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Alghenaim M, Awadh M, Alshafai A, Darwish A. Intestinal Intussusception Complicating an Undiagnosed Burkitt Lymphoma in a Pediatric Arab Patient. Cureus 2024; 16:e55949. [PMID: 38601415 PMCID: PMC11005805 DOI: 10.7759/cureus.55949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Burkitt's lymphoma (BL) is considered an aggressive form of a non-Hodgkin B-cell lymphoma, representing less than 5% of all pediatric malignancies and 30% of pediatric lymphomas. However, intestinal BL may present as a lead point, causing intussusception. Surgery continues to be the gold standard for the treatment and identification of localized tumors to ensure complete removal with proper margin. In this report, we describe a hidden BL presenting as intestinal intussusception in an eight-year-old Arab boy. A computed tomography (CT) scan of the abdomen revealed an ileoileal intussusception with multiple enlarged lymph nodes. The report discusses the role of histopathology, supported by immunohistochemistry studies, in establishing the diagnosis. It also covers the significance of proper laparoscopic surgery and chemotherapy in the management of this child.
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Affiliation(s)
- Marwa Alghenaim
- Department of Pathology and Laboratory Medicine, Bahrain Defense Force (BDF) Royal Medical Services, Riffa, BHR
| | - Mohamed Awadh
- Department of Pathology and Laboratory Medicine, Bahrain Defense Force (BDF) Royal Medical Services, Riffa, BHR
| | - Abdulrahman Alshafai
- Department of Pediatric Surgery, Bahrain Defense Force (BDF) Royal Medical Services, Riffa, BHR
| | - Abdulla Darwish
- Department of Pathology and Laboratory Medicine, Bahrain Defense Force (BDF) Royal Medical Services, Riffa, BHR
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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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Endo Y, Jimbo K, Arai N, Ochi T, Suzuki M, Yamataka A, Shimizu T. A Pediatric Case of Inverted Meckel's Diverticulum Presenting with Cyclic Vomiting-like Symptoms: A Case Report and Literature Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121817. [PMID: 36553261 PMCID: PMC9776476 DOI: 10.3390/children9121817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
Asymptomatic Meckel's diverticulum cases are not uncommon, leading to diagnostic difficulties in cases of atypical presentations with only gastrointestinal symptoms other than bloody stool. A nine-year-old boy diagnosed as having cyclic vomiting because of recurrent abdominal pain and vomiting for 6 months was referred to our institute and hospitalized due to worsening symptoms. After admission, abdominal ultrasonography showed the multiple concentric ring sign and a pseudokidney sign at the lower ileum, leading to the diagnosis of ileo-ileal intussusception, but the gastrointestinal symptoms and ultrasonic findings disappeared spontaneously. Transanal, double-balloon, intestinal endoscopy demonstrated a pedunculated polyp-like structure, and surgical resection was performed. An inverted diverticulum was found in the resected intestinal lumen, and ectopic gastric mucosa was identified histologically, leading to the diagnosis of inverted Meckel's diverticulum. In pediatric cases involving periodic attacks of vomiting and abdominal pain, unnecessary emergent surgery could be avoided by cautious imaging evaluation and consideration of ileo-ileal intussusception with advanced lesions of an inverted Meckel's diverticulum as a differential diagnosis, without facilely diagnosing cyclic vomiting. In addition, previous reports of inverted Meckel's diverticulum were reviewed, and the results were compared between adult and pediatric groups in each category.
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Affiliation(s)
- Yoshiko Endo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Keisuke Jimbo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
- Correspondence: ; Tel.: +81-(0)3-3813-3111
| | - Nobuyasu Arai
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Takanori Ochi
- Department of Pediatric General and Urogenital Surgery, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Mitsuyoshi Suzuki
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
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KATI Ö, GÜNGÖR Ş, KANDUR Y, GÜLER AG. İnvajinasyonda Tedavi Yaklaşımı: Takip mi Cerrahi mı? KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1151371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Objective: In this study, we describe the management and outcome of children with intussusception and analyze the sonographic findings that can be used to differentiate transient, self-limited small bowel intussusception from the cases with an indication for surgery.
Material and Methods: We retrospectively reviewed the medical records of pediatric patients with the diagnosis of invagination who had been followed up in the pediatric surgery service between 2012-2017.
Results: The median age was 39.5±35.9 (range 2-171) months. Among these patients, 57 (64%) had been followed up without surgery, and the remaining patients (n= 32, 36%) had undergone surgery. The median age of patients who had not undergone surgery was significantly greater than that of the patients who had undergone surgery (52.2±38.4 vs. 16.75±12.6; p
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Ileocolic intussusception in pediatric SARS-CoV-2 patients: experience at a tertiary pediatric center. Pediatr Surg Int 2022; 38:437-443. [PMID: 34999941 PMCID: PMC8742661 DOI: 10.1007/s00383-022-05061-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE COVID-19 disease can manifest with intussusception in pediatric patients, but prevalence of abnormalities on ultrasounds performed for intussusception is uncertain. We aim to report our experience in children with COVID-19 presenting with suspected intussusception imaged with ultrasound. METHODS Children under 18 years who had an ultrasound for possible intussusception underwent retrospective analysis and were tested for COVID-19 between April 1 and December 14, 2020. Patients' demographic, clinical, radiological and surgical characteristics were reviewed. RESULTS Twenty-four COVID-19-positive patients were identified; 19 boys with mean age 3 years (range: 3 months-18 years). Ultrasound was abnormal in 11 patients (11/24, 46%). Sonographic features of enterocolitis were documented in seven children (7/24, 29%). Three boys (3/24, 13%) were found to have ileocolic intussusception on ultrasound and underwent air enema with failed reduction (3/3, 100%), precipitating surgical reductions, all with favorable outcomes. One patient (1/24, 4%) was found to have a long segment of persistent small bowel-small bowel intussusception which was surgically repaired. CONCLUSION Given the known association between failed reduction at air enema and delayed presentation, heightened awareness for intussusception in the setting of COVID-19 should be maintained, though more often, the etiology was attributed to other GI manifestations of COVID-19.
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Maruta S, Inoue S, Odaka A, Muta Y, Takeuchi Y, Beck Y, Kikuchi J. Small bowel intussusception caused by a solitary Peutz-Jeghers–type polyp. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Incidental findings are common in the evaluation of surgical patients. Understanding the appropriate assessment and management of these frequent occurrences is important for the provision of comprehensive quality care. This review details the epidemiology, considerations, and recommendations for management of common incidental manifestations in surgical patients, including Meckel diverticulum, adrenal incidentaloma, thyroid nodule, solitary pulmonary nodule, small bowel intussusception, gallstones, and incidental appendectomy.
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Affiliation(s)
- Keely Reidelberger
- University of Nebraska Medical Center College of Medicine, 986880 Nebraska Medical Center, Omaha, NE 68198-6880, USA
| | - Abbey Fingeret
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, 986880 Nebraska Medical Center, Omaha, NE 68198-6880, USA.
