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Carter M, Afowork J, Pitt JB, Ayala SA, Goldstein SD. Scoring System to Evaluate Risk of Nonoperative Management Failure in Children With Intussusception. J Surg Res 2024; 300:503-513. [PMID: 38875949 DOI: 10.1016/j.jss.2024.05.030] [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: 12/01/2023] [Revised: 05/08/2024] [Accepted: 05/18/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Typical first-line management of children with intussusception is enema reduction; however, failure necessitates surgical intervention. The number of attempts varies by clinician, and predictors of failed nonoperative management are not routinely considered in practice. The purpose of this study is to create a scoring system that predicts risk of nonoperative failure and need for surgical intervention. METHODS Children diagnosed with intussusception upon presentation to the emergency department of a tertiary children's hospital between 2019 and 2022 were retrospectively identified. Univariable logistic regression identified predictors of nonoperative failure used as starting covariates for multivariable logistic regression with final model determined by backwards elimination. Regression coefficients for final predictors were used to create the scoring system and optimal cut-points were delineated. RESULTS We identified 143 instances of ultrasound-documented intussusception of which 28 (19.6%) required operative intervention. Predictors of failed nonoperative management included age ≥4 y (odds ratio [OR] 32.83, 95% confidence interval [CI]: 1.91-564.23), ≥1 failed enema reduction attempts (OR 189.53, 95% CI: 19.07-1884.11), presenting heart rate ≥128 (OR 3.38, 95% CI: 0.74-15.36), presenting systolic blood pressure ≥115 mmHg (OR 6.59, 95% CI: 0.93-46.66), and trapped fluid between intussuscepted loops on ultrasound (OR 17.54, 95% CI: 0.77-397.51). Employing these factors, a novel risk scoring system was developed (area under the curve 0.96, 95% CI: 0.93-0.99). Scores range from 0 to 8; ≤2 have low (1.1%), 3-4 moderate (50.0%), and ≥5 high (100%) failure risk. CONCLUSIONS Using known risk factors for enema failure, we produced a risk scoring system with outstanding discriminate ability for children with intussusception necessitating surgical intervention. Prospective validation is warranted prior to clinical integration.
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Affiliation(s)
- Michela Carter
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
| | - Jonathan Afowork
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - J Benjamin Pitt
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Samantha A Ayala
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Seth D Goldstein
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Liu J, Wang Y, Jiang Z, Duan G, Mao X, Zeng D. Developing a Nomogram for Predicting Surgical Intervention in Pediatric Intussusception After Pneumatic Reduction: A Multicenter Study from China. Ther Clin Risk Manag 2024; 20:313-323. [PMID: 38808299 PMCID: PMC11132117 DOI: 10.2147/tcrm.s463086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/16/2024] [Indexed: 05/30/2024] Open
Abstract
Purpose The objective of this study was to develop and validate a nomogram for predicting the need for surgical intervention in pediatric intussusception after pneumatic reduction. Patients and Methods This retrospective study analyzed the clinical data of children with acute intussusception admitted to four hospitals in China from January 2019 to January 2022. Based on the results of pneumatic reduction, the patients were divided into two groups: the successful reduction group (control group) and the failed reduction group (operation group). The total sample was randomly divided into a training set and a validation set in a 7:3 ratio. Logistic regression analysis was performed to establish a predictive model for surgical risk. Results A total of 1041 samples were included in this study, with 852 in the control group and 189 in the operation group. Among the total sample, 728 cases were used for training and 313 cases were used for validation. Logistic regression analysis of the training set identified age, time of abdominal pain, presence or absence of hematostoecia, C-reactive protein value from blood test on admission, and nested position indicated by B-ultrasound as independent predictors of intussusception intervention. Based on the five independent risk factors identified through multivariate logistic regression, a nomogram was successfully constructed to predict the failure of resetting by air enema under X-ray. Conclusion A nomogram was developed to predict the need for surgical intervention after intussusception pneumatic reduction in children. The nomogram was based on clinical risk factors including age, time of abdominal pain, presence or absence of blood in stool, value of C-reactive protein in blood test on admission, and nested position indicated by B-ultrasound. Our internal validation demonstrated that this nomogram can serve as a useful tool for identifying risk factors associated with failure of air enema in children with intussusception.
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Affiliation(s)
- Jie Liu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, People’s Republic of China
- Department of General Surgery and Urology, Maternal and Child Health Hospital/Obstetrics and Gynecology Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of China
| | - Yongkai Wang
- Department of Hepatobiliary Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, People’s Republic of China
| | - Zhihui Jiang
- Department of General Surgery, Qingdao Women and Children’s Hospital, Qingdao, People’s Republic of China
| | - Guangqi Duan
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, People’s Republic of China
| | - Xiaowen Mao
- Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Danping Zeng
- Department of General Surgery and Urology, Maternal and Child Health Hospital/Obstetrics and Gynecology Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of China
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Yu YY, Zhang JJ, Xu YT, Lin ZX, Guo SK, Li ZR, Huang HY, Huang XZ. Developing and validating a nomogram for early predicting the need for intestinal resection in pediatric intussusception. Front Pediatr 2024; 12:1409046. [PMID: 38774298 PMCID: PMC11106445 DOI: 10.3389/fped.2024.1409046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/25/2024] [Indexed: 05/24/2024] Open
Abstract
Purpose Develop and validate a nomogram for predicting intestinal resection in pediatric intussusception suspecting intestinal necrosis. Patients & methods Children with intussusception were retrospectively enrolled after a failed air-enema reduction in the outpatient setting and divided into two groups: the intestinal resection group and the non-intestinal resection group. The enrolled cases were randomly selected for training and validation sets with a split ratio of 3:1. A nomogram for predicting the risk of intestinal resection was visualized using logistic regression analysis with calibration curve, C-index, and decision curve analysis to evaluate the model. Results A total of 547 cases were included in the final analysis, of which 414 had non-intestinal necrosis and 133 had intestinal necrosis and underwent intestinal resection. The training set consisted of 411 patients and the validation cohort included 136 patients. Through forward stepwise regression, four variables (duration of symptoms, C-reaction protein, white blood cells, ascites) were selected for inclusion in the nomogram with a concordance index 0.871 (95% confidence interval: 0.834-0.908). Conclusion We developed a nomogram for predicting intestinal resection in children with intussusception suspecting intestinal necrosis after a failed air-enema based on multivariate regression. This nomogram could be directly applied to facilitate predicting intestinal resection in pediatric intussusception suspecting necrosis.
