
| | - Roel Bakx
- Department of Paediatric Surgery, Emma Children's Hospital - Academic Medical Centre Amsterdam, The Netherlands.
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Prana L, Baijoob S, Rampersad B. Are we doing better? Barium enema reduction of intussusception. Ann R Coll Surg Engl 2018. [PMID: 29543052 DOI: 10.1308/rcsann.2018.0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Intussuception remains one of the most common surgical abdominal emergencies in the paediatric population. The aim of this study was first to re-evaluate our non-operative reduction rate of intussusception using multiple interval barium enemas and second to investigate or discuss an audit cycle, providing evidence and validating the modification of clinical practice. Materials and methods This five-year retrospective study performed at one of two institutions at which a paediatric surgical service is offered. Individuals included were all patients under 12-years of age who were diagnosed with intussusception. Factors considered to be influential in the reduction of the intussusception were collected. End points were defined as successful barium enema reduction or surgical intervention. Results were compared with similar research published in 2010. Results Overall prevalence was found to be 12 cases/year, with a sample size of 60 patients, the mean age at presentation of 13.6 months. Barium enema reduction was attempted in 56/60 patients, while 4/60 patients had operative management as a first intervention. Overall reduction rate was 66% (37/56), 78% occurring on first attempt and 22% on the second attempt. There was no evidence of intussusception in 3/19 patients who had operative management as a second intervention. Delayed interval barium enema reduction demonstrated an improved reduction rate of 66% compared with single-use barium enema reduction of 41% (chi square 0.02). Conclusion A significant benefit was achieved by performing delayed interval enema reduction, which contributed to a 61% increased reduction rate, the actual reduction rate approaches 71%. The audit cycle remains of paramount importance to ensure optimum patient care.
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Affiliation(s)
- L Prana
- Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex , Champs Fleurs , Trinidad and Tobago
| | - S Baijoob
- Department of Surgery, University of the West Indies, Eric Williams Medical Sciences Complex , Champs Fleurs , Trinidad and Tobago
| | - B Rampersad
- Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex , Champs Fleurs , Trinidad and Tobago.,Department of Surgery, University of the West Indies, Eric Williams Medical Sciences Complex , Champs Fleurs , Trinidad and Tobago
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Ultrasound Guided Reduction of Intussusception with Saline and Evaluating the Factors Affecting the Success of the Procedure. IRANIAN JOURNAL OF PEDIATRICS 2018. [DOI: 10.5812/ijp.62442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Variables determining the success of ultrasound-guided hydrostatic reduction of intussusception in infants. ANNALS OF PEDIATRIC SURGERY 2017. [DOI: 10.1097/01.xps.0000508444.67598.8c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Carroll AG, Kavanagh RG, Ni Leidhin C, Cullinan NM, Lavelle LP, Malone DE. Comparative Effectiveness of Imaging Modalities for the Diagnosis and Treatment of Intussusception: A Critically Appraised Topic. Acad Radiol 2017; 24:521-529. [PMID: 28268146 DOI: 10.1016/j.acra.2017.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to critically appraise and compare the diagnostic performance of imaging modalities that are used for the diagnosis of intussusception and methods used in the treatment of ileocolic intussusception. METHODS A focused clinical question was constructed and the literature was searched using the patient, intervention, comparison, outcome (PICO) method comparing radiography, ultrasound, and computed tomography in the detection of intussusception. The same methods were used to compare pneumatic (gas) reduction and hydrostatic (liquid) reduction using saline, water-soluble contrast, and barium. Retrieved articles were appraised and assigned a level of evidence based on the Oxford University Centre for Evidence-Based Medicine hierarchy of validity for diagnostic studies. RESULTS The retrieved sensitivity for the diagnosis of intussusception using plain radiography is 48% (95% confidence interval [CI], 44%-52%), with a specificity of 21% (95% CI, 18%-24%). The retrieved sensitivity for the diagnosis of intussusception using ultrasound is 97.9% (95% CI, 95%-100%), with a specificity of 97.8% (95% CI, 97%-99%). Based on a good quality meta-analysis, the combined success rate of gas enema reduction was shown to be 82.7% (95% CI, 79.9%-85.6%) compared to a combined success rate of 69.6% (95% CI, 65.0%-74.1%) for liquid enema reduction. CONCLUSIONS The best available evidence recommends ultrasound as the diagnostic modality of choice for the diagnosis of ileocolic intussusception in children. In stable children without signs of peritonism, nonoperative reduction is the treatment of choice. Pneumatic (gas) reduction enema has been shown to be superior to hydrostatic (liquid) enema reduction.