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Fidancı İ, Derinöz Güleryüz O, Tokgöz A. Evaluation of spontaneous reduction among the invagination cases admitted to the paediatric emergency department; retrospective study. Int J Clin Pract 2021; 75:e14322. [PMID: 33960061 DOI: 10.1111/ijcp.14322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/11/2021] [Accepted: 05/03/2021] [Indexed: 11/27/2022] Open
Abstract
AIMS We aimed to determine the factors that determine the conditions in cases of invagination with spontaneous reduction. METHODS Study was conducted retrospectively in the Paediatric Emergency Department (PED) of the tertiary University Hospital in Ankara, Turkey. Invagination cases admitted between January 1, 2019 and December 31, 2019 were included in the study. Patient information (demographic data such as age, gender, physical examination findings, laboratory and imaging methods, treatment and follow-up) were recorded on the data form prepared by the researchers before the study, using patient files and hospital patient information system. Data were analysed with IBM SPSS V23. RESULTS During the study period, the number of cases who applied to the PED was 33,849 and 74 of these cases were diagnosed with invagination. In the cases diagnosed with invagination, 69 (93%) of them spontaneously reduced during the follow-up. Among all cases, the male sex ratio was 56.5% (39/69). The average age was 44.6 months (minimum: 6; maximum: 154). The mean follow-up time in the emergency room was 12 hours and in the hospital service was 38 hours. Vomiting was observed in 89.9% (58/69) of all cases, abdominal pain in 68.1% (44/69) and rectal bleeding in 1.4% (1/69).The invagination of 21.7% (15/69) of the patients at the first USG was ileo-ileal. 63.8% (44/69) of the patients were discharged after followed up in emergency observation. The number of USGs was lower in the group that was discharged after the follow-up in the emergency room, than the follow-up groups in the service monitoring (P = .012). CONCLUSION Invagination is one of the surgical emergencies. With the widespread use of USG, most of these cases are followed up by clinical and USG follow-up in paediatric emergency services. Spontaneous reduction frequently develops in cases of intussusception with small bowel localisation and short bowel segment (less than 3 cm).
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Affiliation(s)
- İlknur Fidancı
- Department of Pediatrics, Department of Pediatric Emergency, Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Okşan Derinöz Güleryüz
- Division of Pediatric Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Aslıhan Tokgöz
- Department of Pediatrics, Faculty of Medicine, Gazi University, Ankara, Turkey
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Khasawneh R, El-Heis M, Al-Omari M, Al-Qaralleh MA, Al-Manasra AR, Alqudah AA, Awad S. The radiological characteristics of childhood intussusception including unusual features and rare pathological lead points. Heliyon 2021; 7:e07231. [PMID: 34169171 PMCID: PMC8207212 DOI: 10.1016/j.heliyon.2021.e07231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/17/2021] [Accepted: 06/02/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To describe the radiological characteristics for childhood intussusceptions including unusual radiological features and rare pathological lead points (PLP). MATERIAL AND METHODS The medical records of all childhood intussusceptions between 1/1/2010 -1/10/2020 were retrospectively reviewed. 95 cases were identified in 82 patients. The demographic data, presenting symptoms, diagnostic and treatment methods, radiological features, and PLPs among the different types of intussusception were analyzed. RESULTS Ileocolic intussusception (ICI) represented 53.7% (51/95). The average age for ICI was 1.87 years. Males constituted 72.1% (31/43). 29.4% (15/51) were treated primarily surgically due to peritonitis. Small bowel intussusception (SBI) represented 40% (38/95) in which females constituted 51.5% (17/33). Ileo-ileal represented 63.2% (24/38). 81.8% (27/33) were transient. On ultrasound; There was a statistically significant difference in the size of the outer diameter of ICI compared to SBI (P-value 0.00012). Ileo-ileocolic and colo-colic intussusceptions constituted 3.2% (3/95); each and were more common in females. Vomiting was the most common symptom for intussusception and ultrasound was diagnostic in the majority of cases. PLPs were seen in 36.6% (30/82) of the patients of which the average age was 7 years. PLPs/risk factors were benign in 80% (24/30). A case of colo-colic intussusception was seen in a 16-year-old female due to clear cell sarcoma which was not reported before. 12.2% patients (10/82) had recurrent intussusception. CONCLUSION Our study showed that ICI is the most commonly encountered type. SBIs are mostly transient. It is important to radiologically determine the type of intussusception and to identify PLPs or unusual radiological features to avoid unnecessary intervention and significant patient morbidity.
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Affiliation(s)
- Ruba Khasawneh
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid 22110, Jordan
| | - Mwaffaq El-Heis
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid 22110, Jordan
| | - Mamoon Al-Omari
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid 22110, Jordan
| | - Mohammed A. Al-Qaralleh
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid 22110, Jordan
| | - Abdel rahman Al-Manasra
- Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid 22110, Jordan
| | - Abdallah A. Alqudah
- Department of Diagnostic Radiology, Irbid Specialty Hospital, Irbid 21110, Jordan
| | - Samah Awad
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
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Thadchanamoorthy V, Dayasiri K. Child with dengue haemorrhagic fever complicated by ileocaecal intussusception. BMJ Case Rep 2021; 14:e237697. [PMID: 33727286 PMCID: PMC7970290 DOI: 10.1136/bcr-2020-237697] [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] [Accepted: 03/02/2021] [Indexed: 11/04/2022] Open
Abstract
Dengue fever is one of the most common neglected tropical diseases with an increasing trend seen in Sri Lanka and many other tropical countries. A number of unusual presentations and complications of dengue fever have been reported, and acute abdomen is one such presentation. However, intussusception as the cause of acute abdomen in a patient with dengue haemorrhagic fever has not been previously reported. The authors report a child who was diagnosed to have intussusception during the critical phase of dengue haemorrhagic fever while having a platelet count of 15×103/cumm. The child had initial point-of-care ultrasound followed by detailed ultrasound of the abdomen by the radiologist, and the diagnosis of ileocaecal intussusception was confirmed. Intussusception was relieved by saline reduction and without needing laparotomy. Early diagnosis and non-operative management prevented emergency laparotomy.
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Affiliation(s)
| | - Kavinda Dayasiri
- Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
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Mendiratta P, Yadav A, Borse N. Paediatric small-bowel intussusception on ultrasound - a case report with differentiating features from the ileocolic subtype. J Ultrason 2021; 21:70-73. [PMID: 33791119 PMCID: PMC8008195 DOI: 10.15557/jou.2021.0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/21/2020] [Indexed: 12/02/2022] Open
Abstract
Aim of the study: Intussusception is a common paediatric emergency which can be diagnosed with relative certainty by ultrasonography in trained hands. Both the ileocolic and small-bowel intussusception have overlapping clinical features and imaging findings on ultrasound. The aim is to differentiate between both subtypes based on selective differentiating features which should always be looked for while performing an ultrasound examination in suspected cases. Differentiating between the two subtypes is essential, since patient management may differ depending on the subtype. Case description: We present a case of a 12-year-old boy who presented to our hospital with pain in the abdomen. An emergency ultrasound revealed findings suggestive of small-bowel intussusception. A brief description of the differentiating points from the ileocolic subtype is also described. Conclusions: Based on the features described, it is possible to confidently differentiate between the two subtypes, which is a guiding factor for treatment.