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Affiliation(s)
- Yuan-Yang Yu
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jia-Jie Zhang
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ya-Ting Xu
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zheng-Xiu Lin
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shi-Kun Guo
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhong-Rong Li
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hui-Ya Huang
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiao-Zhong Huang
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
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Wondemagegnehu BD, Kerego EN, Mammo TN, Robele AT, Gebru FT, Aklilu WK. Predictors of Failure in Ultrasound-Guided Hydrostatic Reduction of Intussusception in Children: Retrospective Analysis in a Specialized Center in Ethiopia. Pediatric Health Med Ther 2024; 15:87-94. [PMID: 38405413 PMCID: PMC10887998 DOI: 10.2147/phmt.s451832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/08/2024] [Indexed: 02/27/2024] Open
Abstract
Purpose To identify factors predicting the failure of ultrasound-guided hydrostatic reduction of intussusception in children. Patients and Methods The medical records of 174 children who underwent ultrasound-guided hydrostatic reduction of intussusception over four years were reviewed at Tikur Anbessa Specialized Hospital. Patient's demography, clinical data, and sonography findings (type of intussusception, length of intussusception, presence of lead point, trapped fluid, lymph node, and free peritoneal fluid) were entered into SPSS 25 (IBM) and analyzed using logistic regression. Results The overall success rate of ultrasound-guided hydrostatic reduction was 81.6%. The sex, presence of abdominal cramps, vomiting, diarrhea, trapped lymph nodes on ultrasound, or history of upper respiratory tract infection had no association with hydrostatic reducibility. Currant jelly stool (OR 0.128; 95% CI, 0.27-0.616; P=0.01), Ileo-ileo colic intussusception (OR 0.055; 95% CI, 0.005-0.597; P=0.017), pathologic lead point (OR 0.66; 95% CI, 0.01-0.447; P=0.005) and abdominal distention (OR 0.209; 95% CI, 0.044-0.998; P=0.048) showed significant association with failed hydrostatic reduction. Conclusion The presence of currant jelly stool, ileo-ileo colic type intussusception, pathologic lead point, and abdominal distention are the most important predictors for failed ultrasound ultrasound-guided reduction intussusception in children.
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Affiliation(s)
| | - Ephrem Nidaw Kerego
- Department of Surgery, St. Paul’s Millennium Medical College, Addis Ababa, Ethiopia
| | - Tihtina Negussie Mammo
- Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amezene Tadesse Robele
- Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fisseha Temesgen Gebru
- Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Woubedel Kiflu Aklilu
- Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Shah JY, Banday I, Hamdani HZ, Haq MF, Parray FQ, Banday M, Bhat GA. A Study of Predictors of Failure of Nonoperative Management of Ileocolic Intussusception in Children. Euroasian J Hepatogastroenterol 2024; 14:81-85. [PMID: 39022205 PMCID: PMC11249906 DOI: 10.5005/jp-journals-10018-1432] [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: 04/03/2024] [Accepted: 05/02/2024] [Indexed: 07/20/2024] Open
Abstract
Background Surgery remains the mainstay in treating intussusception in developing nations. A correspondingly high bowel resection rate exists despite a shift to nonoperative reduction in high-income countries. We aimed to study the clinical profile of the patients with intussusception presenting to our hospital and to assess the clinical and radiological predictors of success or failure of nonoperative management of intussusception. Materials and methods This prospective study was conducted in the Department of Pediatric Surgery over a period of 3 years and included a total of 118 patients who presenting to our emergency division with features suggestive of intussusception and were managed accordingly either with hydrostatic reduction or by surgical intervention. Results We observed that the majority of the patients were males (65.5%). The mean age was 13.54 months. Intermittent pain was the most common symptom. Both pain and vomiting did not affect the outcome. Lab parameters like raised total leukocyte counts (TLC), C-reactive protein (CRP) and lactate levels were significantly associated with failure of hydrostatic reduction. Patients with air fluid levels on X-ray were more likely to end up in surgery. Ultrasound findings of bowel wall edema, aperistaltic gut loops and a pathological lead point was associated with failure of hydrostatic reduction as well. The overall success rate of hydrostatic reduction was 85.5%. Conclusion Hydrostatic reduction of intussusception is a safe and effective method of management of intussusception whenever indicated. Factors that might reduce the chance of its success include continuous pain, irritability, tenderness, deranged lab parameters like TLC, CRP and lactate levels, air fluid levels on X-ray, bowel wall edema, aperistalsis and the presence of a lead point. How to cite this article Shah JY, Banday I, Hamdani HZ, et al. A Study of Predictors of Failure of Nonoperative Management of Ileocolic Intussusception in Children. Euroasian J Hepato-Gastroenterol 2024;14(1):81-85.
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Affiliation(s)
- Jibreel Y Shah
- Department of General and Minimal Invasive Surgery, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, India
| | - Imad Banday
- Department of General and Minimal Invasive Surgery, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, India
| | - Hanna Z Hamdani
- Department of Radiodiagnosis and Imaging, Acharya Shri Chander College of Medical Sciences and Hospital, Sidhra, Jammu, India
| | - Mohd Fazlul Haq
- Department of General and Minimal Invasive Surgery, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, India
| | - Fazl Q Parray
- Colorectal Division, Department of General and Minimal Invasive Surgery, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, India
| | - Meeran Banday
- Department of General and Minimal Invasive Surgery, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, India
| | - Gowhar Aziz Bhat
- Colorectal Division, Department of General and Minimal Invasive Surgery, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, India
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Pei Y, Wang G, Cao H, Jiang S, Wang D, Wang H, Wang H, Yu H. A deep-learning pipeline to diagnose pediatric intussusception and assess severity during ultrasound scanning: a multicenter retrospective-prospective study. NPJ Digit Med 2023; 6:182. [PMID: 37775624 PMCID: PMC10541898 DOI: 10.1038/s41746-023-00930-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023] Open
Abstract
Ileocolic intussusception is one of the common acute abdomens in children and is first diagnosed urgently using ultrasound. Manual diagnosis requires extensive experience and skill, and identifying surgical indications in assessing the disease severity is more challenging. We aimed to develop a real-time lesion visualization deep-learning pipeline to solve this problem. This multicenter retrospective-prospective study used 14,085 images in 8736 consecutive patients (median age, eight months) with ileocolic intussusception who underwent ultrasound at six hospitals to train, validate, and test the deep-learning pipeline. Subsequently, the algorithm was validated in an internal image test set and an external video dataset. Furthermore, the performances of junior, intermediate, senior, and junior sonographers with AI-assistance were prospectively compared in 242 volunteers using the DeLong test. This tool recognized 1,086 images with three ileocolic intussusception signs with an average of the area under the receiver operating characteristic curve (average-AUC) of 0.972. It diagnosed 184 patients with no intussusception, nonsurgical intussusception, and surgical intussusception in 184 ultrasound videos with an average-AUC of 0.956. In the prospective pilot study using 242 volunteers, junior sonographers' performances were significantly improved with AI-assistance (average-AUC: 0.966 vs. 0.857, P < 0.001; median scanning-time: 9.46 min vs. 3.66 min, P < 0.001), which were comparable to those of senior sonographers (average-AUC: 0.966 vs. 0.973, P = 0.600). Thus, here, we report that the deep-learning pipeline that guides lesions in real-time and is interpretable during ultrasound scanning could assist sonographers in improving the accuracy and efficiency of diagnosing intussusception and identifying surgical indications.