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Affiliation(s)
- Anne G Carroll
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - Richard G Kavanagh
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | | | - Noelle M Cullinan
- Department of Pediatrics, Our Lady's Children's Hospital, Dublin, Ireland
| | - Lisa P Lavelle
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Dermot E Malone
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Conduite à tenir devant une invagination intestinale aiguë du nourrisson et de l’enfant. Arch Pediatr 2015; 22:1312-7. [DOI: 10.1016/j.arcped.2015.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 06/30/2015] [Accepted: 09/15/2015] [Indexed: 11/23/2022]
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Lautz TB, Thurm CW, Rothstein DH. Delayed repeat enemas are safe and cost-effective in the management of pediatric intussusception. J Pediatr Surg 2015; 50:423-7. [PMID: 25746701 DOI: 10.1016/j.jpedsurg.2014.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 09/01/2014] [Accepted: 09/02/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND/PURPOSE The purpose of the study is to compare outcomes between delayed repeat enema (DRE) and immediate surgery (IS) in children with ileocolic intussusception who fail initial enema reduction. METHODS Retrospective cohort study of children <6 years-of-age from 2008 to 2012 in the Pediatric Health Information System (PHIS) database. Outcomes measured were bowel resection, length of stay (LOS), and adjusted hospital costs (AHC). RESULTS 4980 of 6889 (72.3%) children with intussusception were discharged without operation following a single successful enema. 1407 of 1909 (73.7%) remaining patients underwent IS while 502 (26.3%) had a DRE. Bowel resection was required in 372 of 1407 (26.4%) patients in IS group compared to 59 of 502 (11.8%) in the DRE group (p<0.001). The number of patients needed to treat by DRE to prevent a bowel resection was 7. In multivariable analysis, the IS patients had a 2.5 times greater likelihood of undergoing bowel resection than the DRE patients (adjusted odds ratio [OR] 2.50, 95% confidence interval [CI] 1.83-3.41, p<0.001). The DRE group had a mean LOS of 3.2 days (95% CI 2.9-3.6) and mean AHC of $9205 (95% CI $7673-$10,735). The IS group had a longer LOS (4.4days, 95% CI 4.0-4.8, p≤0.001) and higher AHC ($14,422, 95% CI $12,631-$16,214, p<0.001). CONCLUSION Delayed repeat enemas for ileocolic intussusception increase the success of nonoperative reduction, decrease the rate of bowel resection and reduce mean hospital length of stay and costs.
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Affiliation(s)
- Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago and Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Cary W Thurm
- Children's Hospital Association, Overland Park, KS, USA
| | - David H Rothstein
- Division of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY 14222, USA
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Abstract
OBJECTIVE The objective of this study was to describe fluoroscopy screen time (FST) for children undergoing contrast enema (CE) for suspected intussusception. METHODS This is a single-center, retrospective cohort study of children younger than 7 years examined for intussusception by CE. We reviewed medical records for demographics, radiographic results, and FST. We used nonparametric descriptive statistical tests and calculated odds ratios (OR). RESULTS The median FST for 457 included CEs was 116 seconds. The median FST for positive CEs (n = 194) was 138 seconds (95% confidence interval [CI], 126-152); for negative CEs (n = 250), 86 seconds (95% CI, 78-102); and for uncertain studies (n = 13), 138 seconds (95% CI, 89-208) (P < 0.01). There was no difference in median FST if symptoms were present 24 hours or less versus longer than 24 hours. There was no difference between contrast types. Median FST for successful reductions was 122 seconds (95% CI, 114-138). In cases of failed reductions, median FST for those undergoing surgery was 277 seconds (95% CI, 195-370) and 175 seconds (95% CI, 128-271) (P < 0.01) for those undergoing delayed repeat CE. The OR for receiving a repeat CE was 1.3 (95% CI, 1.1-1.4; P < 0.01) for every minute of FST. The OR for undergoing surgical reduction was 1.3 (95% CI, 1.2-1.5; P < 0.01) for every minute of FST and 3.7 (95% CI, 2.0-6.9; P < 0.01) for FST longer than 3 minutes. CONCLUSIONS Fluoroscopy screen time for the evaluation and diagnosis of intussusception is shorter than that previously described. When an initial screening ultrasound is not available or nondiagnostic and the suspicion is high, further evaluation with a CE may be warranted because the radiation exposure is likely lower than that previously reported.