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Affiliation(s)
- Pushkar Mendiratta
- Department of Radiodiagnosis and Imaging, Military Hospital Mathura, India
| | - Anurav Yadav
- Department of Surgery, Military Hospital Mathura, India
| | - Nitin Borse
- Department of Surgery, Military Hospital Mathura, India
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Childhood Intussusception after Introduction of Indigenous Rotavirus Vaccine: Hospital-Based Surveillance Study from Odisha, India. Indian J Pediatr 2021; 88:112-117. [PMID: 33544368 DOI: 10.1007/s12098-020-03627-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To study the epidemiology of intussusception in children < 2 y of age, postintroduction of Rotavac® (an indigenous oral rotavirus vaccine). METHODS A multicenter hospital-based surveillance was conducted in Odisha from February 2016 to June 2019. The cases were diagnosed according to Brighton level-1 criteria. Data were collected regarding the time of onset, signs and symptoms, radiological diagnosis, management, complications, and outcome (discharged/died). RESULTS One hundred and twenty children < 2 y of age were enrolled. The median age was 7 mo (M:F ratio = 2:1). The most common clinical feature was abdominal distention and blood in stool. The most common method for treatment was hydrostatic/pneumatic reduction. Median time (days) between symptom onset and admission was 2. Median (IQR) duration (days) of hospitalization was 5. Most common location of intussusceptions was ileo-colic. CONCLUSIONS Hydrostatic/pneumatic reduction was possible in the majority presenting ≤ 48 h of symptom onset, and those presenting > 48 h mostly required surgical reduction. Intestinal resection was required in some cases presenting on day 5 of symptom onset. Majority of cases were managed by surgical reduction in Government facility.
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Melvin JE, Zuckerbraun NS, Nworgu CR, Mollen KP, Furtado AD, Manole MD. Management and Outcome of Pediatric Patients With Transient Small Bowel-Small Bowel Intussusception. Pediatr Emerg Care 2021; 37:e110-e115. [PMID: 29746364 DOI: 10.1097/pec.0000000000001503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess the management and outcomes of healthy pediatric patients diagnosed radiologically with transient and benign small bowel-small bowel intussusception (SB-SBI). METHODS Retrospective cohort study of healthy patients 0 to 18 years of age who presented to a children's hospital emergency department from January 1, 2005, to June 30, 2015, and had transient and benign SB-SBI characterized by spontaneous resolution (ie, transient), diameter of less than 2.5 cm, no lead point, normal bowel wall thickness, nondilated proximal small bowel, and no colonic involvement (ie, benign radiographic features). Charts were reviewed for demographics, clinical presentation, radiologic studies obtained, outcomes, and further management. Medical and radiologic records were also reviewed for 1 year after presentation for any subsequent pathologic diagnoses. RESULTS Sixty-eight patients were included in our study, with a total of 87 episodes of transient and benign SB-SBI on initial or follow-up examination. Overall, 39 patients (57%) were admitted to the hospital, and 38 patients (56%) had a surgical consultation. Twenty-four patients (35%) had further radiologic studies obtained, including computed tomography scans, esophagogastroduodenoscopy, Meckel's scan, barium swallow studies, and magnetic resonance imaging. All studies were negative for concerning pathology including apparent lead points. None of the patients required surgical intervention or had any complications. CONCLUSIONS Transient and benign SB-SBIs with reassuring radiologic and clinical features diagnosed in healthy pediatric patients are likely incidentally found and are unlikely to be associated with a pathologic lead point.
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Affiliation(s)
| | | | | | | | | | - Mioara D Manole
- Division of Pediatric Emergency Medicine, Department of Pediatrics
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Ramalingam T, Noor R, Hassan M, Tarmizi M. A case of dual segment intussusception(ileocolic and jejunal jejunal): Dilemma for surgeons and radiologists. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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15
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Thanh Xuan N, Huu Son N, Huu Thien H. Treatment Outcome of Acute Intussusception in Children Under Two Years of Age: A Prospective Cohort Study. Cureus 2020; 12:e7729. [PMID: 32432007 PMCID: PMC7234032 DOI: 10.7759/cureus.7729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Intussusception is a common cause of small intestinal obstruction in children under two years of age. Late diagnosis can lead to a potentially worse condition. This prospective study aims to describe the clinical manifestation and develop a conservative management protocol for acute ileocaecal intussusception in children under two years of age. Methods This prospective study was carried out in 118 consecutive patients under two years of age. Patients presented with symptoms and signs of acute intestinal obstruction and a diagnosis of ileocaecal intussusception confirmed by ultrasound were included in this study. All the patients were managed with either pneumatic reduction or operation. Results There were 70 boys and 48 girls ranging in age from three months to two years with a median of 12.5 months. Clinical presentation included abdominal pain (100%), vomiting (82.2%), bloody stool (11.9%), and a palpable mass (43.2%). Patients hospitalized with the symptoms and signs for less than 24 hours accounted for 80.5% of the cases. The overall success rate of pneumatic reduction was 98.3%. Late hospital admission (≥ 24 hours from illness onset), bloody stool, and presenting with the classic triad of symptoms of intussusception were found as the factors that correlated to the surgical management outcome. All patients recovered well without any complications. The median of postoperative hospital stay of two days for the pneumatic reduction group and six days for the operation group. Conclusion The early diagnosis of intussusception contributes to the success of pneumatic reduction and reduces the requirement of surgical intervention.
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Affiliation(s)
- Nguyen Thanh Xuan
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue, VNM
| | | | - Ho Huu Thien
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue, VNM
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Burnett E, Kabir F, Van Trang N, Rayamajhi A, Satter SM, Liu J, Yousafzai MT, Anh DD, Basnet AT, Flora MS, Houpt E, Qazi SH, Canh TM, Rayamajhi AK, Saha BK, Saddal NS, Muneer S, Hung PH, Islam T, Ali SA, Tate JE, Yen C, Parashar UD. Infectious Etiologies of Intussusception Among Children <2 Years Old in 4 Asian Countries. J Infect Dis 2020; 221:1499-1505. [PMID: 31754717 PMCID: PMC7371463 DOI: 10.1093/infdis/jiz621] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/20/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The etiology of intussusception, the leading cause of bowel obstruction in infants, is unknown in most cases. Adenovirus has been associated with intussusception and slightly increased risk of intussusception with rotavirus vaccination has been found. We conducted a case-control study among children <2 years old in Bangladesh, Nepal, Pakistan, and Vietnam to evaluate infectious etiologies of intussusception before rotavirus vaccine introduction. METHODS From 2015 to 2017, we enrolled 1-to-1 matched intussusception cases and hospital controls; 249 pairs were included. Stool specimens were tested for 37 infectious agents using TaqMan Array technology. We used conditional logistic regression to estimate odds ratio (OR) and 95% confidence interval (CI) of each pathogen associated with intussusception in a pooled analysis and quantitative subanalyses. RESULTS Adenovirus (OR, 2.67; 95% CI, 1.75-4.36) and human herpes virus 6 (OR, 3.50; 95% CI, 1.15-10.63) were detected more frequently in cases than controls. Adenovirus C detection <20 quantification cycles was associated with intussusception (OR, 18.59; 95% CI, 2.45-140.89). Wild-type rotavirus was not associated with intussusception (OR, 1.07; 95% CI, 0.52-2.22). CONCLUSIONS In this comprehensive evaluation, adenovirus and HHV-6 were associated with intussusception. Future research is needed to better understand mechanisms leading to intussusception, particularly after rotavirus vaccination.