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Affiliation(s)
- Yuanyuan Pei
- Provincial Key Laboratory of Research in Structure Birth Defect Disease and Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Guijuan Wang
- School of Computer Science, South China Normal University, Guangzhou, China
| | - Haiwei Cao
- Ultrasonic Department, Kaifeng Children's Hospital, Kaifeng, China
| | - Shuanglan Jiang
- Ultrasonic Department, Dongguan Children's Hospital, Dongguan, China
| | - Dan Wang
- Ultrasonic Department, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Haiyu Wang
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongying Wang
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
| | - Hongkui Yu
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
- Department of Ultrasonography, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China.
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Chang CY, Chen YY, Lin CH, Sheen JM, Shih WT, Chen KJ, Yang YH. Recurrence of pediatric intussusception: A nationwide population-based descriptive study in Taiwan. Medicine (Baltimore) 2023; 102:e34727. [PMID: 37657043 PMCID: PMC10476760 DOI: 10.1097/md.0000000000034727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/21/2023] [Indexed: 09/03/2023] Open
Abstract
Intussusception is frequently observed pediatric emergency that is often followed by recurrent intussusception after initial treatment. This study investigated the risk factors associated with recurrent intussusception in children aged ≤ 3 years. Between January 2007 and December 2015, a cohort study was conducted by linking the Taiwan Maternal and Child Health Database to the Birth Certificate Application database and the National Health Insurance Research Database in Taiwan. Patients aged ≤ 3 years with intussusception diagnosis and related treatment were included in our study. Multivariable logistic regression was used to analyze the risk factors associated with recurrent intussusception. In total, 5341 children with intussusception aged ≤ 3 years were enrolled in our cohort. The adjusted odds ratio (aOR) for recurrent intussusception in children aged 2 to 3 years was 0.62 (95% confidence interval [CI]: 0.47-0.82) compared with children aged < 1 year, and surgery decreased the risk of recurrent intussusception (aOR = 0.64, 95% CI: 0.46-0.88). Male patients had higher risk of recurrent intussusception than female patients had (aOR = 1.41, 95% CI: 1.13-1.75). Higher birth weight may increase the risk of recurrent intussusception, but this association was not statistically significant. Furthermore, gestational age did not seem to affect the risk of recurrent intussusception. Surgical treatment and delayed onset of intussusception are associated with a reduced risk of recurrent intussusception; males are associated with increased risk of recurrent intussusception. In addition, we suggest that in early infancy, patients who received non-surgical treatment as the initial treatment for intussusception should be closely followed up for potential recurrence of intussusception.
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Affiliation(s)
- Chao-Yang Chang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Ying Chen
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chih-Hsuan Lin
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jiunn-Ming Sheen
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan
| | - Wei-Tai Shih
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ko-Jung Chen
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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8
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Zhuang Y, Wang X, Fan X, Li F, He G, Luo M, Tang Y. Developing a nomogram for predicting surgical intervention in pediatric intussusception after hydrostatic reduction. Front Pediatr 2023; 11:1092548. [PMID: 37325352 PMCID: PMC10264573 DOI: 10.3389/fped.2023.1092548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/07/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose The aim of this study was to develop and validate a nomogram for predicting surgical intervention in pediatric intussusception after hydrostatic reduction. Methods Children with intussusception who had treated with sonographically guided saline hydrostatic reduction as an initial treatment were enrolled in this study. The enrolled patients were randomly selected for training and validation sets, and the split ratio was 7:3. The medical records of enrolled patients were retrospectively reviewed. The patients were divided into a surgery and a non-surgery group according to the results of the nonsurgical reduction. A model for predicting the risk of surgical treatment was virtualized by the nomogram using logistic regression analysis. Results The training set consisted of 139 patients and the validation set included 74. After logistic regression analysis using training set, duration of symptoms, bloody stools, white blood cells (WBCs), creatine kinase isoenzyme (CK-MB), long-axis diameter, poor prognostic signs by ultrasound and mental state were identified as the independent predictors of surgical intervention for intussusception. A model that incorporated the above independent predictors was developed and presented as a nomogram. The C-index of the nomogram in the validation set was 0.948 (95% CI, 0.888-1.000). The calibration curve demonstrated a good agreement between prediction and observation. The decision curve analysis (DCA) curve showed that the model achieved a net benefit across all threshold probabilities. Conclusion Based on the predictors of duration of symptoms, bloody stools, WBCs, CK-MB, long-axis diameter, poor prognostic signs by ultrasound and mental state, we developed a nomogram for predicting surgical intervention after hydrostatic reduction. This nomogram could be applied directly to facilitate pre-surgery decision for pediatric intussusception.