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van Heurn LWE, Pakarinen MP, Wester T. Contemporary management of abdominal surgical emergencies in infants and children. Br J Surg 2013; 101:e24-33. [PMID: 24338775 DOI: 10.1002/bjs.9335] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acute abdominal complaints in children are common presentations in the emergency department. The aetiology, presentation, diagnosis and management often differ from those in adults. METHODS This review was based on expert paediatric surgical experience confirmed by evidence from the literature obtained by searching PubMed and the Cochrane Library. Keywords used were the combinations of 'abdominal emergencies', 'acute abdomen' and the disorders 'acute appendicitis', 'intussusception', 'volvulus', 'Meckel's diverticulum', 'incarcerated inguinal hernia', 'testicular torsion' and 'ovarian torsion' with 'children'. Information was included from reviews, randomized clinical trials, meta-analyses, and prospective and retrospective cohort studies. RESULTS Presentation and symptoms of abdominal emergencies, especially in young children, vary widely, which renders recognition of the underlying disorder and treatment challenging. Critically targeted imaging techniques are becoming increasingly important in obtaining the correct diagnosis without unnecessary delay. Minimally invasive techniques have become the method of choice for the diagnosis and treatment of many abdominal emergencies in children. CONCLUSION Knowledge of abdominal disorders in childhood, their specific presentation, diagnosis and treatment facilitates management of children with acute abdomen in emergency departments. Imaging and minimally invasive techniques are becoming increasingly important in the diagnosis of acute abdomen in children. Urgent operation remains the cornerstone of therapy for most acute abdominal disorders.
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Affiliation(s)
- L W E van Heurn
- Departments of Paediatric Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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Fallon SC, Lopez ME, Zhang W, Brandt ML, Wesson DE, Lee TC, Rodriguez JR. Risk factors for surgery in pediatric intussusception in the era of pneumatic reduction. J Pediatr Surg 2013; 48:1032-6. [PMID: 23701778 DOI: 10.1016/j.jpedsurg.2013.02.021] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 02/03/2013] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Surgical treatment is still necessary for intussusception management in a subgroup of patients, despite advances in enema reduction techniques. Early identification of these patients should improve outcomes. METHODS The medical records of patients treated for intussusception at our institution from 2006 to 2011 were reviewed. Univariate and multivariate analyses, including stepwise logistic regression, were performed. RESULTS Overall, 379 patients were treated for intussusception, and 101 (26%) patients required operative management, with 34 undergoing intestinal resection. The post-operative complication rate was 8%. On multivariate analysis, failure of initial reduction (OR 9.9,p=0.001 95% CI, 4.6-21.2), a lead point (OR 18.5,p=0.001 95% CI, 6.6-51.8) or free/interloop fluid (OR 3.3,p=0.001 95% CI, 1.6-6.7) or bowel wall thickening on ultrasound (OR 3.3,p=0.001 95% CI, 1.1-10.1), age <1 year at reduction (OR 2.7,p=0.004, 95% CI, 1.4-5.9), and abdominal symptoms>2 days (OR 2.9,p=0.003, 95% CI, 1.4-5.9) were significantly associated with a requirement for surgery. Similarly, a lead point (OR 14.5, p=0.005 95% CI, 2.3-90.9) or free/interloop fluid on ultrasound (OR 19.8, p=0.001 95% CI, 3.4-117) and fever (OR 7.2, p=0.023 95% CI, 1.1-46) were significantly associated with the need for intestinal resection. CONCLUSION Abdominal symptoms>2 days, age<1 year, multiple ultrasound findings, and failure of initial enema reduction are significant predictors of operative treatment for intussusception. Patients with these findings should be considered for early surgical consultation or transfer to a hospital with pediatric surgical capabilities.
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Affiliation(s)
- Sara C Fallon
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
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Pepper VK, Stanfill AB, Pearl RH. Diagnosis and management of pediatric appendicitis, intussusception, and Meckel diverticulum. Surg Clin North Am 2012; 92:505-26, vii. [PMID: 22595706 DOI: 10.1016/j.suc.2012.03.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Three of the most common causes of surgical abdominal pain in pediatric patients include appendicitis, Meckel diverticulum, and intussusception. All 3 can present with right lower quadrant pain, and can lead to significant morbidity and even mortality. Although ultrasound is the preferred method of diagnosis with appendicitis and intussusception, considerable variety exists in the modalities needed in the diagnosis of Meckel diverticulum. This article discusses the pathways to diagnosis, the modes of treatment, and the continued areas of controversy.
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Affiliation(s)
- Victoria K Pepper
- Section of Pediatric Surgery, Department of Surgery, University of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, Peoria, IL, USA
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