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Affiliation(s)
- Eleanor Burnett
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Furqan Kabir
- Dept. of Pediatrics and Child Health, Aga Khan University Karachi, Pakistan
| | | | - Ajit Rayamajhi
- Janak Medical and Research Center, Balaju, Kathmandu, Nepal
- Kanti Children’s Hospital, Maharajgunj, Kathmandu, Nepal
| | | | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
| | | | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Meerjady S. Flora
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Eric Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
| | - Saqib Hamid Qazi
- Dept. of Pediatrics and Child Health, Aga Khan University Karachi, Pakistan
| | | | | | - Bablu K Saha
- Rangpur Medical College Hospital, Rangpur, Bangladesh
| | | | - Sehrish Muneer
- Dept. of Pediatrics and Child Health, Aga Khan University Karachi, Pakistan
| | | | - Towhidul Islam
- Sher E Bangla Medical College Hospital, Barisal, Bangladesh
| | - Syed Asad Ali
- Dept. of Pediatrics and Child Health, Aga Khan University Karachi, Pakistan
| | - Jacqueline E. Tate
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Catherine Yen
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Umesh D. Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
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Wang Q, Luo M, Xie X, Wu Y, Xiang B. Can intussusceptions of small bowel and colon be transient? A prospective study. Eur J Pediatr 2019; 178:1537-1544. [PMID: 31446463 DOI: 10.1007/s00431-019-03455-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/09/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
Abstract
We performed a prospective study to explore a diagnosis and treatment protocol of transient intussusception in children (TIC). Totally, 143 children with intussusception who met the inclusion criteria were firstly divided into intussusception involving only the small bowel and intussusception involving the colon group. And in each group, they were further divided into short-segment (≤ 3.0 cm) and long-segment (> 3.0 cm) groups according to the length of intussusception. After a period of conservative treatment, the incidence of TIC, the incidence of surgery, and recurrence were collected and analyzed. Finally, we found that the incidence of TIC in the short-segment group of small bowel intussusception (96.29%) was significantly higher than that in other groups (P ≤ 0.001). Besides, the incidence of surgery and recurrence in this group was relatively low too. Therefore, we summarized the inclusion criteria and treatments to the short-segment group of small bowel intussusception as the suggested protocol to TIC.Conclusion: For cases of small bowel intussusception with no identified pathologic lead point, a short duration of symptoms, a length of ≤ 3.0 cm, a relatively abundant vascular flow signal, and a stable general condition, the spontaneous reduction could be expected and a period of conservative treatment with careful monitoring is recommended. What is Known: • The phenomenon of spontaneous reduction in intussusception (transient intussusception) among pediatric patients has been widely reported. • To distinguish the transient intussusception from the other types is important for the transient ones only need conservative treatment rather than enema reduction or surgery. What is New: • This is the first prospective study to explore a diagnosis and treatment protocol of transient intussusception in children. • Short-segment small bowel intussusceptions have a higher rate (96.29%) to get spontaneous reduction than the other types of intussusception.
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Affiliation(s)
- Qi Wang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Mengqi Luo
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaolong Xie
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yang Wu
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Bo Xiang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China.
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18
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Paul C, Anderson S. The Correlation Between Pediatric Intussusceptions and Celiac Disease. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319855005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The most common acute abdominal disorder in the pediatric population appears as a telescoping of the bowel, resulting in either intermittent or complete obstruction. Intussusceptions transpire as the bowel prolapses into a more distal bowel segment and is propelled forward. A case is presented of multiple small bowel intussusceptions, pneumatosis, intraperitoneal fluid, and pericardial effusion. Sonography initially visualized the obstructions, along with multiple other indicators of an abdominal disorder. The use of computed tomography followed to provide a more comprehensive view of the child’s abdomen. Each imaging technique revealed new aspects of the abdominal disorder and concluded in the diagnosis of celiac disease. This case supports the idea that small bowel intussusceptions should not be disregarded as insignificant incidental findings but rather should alert sonographers to further investigate for evidence of celiac disease.
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Affiliation(s)
- Cassidy Paul
- University of Missouri, Diagnostic Medical Ultrasound Program, Columbia, MO, USA
| | - Sharlette Anderson
- University of Missouri, Diagnostic Medical Ultrasound Program, Columbia, MO, USA
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19
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Handa A, Nozaki T, Makidono A, Okabe T, Morita Y, Fujita K, Matsusako M, Kono T, Kurihara Y, Hasegawa D, Kumamoto T, Ogawa C, Yuza Y, Manabe A. Pediatric oncologic emergencies: Clinical and imaging review for pediatricians. Pediatr Int 2019; 61:122-139. [PMID: 30565795 DOI: 10.1111/ped.13755] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 11/10/2018] [Accepted: 12/13/2018] [Indexed: 12/20/2022]
Abstract
Children with cancer are at increased risk of life-threatening emergencies, either from the cancer itself or related to the cancer treatment. These conditions need to be assessed and treated as early as possible to minimize morbidity and mortality. Cardiothoracic emergencies encompass a variety of pathologies, including pericardial effusion and cardiac tamponade, massive hemoptysis, superior vena cava syndrome, pulmonary embolism, and pneumonia. Abdominal emergencies include bowel obstruction, intussusception, perforation, tumor rupture, intestinal graft-versus-host disease, acute pancreatitis, neutropenic colitis, and obstructive uropathy. Radiology plays a vital role in the diagnosis of these emergencies. We here review the clinical features and imaging in pediatric patients with oncologic emergencies, including a review of recently published studies. Key radiological images are presented to highlight the radiological approach to diagnosis. Pediatricians, pediatric surgeons, and pediatric radiologists need to work together to arrive at the correct diagnosis and to ensure prompt and appropriate treatment strategies.