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Affiliation(s)
| | | | | | | | | | - Miao Luo
- Correspondence: Miao Luo Yingming Tang
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Khorana J, Tepjuk S, Singhavejsakul J, Tepmalai K, Chantakhow S, Ukarapol N, Damrongmanee A, Samerchua A, Bunchungmongkol N, Visrutaratna P, Morakote W, Nate-Anong B, Chanaturakarnnon S, Itthidecharon K, Chaimongkhon P. A comparison of the success rate of pneumatic reduction in intussusception between general anesthesia and deep sedation: a randomized controlled trial. Pediatr Surg Int 2023; 39:186. [PMID: 37095299 DOI: 10.1007/s00383-023-05474-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE This study was aimed to compare the success rate between patients who underwent general anesthesia and deep sedation. METHODS Patients who were diagnosed with intussusception and had no contraindications would receive non-operative treatment first by undergoing pneumatic reduction. The patients were then split in to two groups: one group underwent general anesthesia (GA group), while the other underwent deep sedation (SD group). This study was a randomized controlled trial which compared success rate between two groups. RESULTS A total of 49 episodes diagnosed with intussusception were random into 25 episodes in GA group and 24 episodes in SD group. There was no significant difference in baseline characteristic between the two groups. The success rates of GA group and SD group were equally 88.0% (p = 1.00). Sub-analysis of the success rate was lower in the patients with high-risk score for failed reduction. (Chiang Mai University Intussusception (CMUI) failed score in success VS failed = 6.9 ± 3.2 vs. 10.3 ± 3.0 p = 0.017). CONCLUSION General anesthesia and deep sedation offered similar success rates. In cases of high risk of failure, general anesthesia should be considered to accommodate the switch to surgical management in the same setting if the non-operative approach fails. The appropriate treatment and sedative protocol also increase the success of reduction.
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Affiliation(s)
- Jiraporn Khorana
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University Hospital, 110 Intavaroros Road, Muang Chiang Mai District, Chiang Mai, 50200, Thailand.
- Center of Clinical Epidemiology and Clinical Statistic, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Sasiwimol Tepjuk
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University Hospital, 110 Intavaroros Road, Muang Chiang Mai District, Chiang Mai, 50200, Thailand
| | - Jesda Singhavejsakul
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University Hospital, 110 Intavaroros Road, Muang Chiang Mai District, Chiang Mai, 50200, Thailand
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kanokkan Tepmalai
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University Hospital, 110 Intavaroros Road, Muang Chiang Mai District, Chiang Mai, 50200, Thailand
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sireekarn Chantakhow
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University Hospital, 110 Intavaroros Road, Muang Chiang Mai District, Chiang Mai, 50200, Thailand
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nuthapong Ukarapol
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Alisara Damrongmanee
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Artid Samerchua
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Pannee Visrutaratna
- Division of Pediatric Radiology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wipawee Morakote
- Division of Pediatric Radiology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Butsarin Nate-Anong
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University Hospital, 110 Intavaroros Road, Muang Chiang Mai District, Chiang Mai, 50200, Thailand
| | - Sutinee Chanaturakarnnon
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University Hospital, 110 Intavaroros Road, Muang Chiang Mai District, Chiang Mai, 50200, Thailand
| | - Krittayanee Itthidecharon
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University Hospital, 110 Intavaroros Road, Muang Chiang Mai District, Chiang Mai, 50200, Thailand
| | - Patiphon Chaimongkhon
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University Hospital, 110 Intavaroros Road, Muang Chiang Mai District, Chiang Mai, 50200, Thailand
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Hwang J, Yoon HM, Kim PH, Jung AY, Lee JS, Cho YA. Current diagnosis and image-guided reduction for intussusception in children. Clin Exp Pediatr 2023; 66:12-21. [PMID: 35798026 PMCID: PMC9815940 DOI: 10.3345/cep.2021.01816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 06/02/2022] [Indexed: 02/04/2023] Open
Abstract
Intussusception involves an invagination of the proximal bowel into the distal bowel, with ileocolic intussusception being the most common type. However, a diagnostic delay can lead to intestinal ischemia, bowel infarction, or even death; therefore, its early diagnosis and management are important. The primary role of abdominal radiography is to detect pneumoperitoneum or high-grade bowel obstruction in cases of suspected intussusception, and ultrasonography is the modality of choice for its diagnosis. Nonoperative enema reduction, the treatment of choice for childhood intussusception in cases without signs of perforation or peritonitis, can be safely performed with a success rate of 82%. Enema reduction can be performed in various ways according to image guidance method (fluoroscopy or ultrasonography) and reduction medium (liquid or air). Successful enema reduction is less likely to be achieved in children with a longer symptom duration, younger age, lethargy, fever, bloody diarrhea, unfavorable radiologic findings (small bowel obstruction, trapped fluid, ascites, absence of flow in the intussusception, intussusception in the left-sided colon), and pathological lead points. This review highlights the current concepts of intussusception diagnosis, nonsurgical enema reduction, success rates, predictors of failed enema reduction, complications, and recurrence to guide general pediatricians in the management of childhood intussusception.
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Affiliation(s)
- Jisun Hwang
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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11
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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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12
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Factors associated with surgical treatment in pediatric intussusception. Wien Med Wochenschr 2022; 172:313-316. [PMID: 35896760 DOI: 10.1007/s10354-022-00953-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/07/2022] [Indexed: 10/16/2022]
Abstract
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.
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Akdulum İ, Gürün E, Akyüz M, Tiken R, Oral H, Kaya C, Boyunaga ÖL. Shear wave elastography evaluation in predicting the success of ultrasound-guided saline enema hydrostatic reduction technique in ileocolic intussusception. Acta Radiol 2022; 63:862-866. [PMID: 34018819 DOI: 10.1177/02841851211018799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- İsmail Akdulum
- Department of Pediatric Radiology, Gazi University, Ankara, Turkey
| | - Enes Gürün
- Department of Radiology, İskilip Atıf Hoca State Hospital, Çorum, Turkey
| | - Melih Akyüz
- Department of Radiology, Rush University Medical Center, Chicago, IL, USA
| | - Ramazan Tiken
- Department of Pediatric Radiology, Gazi University, Ankara, Turkey
| | - Hayrunnisa Oral
- Department of Pediatric Radiology, Gazi University, Ankara, Turkey
| | - Cem Kaya
- Department of Pediatric Radiology, Gazi University, Ankara, Turkey
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Khorana J, Sayuen C, Chanaturakarnnon S, Nate-anong B, Singhavejsakul J, Tepmalai K, Chantakhow S, Sathavornvichit W. Temporal Validation of Chiang Mai University Intussusception Failed Reduction Score (CMUI). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095289. [PMID: 35564684 PMCID: PMC9102458 DOI: 10.3390/ijerph19095289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 02/04/2023]
Abstract
This study aimed to validate the “Chiang Mai University Intussusception Failed Score (CMUI)” for intussusception non-operative reduction. Both a 2-year retrospective and a 5-year prospective consecutive review of patients with intussusception were conducted. Data were collected from January 2013 to December 2020. Related retrospective data of a developmental set from two centers from January 2006 to December 2012 were used. Ten prespecified prognostic factors for failed reduction were collected and from these a predictive score was calculated. The actual results of non-operative reduction were collected and set as a reference standard. Altogether, 195 episodes of intussusception were found. Twenty-two patients were excluded due to contraindications; therefore, a total of 173 episodes were included in the validation dataset. The development data set comprised 170 episodes. We found that no statistical significance was found from comparing the areas under the ROC of two datasets (p-value = 0.31), while specificity of the validation set was 93.8% (88.1–97.3). This temporal validation showed a high specificity and a high affinity for prediction of failed reduction as the development dataset despite being in an era of a higher successful reduction rate. The intensive reduction protocols might be introduced among patients with high-risk scores.
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Affiliation(s)
- Jiraporn Khorana
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (C.S.); (S.C.); (B.N.-a.); (J.S.); (K.T.); (S.C.)
- Center of Clinical Epidemiology and Clinical Statistic, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence: or ; Tel.: +66-819929767
| | - Chanathip Sayuen
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (C.S.); (S.C.); (B.N.-a.); (J.S.); (K.T.); (S.C.)
| | - Sutinee Chanaturakarnnon
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (C.S.); (S.C.); (B.N.-a.); (J.S.); (K.T.); (S.C.)
| | - Butsarin Nate-anong
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (C.S.); (S.C.); (B.N.-a.); (J.S.); (K.T.); (S.C.)
| | - Jesda Singhavejsakul
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (C.S.); (S.C.); (B.N.-a.); (J.S.); (K.T.); (S.C.)
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Kanokkan Tepmalai
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (C.S.); (S.C.); (B.N.-a.); (J.S.); (K.T.); (S.C.)
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sireekarn Chantakhow
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (C.S.); (S.C.); (B.N.-a.); (J.S.); (K.T.); (S.C.)
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wilai Sathavornvichit
- Pediatric Nursing Section, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
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Adhikari S, Koirala DP, Pokhrel RP, Dahal GR, Kharel S, Neupane S. Risk factors for recurrent intussusception after successful reduction in pediatric patients in a tertiary care hospital of Nepal: A prospective study. Ann Med Surg (Lond) 2022; 76:103427. [PMID: 35495376 PMCID: PMC9052128 DOI: 10.1016/j.amsu.2022.103427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background Intussusception is defined as the invagination of one segment of intestine into another segment of intestine. It may recur because of persistence or return of some factor responsible for the primary intussusception. Various risk factors have been reported but still not well elucidated. Materials and methods This is the prospective observational study. In this study, 78 patients, age <16 years with diagnosis of intussusception between June 2019 and April 2020 who had successful reduction with either hydrostatic reduction and/or operative reduction in Teaching Hospital were enrolled in the study. This is study of early recurrence as patients were followed up to a period of 1 month for recurrence of intussusception. The recurrent cases were thus identified and various variables were compared between recurrent and non-recurrent cases by univariable and multivariable analysis. Results Among 78 patients, 13 patients (16.7%) had recurrent intussusception. In the univariable analysis model, the significant risk factors for recurrence of intussusception analyzed were duration of symptoms of 48 h or more, fever, blood in stool and palpable mass. While after multivariable analysis, we found that the significant risk factors for recurrence of intussusception were duration of symptoms ≥48 h (OR = 5.32, p-value = 0.047), Fever (OR = 17.32, p-value = 0.001), palpable mass (OR = 24.12, p-value = 0.017). Conclusion Attention and awareness among pediatricians about these sonographic and clinical risk factors especially symptoms for recurrence are needed to minimize pre-hospital delay and identify patients in risk of recurrence. This ultimately helps to improve care for pediatric patients with recurrent intussusception. Intussusception is a common abdominal emergency in infancy and childhood. Definitive or reliable risk factors for recurrence, other than anatomical features, have not been well elucidated. Duration of symptoms >24 h, fever and palpable mass are the risk factors.
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Affiliation(s)
- Shankar Adhikari
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Dinesh Prasad Koirala
- Department of GI and General Surgery, Pediatric Surgery Unit, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Rameshwor Prasad Pokhrel
- Department of GI and General Surgery, Pediatric Surgery Unit, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Geha Raj Dahal
- Department of GI and General Surgery, Pediatric Surgery Unit, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Sanjeev Kharel
- Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - Subita Neupane
- Department of General Practice and Emergency Medicine, Bir Hospital, Kathmandu, Nepal
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16
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Gadgade BD, Radhakrishna V, Kumar N. Factors Associated with a Failed Nonoperative Reduction of Intussusception in Children. J Indian Assoc Pediatr Surg 2021; 26:421-426. [PMID: 34912140 PMCID: PMC8637975 DOI: 10.4103/jiaps.jiaps_297_20] [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] [Received: 08/29/2020] [Revised: 10/11/2020] [Accepted: 10/28/2020] [Indexed: 11/17/2022] Open
Abstract
Aims: The aim of this study was to evaluate the factors associated with the failure of nonoperative reduction of intussusception in children. Methods: A retrospective study was conducted in a tertiary care pediatric surgery hospital. The children admitted to the department of pediatric surgery between November 2013 and February 2020 with the diagnosis of Intussusception were included. Results: A total of 106 (67%) children underwent pneumatic reduction. Eighty-nine (84%) children had a successful reduction. A higher rate of failed reduction was found in children who presented at or after 48 h of the onset of symptoms (P = 0.03) and abdominal distension at presentation (P < 0.002). On multiple logistic regression analysis, the children presenting at or after 48 h of the onset of symptoms (odds ratio [OR] = 11.3; P = 0.039) and abdominal distension at presentation (OR = 4.46; P = 0.021) were found to be associated with increased risk of failure of nonoperative reduction. The variables age <1 year, weight <10 kg, pain abdomen, vomiting, bilious vomiting, fever, bleeding per rectum, and palpable mass were not associated with the failed nonoperative reduction. The variables, presentation at or after 48 h of the onset of symptoms (OR = 2.812; P = 0.045) and abdominal distension at presentation (OR = 8.758; P = 0.000) were found to be associated with an increased need for surgery. Conclusion: The risk factors for failed nonoperative reduction of intussusception include a presentation at or after 48 h of the onset of symptoms and the presence of abdominal distension at presentation. The delayed presentation was associated with the increased need for surgery and increased chances of intestinal nonviability.