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Affiliation(s)
- Atsuhiko Handa
- Department of Radiology, St Luke's International Hospital, Tokyo, Japan.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Taiki Nozaki
- Department of Radiology, St Luke's International Hospital, Tokyo, Japan
| | - Akari Makidono
- Department of Radiology, St Luke's International Hospital, Tokyo, Japan.,Department of Diagnostic Radiology, Tokyo Metropolitan Children's Medical Center, Yokohama, Japan
| | - Tetsuhiko Okabe
- Department of Radiology, St Luke's International Hospital, Tokyo, Japan.,Department of Radiology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yuka Morita
- Department of Radiology, St Luke's International Hospital, Tokyo, Japan.,Department of Radiology, University of the Ryukyus Hospital, Okinawa, Japan
| | - Kazutoshi Fujita
- Department of Diagnostic Radiology, Tokyo Metropolitan Children's Medical Center, Yokohama, Japan.,Department of Radiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Masaki Matsusako
- Department of Radiology, St Luke's International Hospital, Tokyo, Japan
| | - Tatsuo Kono
- Department of Diagnostic Radiology, Tokyo Metropolitan Children's Medical Center, Yokohama, Japan
| | - Yasuyuki Kurihara
- Department of Radiology, St Luke's International Hospital, Tokyo, Japan
| | - Daisuke Hasegawa
- Department of Pediatrics, St Luke's International Hospital, Tokyo, Japan
| | - Tadashi Kumamoto
- Department of Pediatrics, St Luke's International Hospital, Tokyo, Japan.,Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Chitose Ogawa
- Department of Pediatrics, St Luke's International Hospital, Tokyo, Japan.,Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuki Yuza
- Department of Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Atsushi Manabe
- Department of Pediatrics, St Luke's International Hospital, Tokyo, Japan
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20
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Radiographic and Clinical Factors in Pediatric Patients With Surgical Small-bowel Intussusception. J Surg Res 2019; 233:167-172. [DOI: 10.1016/j.jss.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/03/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023]
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21
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Burnett E, Van Trang N, Rayamajhi A, Yousafzai MT, Satter SM, Anh DD, Thapa A, Qazi SH, Heffelfinger JD, Hung PH, Rayamajhi AK, Saddal N, Flora MS, Canh TM, Ali SA, Gurley ES, Tate JE, Yen C, Parashar UD. Preparing for safety monitoring after rotavirus vaccine introduction - Assessment of baseline epidemiology of intussusception among children <2 years of age in four Asian countries. Vaccine 2018; 36:7593-7598. [PMID: 30414781 PMCID: PMC10983083 DOI: 10.1016/j.vaccine.2018.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/29/2018] [Accepted: 11/01/2018] [Indexed: 11/23/2022]
Abstract
Intussusception is the invagination of one segment of the bowel into a distal segment, characterized by symptoms of bloody stool, vomiting, and abdominal pain. Previous studies have found regional differences in incidence but the etiology of most intussusception cases is unknown. Rotavirus vaccines were associated with a slightly of increased risk of intussusception in post-licensure evaluations in high- and middle-income countries, but not in low income African countries. To describe the baseline epidemiology of intussusception in young children prior to rotavirus vaccine implementation, active sentinel hospital surveillance for intussusception in children < 2 years of age was conducted in 4 low income Asian countries (Bangladesh, Nepal, Pakistan and Vietnam). Over a 24-month period, 15 sites enrolled 1,415 intussusception cases, of which 70% were enrolled in Vietnam. Overall, 61% of cases were male and 1% (n = 16) died, ranging from 8% in Pakistan to 0% in Vietnam. The median age of cases enrolled ranged from 6 months in Bangladesh and Pakistan to 12 months in Vietnam. The proportion of cases receiving surgical management was 100% in Bangladesh, 88% in Pakistan, 61% in Nepal, and 1% in Vietnam. The high proportion of males and median age of cases around 6 months of age found in this regional surveillance network are consistent with previous descriptions of the epidemiology of intussusception in these countries and elsewhere. Differences in management and the fatality rate of cases between the countries likely reflect differences in access to healthcare and availability of diagnostic modalities. These baseline data will be useful for post-rotavirus vaccine introduction safety monitoring.
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Affiliation(s)
- Eleanor Burnett
- CDC Foundation for the US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Nguyen Van Trang
- National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam
| | - Ajit Rayamajhi
- Janek Medical and Research Center, Kathmandu, Nepal; Kanthi Children's Hospital, Kathmandu, Nepal
| | | | | | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam
| | | | - Saqib Hamid Qazi
- Department of Pediatric Surgery, Aga Khan University, Karachi, Pakistan
| | | | | | | | - Nasir Saddal
- Department of Surgery, National Institute of Child Health, Karachi, Pakistan
| | - Meerjady S Flora
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | - Syed Asad Ali
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Catherine Yen
- Centers for Disease Control and Prevention, Atlanta, USA
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22
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Zacharias SA, Prasad R, Ciullo S, Mallon MG, Marinovich A, Pall H. Small Bowel Intussusception in a 16-Month-Old Child With Peutz-Jeghers Syndrome. Clin Pediatr (Phila) 2018; 57:745-748. [PMID: 28929791 DOI: 10.1177/0009922817732148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Rajeev Prasad
- 1 St Christopher's Hospital for Children, Philadelphia, PA, USA.,2 Drexel University College of Medicine, Philadelphia, PA, USA
| | - Sean Ciullo
- 1 St Christopher's Hospital for Children, Philadelphia, PA, USA.,2 Drexel University College of Medicine, Philadelphia, PA, USA
| | - Mary G Mallon
- 1 St Christopher's Hospital for Children, Philadelphia, PA, USA.,2 Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Harpreet Pall
- 1 St Christopher's Hospital for Children, Philadelphia, PA, USA.,2 Drexel University College of Medicine, Philadelphia, PA, USA
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23
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24
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Satter SM, Aliabadi N, Yen C, Gastañaduy PA, Ahmed M, Mamun A, Islam K, Flora MS, Rahman M, Zaman K, Rahman M, Heffelfinger JD, Luby SP, Gurley ES, Parashar UD. Epidemiology of childhood intussusception in Bangladesh: Findings from an active national hospital based surveillance system, 2012-2016. Vaccine 2017; 36:7805-7810. [PMID: 28941622 PMCID: PMC5864564 DOI: 10.1016/j.vaccine.2017.08.092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/06/2017] [Accepted: 08/09/2017] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Rotavirus vaccines have significantly decreased the burden of diarrheal diseases in countries that have introduced them into their immunization programs. In some studies, there has been a small association between rotavirus vaccines and intussusception in post-marketing surveillance, highlighting the importance of tracking incidence before and after vaccine introduction. The objective of this study was to describe the epidemiology of intussusception among Bangladeshi children pre-vaccine introduction. METHODS We conducted active, hospital-based surveillance for intussusception at 7 tertiary care hospitals with pediatric surgical facilities during July 2012 to September 2016. Hospitalized children under 2years of age were identified according to Brighton Collaboration level 1 criteria for intussusception. The frequency and proportion of intussusception among overall surgical admissions, as well as the demographic and clinical information of the cases is described. RESULTS Overall 153 cases of intussusception among children <2years-old were identified at participating sites over the enrolment period, confirmed by Level 1 Brighton criteria. These cases represented 2% of all surgical admissions under 2years of age. One hundred twelve cases (73%) were male; the median age was 7months; and the median duration of hospitalization was 7days. One hundred forty-six (95%) children with intussusception required surgery, and 11 (7%) died. CONCLUSIONS Confirmed cases of intussusception represented nearly 2% of pediatric surgical admissions at tertiary referral centers in Bangladesh during the study period and 7% of children with intussusception died. Given the high burden of rotavirus disease in Bangladesh, vaccine introduction is warranted, however, further studies after introduction of rotavirus vaccine are necessary to determine any association between vaccine and intussusception in this setting.