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Affiliation(s)
- Bahubali Deepak Gadgade
- Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Veerabhadra Radhakrishna
- Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Nitin Kumar
- Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
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Bergmann KR, Arroyo AC, Tessaro MO, Nielson J, Whitcomb V, Madhok M, Yock-Corrales A, Guerrero-Quesada G, Chaudoin L, Berant R, Shahar-Nissan K, Deanehan JK, Lam SHF, Snelling PJ, Avendano P, Cohen SG, Friedman N, Ekpenyong A, Pade KH, Park DB, Lin-Martore M, Kornblith AE, Montes-Amaya G, Thomas-Mohtat R, Jin J, Watson D, Sivitz A. Diagnostic Accuracy of Point-of-Care Ultrasound for Intussusception: A Multicenter, Noninferiority Study of Paired Diagnostic Tests. Ann Emerg Med 2021; 78:606-615. [PMID: 34226072 DOI: 10.1016/j.annemergmed.2021.04.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/13/2021] [Accepted: 04/27/2021] [Indexed: 01/09/2023]
Abstract
STUDY OBJECTIVE To determine the diagnostic accuracy of point-of-care ultrasound (POCUS) performed by experienced clinician sonologists compared to radiology-performed ultrasound (RADUS) for detection of clinically important intussusception, defined as intussusception requiring radiographic or surgical reduction. METHODS We conducted a multicenter, noninferiority, observational study among a convenience sample of children aged 3 months to 6 years treated in tertiary care emergency departments across North and Central America, Europe, and Australia. The primary outcome was diagnostic accuracy of POCUS and RADUS with respect to clinically important intussusception. Sample size was determined using a 4-percentage-point noninferiority margin for the absolute difference in accuracy. Secondary outcomes included agreement between POCUS and RADUS for identification of secondary sonographic findings. RESULTS The analysis included 256 children across 17 sites (35 sonologists). Of the 256 children, 58 (22.7%) had clinically important intussusception. POCUS identified 60 (23.4%) children with clinically important intussusception. The diagnostic accuracy of POCUS was 97.7% (95% confidence interval [CI] 94.9% to 99.0%), compared to 99.3% (95% CI 96.8% to 99.9%) for RADUS. The absolute difference between the accuracy of RADUS and that of POCUS was 1.5 percentage points (95% CI -0.6 to 3.6). Sensitivity for POCUS was 96.6% (95% CI 87.2% to 99.1%), and specificity was 98.0% (95% CI 94.7% to 99.2%). Agreement was high between POCUS and RADUS for identification of trapped free fluid (83.3%, n=40/48) and decreased color Doppler signal (95.7%, n=22/23). CONCLUSION Our findings suggest that the diagnostic accuracy of POCUS performed by experienced clinician sonologists may be noninferior to that of RADUS for detection of clinically important intussusception. Given the limitations of convenience sampling and spectrum bias, a larger randomized controlled trial is warranted.
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Affiliation(s)
- Kelly R Bergmann
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN.
| | - Alexander C Arroyo
- Department of Pediatric Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Mark O Tessaro
- Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jonathan Nielson
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Valerie Whitcomb
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Manu Madhok
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Adriana Yock-Corrales
- Department of Emergency Medicine, Hospital Nacional de Niños: "Dr. Carlos Sáenz Herrera," CCSS, San José, Costa Rica
| | - German Guerrero-Quesada
- Department of Surgery, Hospital Nacional de Niños: "Dr. Carlos Sáenz Herrera," CCSS, San José, Costa Rica
| | - Lindsey Chaudoin
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, NC
| | - Ron Berant
- Department of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Keren Shahar-Nissan
- Department of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - J Kate Deanehan
- Department of Pediatric Emergency Medicine, Johns Hopkins Children's Center, Baltimore, MD
| | - Samuel H F Lam
- Department of Emergency Medicine, Sutter Medical Center Sacramento, Sacramento, CA
| | - Peter J Snelling
- Department of Pediatric Emergency Medicine, Gold Coast University Hospital and Griffith University, Southport, Queensland, Australia
| | - Pablo Avendano
- Division of Pediatric Emergency Medicine, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Stephanie G Cohen
- Department of Pediatrics and Emergency Medicine, Children's Healthcare Atlanta and Emory University, Atlanta, GA
| | - Nir Friedman
- Department of Pediatric Emergency Medicine, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Atim Ekpenyong
- Department of Pediatrics, University of California, San Diego, CA
| | - Kathryn H Pade
- Department of Pediatrics, University of California, San Diego, CA
| | - Daniel B Park
- Department of Pediatrics and Emergency Medicine, University of North Carolina, Chapel Hill, NC
| | - Margaret Lin-Martore
- Department of Emergency Medicine and Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Aaron E Kornblith
- Department of Emergency Medicine and Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Gerardo Montes-Amaya
- Department of Pediatric Emergency Medicine, Hospital Infantil Ciudad Juárez, Chihuahua, Mexico
| | - Rosemary Thomas-Mohtat
- Department of Pediatric Emergency Medicine, Children's National Hospital, Washington, DC
| | - Jing Jin
- Department of Research and Sponsored Programs, Children's Minnesota, Minneapolis, MN
| | - Dave Watson
- Department of Research and Sponsored Programs, Children's Minnesota, Minneapolis, MN
| | - Adam Sivitz
- Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, NJ
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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: 21] [Impact Index Per Article: 7.0] [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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19
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Athamnah MN, Masade S, Hamdallah H, Banikhaled N, Shatnawi W, Elmughrabi M, Al Azzam HSO. COVID-19 presenting as intussusception in infants: A case report with literature review. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021; 66:101779. [PMID: 33520650 PMCID: PMC7834375 DOI: 10.1016/j.epsc.2021.101779] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 02/06/2023] Open
Abstract
The novel Corona virus disease 2019 (COVID-19) first presented in Wuhan, China. The virus was able to spread throughout the world, causing a global health crisis. The virus spread widely in Jordan after a wedding party held in northern Jordan. In most cases of COVID-19 infection, respiratory symptoms are predominant. However, in rare cases the disease may present with non-respiratory symptoms. The presentation of COVID-19 as a case of intussusception in children is a strange and rare phenomenon. We present here a case of a two-and-a-half month old male baby who was brought to hospital due to fever, frequent vomiting, dehydration and blood in stool. He was diagnosed as intussusception. The child was tested for corona due to the large societal spread of the virus and because he was near his mother, who was suffering from symptoms similar to corona or seasonal flu (she did not conduct a corona test). Patient was treated without surgery and recovered quickly. The COVID-19 infection was without respiratory symptoms, and there was no need for the child to remain in hospital after treatment of intussusception. The relationship between viruses, mesenteric lymphoid hyperplasia, and intussusception is a confirmed relation. ACE2 is the key receptor required for SARA-COV-2 to enter the host cells. ACE2 has been also found in the brush border of the intestinal mucosa, as well as it is a key inflammatory regulator in the intestine. This may suggest that SARSA-COV-2 could invade the respiratory tract as well as gastrointestinal tract or both. Few case reports documented the presentation of COVID-19 as intussusception in children. In the light of the wide-spread of corona virus, performing COVID-19 tests for children with intussusception can help linking the two entities. Development of gastrointestinal symptoms in COVID-19 positive children should raise concern about the development of intussusception.
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Affiliation(s)
- Mohammad N Athamnah
- General Surgery Department, Princess Basma Teaching Hospital, Jordan Ministry of Health, Irbid, Jordan
| | | | | | - Nasser Banikhaled
- Pediatric Infectious Diseases, Jordanian Royal Medical Services, Jordan
| | | | | | - Hussein S O Al Azzam
- General Surgery Department, Princess Basma Teaching Hospital, Jordan Ministry of Health, Irbid, Jordan
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20
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Ajao AE, Lawal TA, Ogundoyin OO, Olulana DI. Clinical predictors and outcome of bowel resection in paediatric intussusception. Afr Health Sci 2020; 20:1463-1470. [PMID: 33402995 PMCID: PMC7751555 DOI: 10.4314/ahs.v20i3.52] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Surgery remains the mainstay in treating intussusception in developing countries, with a correspondingly high bowel resection rate despite a shift to non-operative reduction in high-income countries. Objective To assess factors associated with bowel resection and the outcomes of resection in childhood intussusception. Methods A review of children with intussusception between January 2006 and December 2015 at the University College Hospital, Ibadan, Nigeria. The patients were categorized based on the need for bowel resection and analysis done using the SPSS version 23. Results 121 children were managed for intussusception during this period. 53 (43.8%) had bowel resection, 61 (50.4%) did not require resection and 7 (5.8%) were unknown. 40 (75.5%) of the resections were right hemi-colectomy. The presence of fever, abdominal pain, distension, rectal mass, age < 12 months, heart rate > 145/min and duration of symptoms > 2 days were associated with the need for bowel resection (p < 0.05). However, only age and abdominal pain independently predicted need for resection. Bowel resection was more associated with development of post-operative complications and prolonged hospital stay (p < 0.05). Conclusion Infants presenting with abdominal pain and abdominal distension after two days of onset of symptoms were more likely to require bowel resection. Resection in intussusception significantly increased post-operative complications and length of hospital stay.
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Affiliation(s)
- Akinlabi E Ajao
- Department of Surgery, Bowen University Iwo and Bowen University Teaching Hospital, Ogbomoso, Nigeria
| | - Taiwo A Lawal
- Department of Surgery, University of Ibadan and University College Hospital, Ibadan
| | | | - Dare I Olulana
- Department of Surgery, University of Ibadan and University College Hospital, Ibadan
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21
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Boonsanit K, Kritsaneepaiboon S, Chiengkriwate P, Sangkhathat S. Validation and modification of the ‘Chiang Mai University Intussusception scoring system’ used to predict failure of non-surgical treatment in infantile intussusception. WORLD JOURNAL OF PEDIATRIC SURGERY 2019. [DOI: 10.1136/wjps-2019-000060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BackgroundThis study aimed to validate and modify the recently released Chiang Mai University Intussusception (CMUI) scoring system in predicting failure of non-surgical management of infantile intussusception.MethodsA retrospective review was conducted in 151 cases of infantile intussusception who were primarily treated with pneumatic reduction in our institute during 2008–2018. The analysis focused on the validation of the CMUI scoring system. Following this analysis, the scoring system was modified to be more suitable for our clinical practice, in which we perform pneumatic reduction in all cases.ResultsPneumatic reduction was successfully performed in 120/151 cases (79.5%). A high CMUI score was significantly associated with increased likelihood of failure at the positive likelihood ratio of 1.49 (sensitivity 25.8 and specificity 82.7). The area under the receiver operating characteristic curve (AUC) was 0.73. We modified the CMUI System in two ways, first by removing the item ‘method of reduction’ and replacing it with ‘hyponatremia’, and by changing the definition of low body weight to less than 9 kg. The modified CMUI had an AUC of 0.76. A high score (>9 points) on the modified version gave a positive likelihood ratio of 4.77 (sensitivity 53.0 and specificity 80.9).ConclusionIn infantile intussusception primarily treated with pneumatic reduction, the modified CMUI scoring system gave a better prediction reliability than the original.
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22
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Perforated gangrenous ileo-colic intussusception in a 9 month old Nigerian infant presenting at a private hospital: A case report. Int J Surg Case Rep 2019; 59:148-151. [PMID: 31163329 PMCID: PMC6545395 DOI: 10.1016/j.ijscr.2019.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/17/2019] [Accepted: 05/02/2019] [Indexed: 11/20/2022] Open
Abstract
The current case presented late with complication of gangrene and perforation because it was first managed as a case of gastroenteritis. Gastroenteritis is among the various differential diagnosis of intussusception a high index of suspicion is required for timely diagnosis. Being available, cheap and free of radiation, using ultrasound more often in infants can aid diagnosis.