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Affiliation(s)
| | - Negar Aliabadi
- Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Catherine Yen
- Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | | | - Makhdum Ahmed
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Khaleda Islam
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Meerjady S Flora
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | | | | | - Stephen P Luby
- Center for Innovation in Global Health, Stanford University, USA
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25
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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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26
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Unusual ultrasound appearance of small bowel intussusception and secondary bowel obstruction in a child with Peutz-Jeghers syndrome. Clin Imaging 2017; 43:136-139. [PMID: 28314199 DOI: 10.1016/j.clinimag.2017.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/15/2017] [Accepted: 03/07/2017] [Indexed: 11/22/2022]
Abstract
Small bowel intussusception (SBI) in pediatric patients resolves spontaneously in the majority of cases. Pathologic small bowel intussusception with a lead point is rare in children. Ultrasound (US) is the preferred initial imaging study for the diagnosis of intussusception. We report a case of long-segment SBI and secondary bowel obstruction caused by a large hamartomatous polyp. This case emphasizes unique, atypical ultrasound findings that may be encountered in small bowel intussusception, with correlative radiographic, CT (computed tomography) and intra-operative findings. Increased awareness of these atypical imaging features can lead to early diagnosis and decrease the risk of potential complications including mesenteric venous thrombosis, bowel ischemia and necrosis.
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Marsicovetere P, Ivatury SJ, White B, Holubar SD. Intestinal Intussusception: Etiology, Diagnosis, and Treatment. Clin Colon Rectal Surg 2016; 30:30-39. [PMID: 28144210 DOI: 10.1055/s-0036-1593429] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Intussusception is defined as the invagination of one segment of the bowel into an immediately adjacent segment of the bowel. Idiopathic ileocolic intussusception is the most common form in children and is typically managed with nonoperative reduction via pneumatic and/or hydrostatic enemas. In the adult population, intussusception is uncommon and occurs more often in the small intestine than in the colon. It is associated with lead point pathology in most symptomatic cases presenting as bowel obstruction. When lead point pathology is present in adult small bowel intussusception, it is usually benign, though when malignant it is most frequently due to diffuse metastatic disease, for example, melanoma. In contrast, adult ileocolic and colonic intussusception lead point pathology is most frequently primary adenocarcinoma when malignant. The diagnosis is typically made intraoperatively or by cross-sectional imaging. With increasingly frequent CT/MRI of the adult abdomen in the current era, transient and/or asymptomatic intussusceptions are increasingly found and may often be appropriately observed without intervention. When intervention in the adult population is warranted, usually oncologic bowel resection is performed due to the association with lead point pathology.
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Affiliation(s)
- Priscilla Marsicovetere
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire
| | - S Joga Ivatury
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire; The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire
| | - Brent White
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire
| | - Stefan D Holubar
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire; The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire
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28
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Gale HI, Gee MS, Westra SJ, Nimkin K. Abdominal ultrasonography of the pediatric gastrointestinal tract. World J Radiol 2016; 8:656-667. [PMID: 27551336 PMCID: PMC4965350 DOI: 10.4329/wjr.v8.i7.656] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/11/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023] Open
Abstract
Ultrasound is an invaluable imaging modality in the evaluation of pediatric gastrointestinal pathology; it can provide real-time evaluation of the bowel without the need for sedation or intravenous contrast. Recent improvements in ultrasound technique can be utilized to improve detection of bowel pathology in children: Higher resolution probes, color Doppler, harmonic and panoramic imaging are excellent tools in this setting. Graded compression and cine clips provide dynamic information and oral and intravenous contrast agents aid in detection of bowel wall pathology. Ultrasound of the bowel in children is typically a targeted exam; common indications include evaluation for appendicitis, pyloric stenosis and intussusception. Bowel abnormalities that are detected prenatally can be evaluated after birth with ultrasound. Likewise, acquired conditions such as bowel hematoma, bowel infections and hernias can be detected with ultrasound. Rare bowel neoplasms, vascular disorders and foreign bodies may first be detected with sonography, as well. At some centers, comprehensive exams of the gastrointestinal tract are performed on children with inflammatory bowel disease and celiac disease to evaluate for disease activity or to confirm the diagnosis. The goal of this article is to review up-to-date imaging techniques, normal sonographic anatomy, and characteristic sonographic features of common and uncommon disorders affecting the gastrointestinal tract in children.
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Aydin N, Roth A, Misra S. Surgical versus conservative management of adult intussusception: Case series and review. Int J Surg Case Rep 2016; 20:142-6. [PMID: 26859872 PMCID: PMC4818310 DOI: 10.1016/j.ijscr.2016.01.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/16/2016] [Indexed: 11/17/2022] Open
Abstract
Adult intussusception has traditionally been considered an indication for surgery. Transient intussusceptions are now detected with increased use of imaging. In patients with low risk for underlying neoplasm, supportive care is sufficient. Smaller intussusceptions are more likely to resolve with conservative treatment.
Introduction Intussusception is the telescoping of a segment of bowel into its adjacent segment. It is a known cause of abdominal pain in the pediatric population, however, it is rare in the adult. Adults do not always present with the typical symptoms seen in young children, making the clinical diagnosis more difficult. The etiology of adult intussusception can be idiopathic, benign, or malignant. Diagnosis is most accurately made with computed tomography, which is sensitive in detecting intussusception as well as potential lead points. Presentation of cases This study presents four adult patients with intussusception. The first three patients are adults with idiopathic intussusception and no evidence of a lead point. The fourth case involves intussusception secondary to a jejunal carcinoid tumor which was treated surgically. Each case has unique features in terms of length and number of intussusceptions, duration of symptoms, and recurrence. Discussion Surgical treatment was once argued to be universally appropriate for adult intussusceptions; however, with increased use of advanced imaging, newer literature is demonstrating that this is not true in all cases. Idiopathic intussusception presents with nonspecific symptoms and can be managed with supportive care when the history and clinical picture indicate low probability of a neoplasm. Conclusion This study aims to raise awareness to the potential diagnosis and management of intussusceptions, particularly the symptomatic idiopathic type in the young adult.
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Affiliation(s)
- Nail Aydin
- Department of Surgery, Texas Tech University Health Sciences Center, 1400 South Coulter Street, Amarillo, TX 79106-1786, USA.
| | - Andrew Roth
- Department of Surgery, Texas Tech University Health Sciences Center, 1400 South Coulter Street, Amarillo, TX 79106-1786, USA.
| | - Subhasis Misra
- Department of Surgery, Texas Tech University Health Sciences Center, 1400 South Coulter Street, Amarillo, TX 79106-1786, USA.
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Bartocci M, Fabrizi G, Valente I, Manzoni C, Speca S, Bonomo L. Intussusception in childhood: role of sonography on diagnosis and treatment. J Ultrasound 2014; 18:205-11. [PMID: 26261462 DOI: 10.1007/s40477-014-0110-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 05/30/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine the role of ultrasound in the diagnosis and treatment of pediatric patients with acute abdominal pain caused by intussusceptions. MATERIALS AND METHODS We performed a retrospective study of all pediatric patients with acute abdominal pain caused by intussusceptions and that underwent ultrasound examination at the emergency service of the Radiology Department between November 2007 and June 2013. The role of ultrasonography in the diagnosis of intussusceptions has been assessed by comparing the echographic presumptive diagnosis with the final diagnosis of discharge. Its importance in the treatment has been assessed by determining the value of ultrasound findings in the choice of the best treatment. RESULTS The ultrasound examination was positive in 16/18 patients with a final diagnosis of intussusception. Some sonographic findings seemed to be able to predict the opportunity to resort to non-surgical therapeutic options like hydrostatic or pneumatic reduction of the intestinal segments invaginated. In our casuistry, five children presented characteristics typical of this subgroup and underwent barium enema which provided the reduction of the intestinal segments involved. The future challenge will be to perform non-surgical ultrasound-guided reductions to avoid the exposure of the infants to ionizing radiations. CONCLUSIONS Ultrasonography is essential not only in the diagnosis, but also it adds important elements in the therapeutic choice and could play in the future an important role in non-surgical reduction of intestinal intussusceptions in pediatric patients.