Introduction Intussusception is the process of invagination of a bowel segment into the adjoining intestinal lumen which may cause bowel obstruction and gangrene. It commonly occurs in infants at a mean age of 9-months with male preponderance. The condition has excellent prognosis if diagnosis is made early and appropriate treatment commenced and mortality rate from intussusception in children can be less than 1%. However, if diagnosis or treatments are delayed it can be fatal in a few days. Presentation of case We present a case of Ileo-colic perforated ileum due to delayed diagnosis. It was initially misdiagnosed as gastroenteritis at another hospital. The infant was resuscitated with intravenous fluid and had laparotomy. A signed consent was obtained before the surgery and media consent was signed for publication. A gangrenous terminal ileum was resected and ileo-colic anastomosis was done. Post-operative course was uncomplicated and the patient was discharged after 5days. Discussion The index case presented late with complication of gangrene and perforation because it was first managed as a case of gastroenteritis. Gastroenteritis is among the various differential diagnosis of intussusception. Complications have been reported to increase numbers of surgical treatment and sometimes mortality, but rarely occur with good diagnostic acumen. Conclusion We conclude that high clinical suspicion, interaction with senior surgeons and regular use of ultrasound in infants with gastrointestinal symptoms will aid diagnosis. Although surgery was performed in the index case, non-surgical reduction is a very efficient treatment modality in uncomplicated cases.
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Talabi AO, Famurewa OC, Bamigbola KT, Sowande OA, Afolabi BI, Adejuyigbe O. Sonographic guided hydrostatic saline enema reduction of childhood intussusception: a prospective study. BMC Emerg Med 2018; 18:46. [PMID: 30463518 PMCID: PMC6249894 DOI: 10.1186/s12873-018-0196-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 11/05/2018] [Indexed: 11/26/2022] Open
Abstract
Background The management of childhood intussusception in our sub-region is still via surgical intervention. Currently, the gold standard of treatment is non-operative reduction. We sought to assess the suitability of hydrostatic (saline) reduction of intussusception in children in our institution. Materials and methods A prospective study was conducted between January 2016 and June 2017 in all children with ultrasound confirmed intussusception at a tertiary teaching hospital in Nigeria. All children excluding those with signs of peritonitis, bowel gangrene and intestinal prolapse were selected for ultrasound-guided hydrostatic reduction (USGHR). We allowed a maximum of three attempts at reduction. Results The age range was 3 months to 48 months with a mean of 10.8 ± 9.1 months. Forty percent (N = 18) presented after 24 h of onset of symptoms. The success rate of hydrostatic reduction with saline enema was 84.4% (N = 38). Two (4.4%) perforations occurred during the procedure. Three (7.5%) patients had recurrent intussusception within six months. The duration of symptoms greater than 24 h, age and sex of patients did not influence successful reduction p > 0.05. The duration of admission between those who had successful non-operative reduction and those who subsequently had operative reduction and or resection attained statistical significant difference, p = 0.001. There was no mortality. We achieved a 68% decrease in the operative reduction of intussusception using USGHR as the primary modality of treatment. Conclusion Our study found out that USGHR is a suitable alternative for the treatment of childhood intussusception.
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Affiliation(s)
- Ademola Olusegun Talabi
- Department of Surgery, Obafemi Awolowo University, P. O. BOX 5538, Ile-Ife, Osun State, Nigeria.
| | | | | | - Oludayo Adedapo Sowande
- Department of Surgery, Obafemi Awolowo University, P. O. BOX 5538, Ile-Ife, Osun State, Nigeria
| | | | - Olusanya Adejuyigbe
- Department of Surgery, Obafemi Awolowo University, P. O. BOX 5538, Ile-Ife, Osun State, Nigeria
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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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Khorana J, Patumanond J, Ukarapol N, Laohapensang M, Visrutaratna P, Singhavejsakul J. Clinical prediction rules for failed nonoperative reduction of intussusception. Ther Clin Risk Manag 2016; 12:1411-1416. [PMID: 27695337 PMCID: PMC5028175 DOI: 10.2147/tcrm.s115253] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
PURPOSE The nonoperative reduction of intussusception in children can be performed safely if there are no contraindications. Many risk factors associated with failed reduction were defined. The aim of this study was to develop a scoring system for predicting the failure of nonoperative reduction using various determinants. PATIENTS AND METHODS The data were collected from Chiang Mai University Hospital and Siriraj Hospital from January 2006 to December 2012. Inclusion criteria consisted of patients with intussusception aged 0-15 years with no contraindications for nonoperative reduction. The clinical prediction rules were developed using significant risk factors from the multivariable analysis. RESULTS A total of 170 patients with intussusception were included in the study. In the final analysis model, 154 patients were used for identifying the significant risk factors of failure of reduction. Ten factors clustering by the age of 3 years were identified and used for developing the clinical prediction rules, and the factors were as follows: body weight <12 kg (relative risk [RR] =1.48, P=0.004), duration of symptoms >48 hours (RR =1.26, P<0.001), vomiting (RR =1.63, P<0.001), rectal bleeding (RR =1.50, P<0.001), abdominal distension (RR =1.60, P=0.003), temperature >37.8°C (RR =1.51, P<0.001), palpable mass (RR =1.26, P<0.001), location of mass (left over right side RR =1.48, P<0.001), ultrasound showed poor prognostic signs (RR =1.35, P<0.001), and the method of reduction (hydrostatic over pneumatic, RR =1.34, P=0.023). Prediction scores ranged from 0 to 16. A high-risk group (scores 12-16) predicted a greater chance of reduction failure (likelihood ratio of positive [LR+] =18.22, P<0.001). A low-risk group (score 0-11) predicted a lower chance of reduction failure (LR+ =0.79, P<0.001). The performance of the scoring model was 80.68% (area under the receiver operating characteristic curve). CONCLUSION This scoring guideline was used to predict the results of nonoperative reduction and forecast the prognosis of the failed reduction. The usefulness of these prediction scores is for informing the parents before the reduction. This scoring system can be used as a guide to promote the possible referral of the cases to tertiary centers with facilities for nonoperative reduction if possible.
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Affiliation(s)
- Jiraporn Khorana
- Department of Surgery, Division of Pediatric Surgery, Chiang Mai University Hospital, Chiang Mai
| | - Jayanton Patumanond
- Center of Excellence in Applied Epidemiology, Thammasat University Hospital, Bangkok
| | - Nuthapong Ukarapol
- Department of Pediatrics, Division of Gastroenterology, Chiang Mai University Hospital, Chiang Mai
| | - Mongkol Laohapensang
- Department of Surgery, Division of Pediatric Surgery, Siriraj Hospital, Mahidol University, Bangkok
| | - Pannee Visrutaratna
- Department of Radiology, Chiang Mai University Hospital, Chiang Mai, Thailand
| | - Jesda Singhavejsakul
- Department of Surgery, Division of Pediatric Surgery, Chiang Mai University Hospital, Chiang Mai
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