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Affiliation(s)
- M Bartocci
- Department of Radiological Sciences, Radiology Institute, Catholic University of Rome, A. Gemelli Hospital. L.go A. Gemelli 8, 00168 Rome, Italy ; Via Monte Nagni n°5, 06034 Foligno (PG), Italy
| | - G Fabrizi
- Department of Radiological Sciences, Radiology Institute, Catholic University of Rome, A. Gemelli Hospital. L.go A. Gemelli 8, 00168 Rome, Italy
| | - I Valente
- Department of Radiological Sciences, Radiology Institute, Catholic University of Rome, A. Gemelli Hospital. L.go A. Gemelli 8, 00168 Rome, Italy
| | - C Manzoni
- Department of Surgical Sciences, Pediatric Surgery Institute, Catholic University of Rome, A. Gemelli Hospital. L.go A. Gemelli 8, 00168 Rome, Italy
| | - S Speca
- Department of Radiological Sciences, Radiology Institute, Catholic University of Rome, A. Gemelli Hospital. L.go A. Gemelli 8, 00168 Rome, Italy
| | - L Bonomo
- Department of Radiological Sciences, Radiology Institute, Catholic University of Rome, A. Gemelli Hospital. L.go A. Gemelli 8, 00168 Rome, Italy
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Lioubashevsky N, Hiller N, Rozovsky K, Segev L, Simanovsky N. Ileocolic versus small-bowel intussusception in children: can US enable reliable differentiation? Radiology 2013; 269:266-71. [PMID: 23801771 DOI: 10.1148/radiol.13122639] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To assess clinical and ultrasonographic (US) criteria that can be used to confidently differentiate ileocolic from small-bowel intussusception. MATERIALS AND METHODS Institutional review board approval was obtained for this retrospective study, and the need to obtain informed consent was waived. US and clinical data for children given a diagnosis of intussusception in the years 2007 through 2011 were evaluated. The diameters of the intussusception and the inner fat core, the outer bowel wall thickness, and the presence or absence of lymph nodes inside the intussusception and mesentery were noted. The Student t test, the Mann-Whitney test, and the Levene test were used for comparison of parametric variables, while the χ(2) and Fisher exact tests were used for comparison of categoric data. RESULTS There were 200 cases of intussusception in 174 patients (126 boys, 48 girls; mean age, 17.2 months (range, 0 years to 7 years 1 month); 57 (28.5%) were small-bowel and 143 (71.5%) were ileocolic intussusceptions. Mean lesion diameter was 2.63 cm (range, 1.3-4.0 cm) for ileocolic versus 1.42 cm (range, 0.8-3.0 cm) for small-bowel intussusception (P < .0001). Mean fat core diameter was 1.32 cm (range, 0.6-2.2 cm) for ileocolic versus 0.1 cm (range, 0-0.75 cm) for small-bowel intussusception (P < .0001). The ratio of inner fat core diameter to outer wall thickness was greater than 1.0 in all ileocolic intussusceptions and was less than 1.0 in all small-bowel intussusceptions (P < .0001). Lymph nodes inside the lesion were seen in 128 (89.5%) of the 143 ileocolic intussusceptions versus in eight (14.0%) of the 57 small-bowel intussusceptions (P < .0001). Children with ileocolic intussusception had more severe clinical symptoms and signs, with more vomiting (P = .003), leukocytosis (P = .003), and blood in the stool (P = .00005). CONCLUSION The presence of an inner fatty core in the intussusception, lesion diameter, wall thickness, the ratio of fatty core thickness to outer wall thickness, and the presence of lymph nodes in the lesion may enable reliable differentiation between ileocolic and small-bowel intussusceptions.
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Affiliation(s)
- Natali Lioubashevsky
- Department of Medical Imaging, Hadassah-Hebrew University Medical Center, POB 24035, Jerusalem, Israel 91120
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Multiple intestinal intussusceptions as a complication of severe hyperglycemia in a patient with diabetic ketoacidosis. Case Rep Endocrinol 2012; 2012:526041. [PMID: 23056964 PMCID: PMC3463912 DOI: 10.1155/2012/526041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 08/16/2012] [Indexed: 01/24/2023] Open
Abstract
Intussusception in adults is a rare phenomenon, occurring in approximately 1 in 30,000 hospital admissions annually. When it does occur, the majority of cases involve an organic lesion serving as a lead point for intussusception, such as tumors or postoperative adhesions. In a small percentage of cases, a lead point is not found, and intussusception is thought to be idiopathic or secondary to a disease process contributing to dysrhythmic peristalsis of the gastrointestinal tract. A few cases of functional intussusception have been reported as being secondary to severe hyperglycemia and metabolic derangements, including metabolic acidosis and hyperkalemia, by causing impaired gastrointestinal motility. We present a case of a 23-year-old Caucasian male who presented with severe hyperglycemia and diabetic ketoacidosis. Imaging of the abdomen revealed three intussusceptions involving the small intestine, which were easily reduced manually during exploratory laparotomy.
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Cogley JR, O'Connor SC, Houshyar R, Al Dulaimy K. Emergent pediatric US: what every radiologist should know. Radiographics 2012; 32:651-665. [PMID: 22582352 DOI: 10.1148/rg.323115111] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Appendicitis, intussusception, and hypertrophic pyloric stenosis (HPS) are three of the most common reasons for emergent abdominal imaging in pediatric patients. Although the use of computed tomography has risen dramatically over the past 2 decades, children are particularly at risk for the adverse effects of ionizing radiation, and even low-dose radiation is associated with a small but significant increase in lifetime risk of fatal cancer. In most emergency departments, the use of magnetic resonance (MR) imaging as a primary modality for the evaluation of a child with abdominal pain remains impractical due to its high cost, its limited availability, and the frequent need for sedation. Ultrasonography (US) does not involve ionizing radiation and, unlike MR imaging, is relatively inexpensive, is widely available, and does not require sedation. Another major advantage of US in abdominal imaging is that it allows dynamic assessment of bowel peristalsis and compressibility. Delayed diagnosis of any of the aforementioned disease processes can lead to serious morbidity and, in some cases, death. The ability to diagnose or exclude disease with US should be part of a core radiology skill set for any practice that includes a pediatric population.
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Affiliation(s)
- Jonathan R Cogley
- Department of Radiology, Baystate Medical Center and Children's Hospital, Western Campus of Tufts University School of Medicine, 759 Chestnut St, Springfield, MA 01199, USA.
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Acharyya BC, Doshi J, Pahari A. Conservative management of small intestinal intussusception and cholelithiasis in a child with celiac disease. APOLLO MEDICINE 2011. [DOI: 10.1016/s0976-0016(11)60016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sonographic findings predictive of the need for surgical management in pediatric patients with small bowel intussusceptions. Langenbecks Arch Surg 2011; 396:1035-40. [PMID: 21274558 DOI: 10.1007/s00423-011-0742-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 01/17/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aims to evaluate ultrasound findings that are predictive of the need for surgical management in pediatric patients with small bowel intussusceptions (SBIs). METHODS A retrospective review of pediatric patients with SBIs treated from 2004 to 2009 was conducted. Patients were divided into surgical and non-surgical groups. Demographic data, ultrasound findings, treatments, and outcomes were collected and analyzed. RESULTS There were 56 cases of SBIs in 31 males and 25 females ranging in age from 4 months to 9 years; 39 patients were managed conservatively and 17 patients underwent surgery. The mean length and diameter of the intussusception in the surgical group were 6.53 and 2.78 cm, respectively, and 3.21 and 1.81 cm, respectively in the non-surgical group (both, P < 0.001). Multivariate logistic regression analysis indicated that diameter, length, and thickness of the outer rim were independent predictors of surgery. Receiver operating characteristic curve analysis indicated an intussusception diameter ≥2.1 cm, length ≥4.2 cm, and thickness of the outer rim ≥0.40 cm were optimal cutoff values for predicting the need for surgery. CONCLUSIONS A diameter ≥2.1 cm, length ≥4.2 cm, and thickness of the outer rim ≥0.40 cm predict the need for surgical management in pediatric patients with SBIs.
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Kong FT, Liu WY, Tang YM, Zhong L, Wang XJ, Yang G, Chen HP. Intussusception in infants younger than 3 months: a single center's experience. World J Pediatr 2010; 6:55-9. [PMID: 20143212 DOI: 10.1007/s12519-010-0007-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 08/11/2009] [Indexed: 02/05/2023]
Abstract
BACKGROUND The diagnosis and treatment of intussusception is often confusing in infants aged younger than 3 months. This study aimed to discuss the particularity of diagnosis and treatment of intussusception in this age group. METHODS From April 1983 to June 2008, 39 infants aged 3 months or younger who had been diagnosed with intussusception were treated and their clinical data were analyzed retrospectively. RESULTS Of the 39 infants (29 boys and 10 girls), ages ranged from 12 hours to 3 months, with a mean age of 52.6 days. The duration from onset to admission ranged from 7 to 142 hours (mean 39.6 hours). Three infants had intrauterine intussusception and 36 postnatal intussusception. The 3 infants with intrauterine intussusception had typical presentations of complete ileus after birth. Gap type ileal atresia was found in surgery in 2 of the 3 infants and primary anatomosis was performed therapeutically. The other infant was found to have ileal separation and a patent proximal end with diffused meconium peritonitis. The patient died 2 days after primary anastomosis. Most infants with postnatal intussusception had two or more manifestations of the tetralogy, namely intermittent screaming, vomiting, bloody stool, and abdominal mass. In 23 infants who underwent pneumatic reduction, 17 had a successful reduction and 6 converted to open surgery. Surgery was indicated for 19 infants, with maneuver procedure in 14. Meckel's diverticulum was noted as a leading cause in 2 infants, ileal duplication in 1 with necrosis of intussusceptum, and primary intussusception with lead point necrosis in 2. The 5 infants, on whom segmental resection was performed, underwent primary anastomosis. All infants with postnatal intussusception had a smooth recovery. CONCLUSIONS Infants aged 3 months or younger may suffer from intussusception and most of them present with typical symptoms. Early diagnosis and treatment are needed for a good prognosis. Intrauterine intussusception may be an etiological factor for ileal atresia.
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Affiliation(s)
- Fei-Teng Kong
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
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Ko SF, Tiao MM, Hsieh CS, Huang FC, Huang CC, Ng SH, Lee SY, Chen MC. Pediatric small bowel intussusception disease: feasibility of screening for surgery with early computed tomographic evaluation. Surgery 2009; 147:521-8. [PMID: 20004447 DOI: 10.1016/j.surg.2009.10.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 10/06/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study investigated the feasibility of early computed tomographic (CT) evaluation and the operative results of pediatric small bowel intussusception with deteriorating ischemic or obstructive symptoms, so-called small bowel intussusception disease (SBID). METHODS Between 1988 and 1999, among 18 patients surgically proven SBID (conventional group), 12 mimicked ileocolic intussusception and were conventionally managed with abdominal radiography, ultrasonography, reduction enema, and eventually operation. Between 2000 and 2008, we applied a modified approach with inclusion of early CT evaluation if ultrasonography showed a target lesion suspicious for SBID (diameter </=3.0 cm and/or atypically located in the paraumbilical or left abdomen). Among 15 surgically proven SBID patients (early CT group), 13 underwent early operation after CT confirmation. The clinical, imaging, and operative findings were compared between the 2 groups. RESULTS There were no significant differences between the 2 groups in age, gender, clinical presentations, leukocyte count, ultrasonographic features, locations of SBID, or the presence of lead points. Most patients presented with vomiting, abdominal pain, or irritable crying. In comparison with the conventional group, early CT group patients had a significantly shorter duration between admission and surgery (31.44 +/- 30.39 vs 7.47 +/- 5.95 hours; P < .01) and a lower rate of bowel complications (44.4% vs 6.7%; P = .02). CONCLUSION Pediatric SBID may present with nonspecific symptoms and may mimic ileocolic intussusception leading to delayed operative intervention. Early CT evaluation of patients with suspicious SBID ultrasonographic features is effective in avoiding futile reduction enema and significantly reducing the waiting time for operative management and the resultant incidence of bowel complications.
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Affiliation(s)
- Sheung-Fat Ko
- Department of Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Bai YZ, Chen H, Wang WL. A special type of postoperative intussusception: ileoileal intussusception after surgical reduction of ileocolic intussusception in infants and children. J Pediatr Surg 2009; 44:755-8. [PMID: 19361636 DOI: 10.1016/j.jpedsurg.2008.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 08/04/2008] [Accepted: 08/08/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postoperative ileoileal intussusception after surgical reduction of ileocolic intussusception in infants and children is extremely rare, and no reports of this special type of postoperative small bowel intussusception have been found in the literature. METHODS We retrospectively reviewed the clinical charts of 6 infants and children with postoperative ileoileal intussusception that occurred after surgical reduction of ileocolic intussusception between January 1994 and December 2006. Clinical features, diagnostic strategy, operative findings, and outcome were analyzed. RESULTS All 6 cases of postoperative ileoileal intussusception after surgery for ileocolic intussusception occurred within 1 week after the initial operation. The clinical manifestation was intestinal obstruction without abdominal palpable mass or bloody stool. Abdominal ultrasound examination revealed the target sign in 5 cases. Manual reduction of the intussusception was performed successfully at reoperation in each instance. CONCLUSIONS The clinical symptoms of postoperative ileoileal intussusception after operations for ileocolic intussusception are not typical. A second postoperative (ileoileal) intussusception should be kept in mind after surgical reduction of the first (ileocolic) intussusception in children. In any atypical postoperative ileus, a sonographic study should be done to rule out the diagnosis of postoperative intussusception. Once this condition is diagnosed, surgical treatment should be performed as soon as possible.
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Affiliation(s)
- Yu Zuo Bai
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, PR China.
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