Profile and outcome of pediatric intussusception: a 5-year experience in a tertiary care center

Background Intussusception is the most frequent cause of bowel obstruction in infants and toddlers; idiopathic intussusception occurs predominantly under the age of 3 and is rare after the age of 6 years; the highest incidence occurs in infants between 4 and 9 months; the gold standard for treatment of intussusception is non-operative reduction. This research will tackle the problem of pediatric intussusception in our center which is the largest tertiary center in our region. The primary outcome is to study the profile of intussusception; the secondary outcome is to assess the success rate of pneumatic reduction in the center’s pediatric population as well as to study the seasonal variation if present. Results During the study period, eighty-six (N=86) cases were identified, from which 10 cases were recurrent intussusception. Seventy-six (N=76) cases were included from the study period. N=68 (89%) were less than 3 years of age, and only N=2 (3%) were above 6 years. Seasonal variation was not significant; N=69 (91%) patients had successful pneumatic reduction under fluoroscopy while thirteen patients N=13 (17%) needed operative intervention. Conclusion Ileocolic intussusception is one of the most common pediatric surgical emergencies that can be successfully managed non-operatively in our institute; 89% of the cases were below 3 years of age, and no seasonal variation was demonstrated. Operative intervention was required in 13 cases with the main reason being lead point. The fact that the pediatric surgeon performs the reduction might have contributed to a high success rate reaching 91% in our center. This study provides a valuable opportunity for future regional data comparisons and pooled data analyses.

Effectiveness and safety of ultrasound-guided hydrostatic reduction for children with acute intussusception

Objective This study aims to explore the effectiveness and safety of the new-type ultrasound-guided hydrostatic reduction for children with acute intussusception. Methods The clinical data of 364 children with primary acute intussusception who underwent nonsurgical reduction in our hospital between January 2016 and May 2019 were retrospectively analyzed. Among the 364 children, 119 formed the hydrostatic reduction group. There were 89 males and 30 females, and the average age of admission was 25.13 ± 1.43 months. Among the pneumatic reduction group of 245 patients, there were 163 males and 82 females. The average age of admission was 22.47 ± 1.52 months. The reduction rate, length of stay, and perforation rate were compared between the two groups. Results Univariate analysis showed that the reduction rate in the hydrostatic group (94.96%) was higher than in the pneumatic group (85.31%) ( p = 0.007), and the hospital stay (2.76 ± 0.15 days) of the hydrostatic reduction group was shorter than that of the pneumatic reduction group (3.56 ± 0.35 days) ( p = 0.038). In children with intussusception time >48 h, the reduction rate was 95.45% in the hydrostatic reduction group and 86.20% in the pneumatic reduction group. Conclusion The new-type ultrasound-guided hydrostatic reduction has a higher reduction rate in the treatment of acute intussusception in children results in a shortened hospital stay, It is effective, safe, and avoids radiation exposure.

Factors Associated with Failure of Pneumatic Reduction in Children with Ileocolic Intussusception

Intussusception is one of the most common causes of intestinal obstruction in children. Pneumatic reduction is the treatment of choice and has a high success rate. The most common cause of pneumatic reduction failure is the presence of a pathological leading point. We aimed to identify other factors that can lead to pneumatic reduction failure in children with ileocolic intussusception. This was a retrospective study conducted in two centers. Data were collected from January 2013 to December 2014. A total of 156 patients were diagnosed with intussusception and underwent pneumatic reduction, with the exception of one patient with peritonitis. We included patients with ileocolic-type intussusception without apparent pathological leading points. Logistic regression analysis of clinical parameters was performed to identify factors associated with pneumatic reduction failure. Of 156 patients diagnosed with intussusception in both hospitals, 145 were enrolled in the study. The overall efficacy of pneumatic reduction was 85.7%, and surgical reduction was performed in 21 patients. Univariate analysis showed that a high segmented neutrophil count, low hemoglobin level, high body temperature, and higher weight percentile were associated with pneumatic reduction failure. Multivariate analysis showed that a high segmented neutrophil count, low hemoglobin level, and higher weight percentile were significantly associated with pneumatic reduction failure. Pneumatic reduction is safe and effective as a first-line treatment for pediatric intussusception. However, a high segmented neutrophil count, low hemoglobin level, and higher weight percentile are associated with the failure of this treatment.

L’invaginazione ileocolica

Ileo-colic intussusception is a major cause of intestinal obstruction in early childhood. Diagnosis of this condition might be hampered by variability in clinical presentation. Indeed, the so-called “classic” symptoms, namely abdominal pain, red currant jelly stool, vomiting and palpable mass, may not be present. Nevertheless, prompt diagnosis and treatment are critical to prevent bowel perforation or necrosis and peritonitis. Pneumatic reduction of intussusception with an air enema is the usual treatment. The aim of this study is to highlight the main clinical features of ileo-colic intussusception and its management.

Treatment of Pediatric Intussusception by Pneumatic Reduction: a Safe Technique using Equipment Readily Available in the Hospital

Treatment of Pediatric Intussusception by Pneumatic Reduction: a Safe Technique using Equipment Readily Available in the Hospital

Tension Pneumoperitoneum Following Attempted Pneumatic Reduction of Intussusception

Tension pneumoperitoneum is a life-threatening complication of pneumatic reduction for intussusception if not immediately recognized and treated. We describe a 3-month-old woman who presented with intussusception, underwent attempted pneumatic reduction, and subsequently developed tension pneumoperitoneum with associated hemodynamic instability requiring emergent laparotomy. This is a known, rare complication of pneumatic reduction which highlights the need to have a high index of suspicion for early surgical management to obtain a positive outcome.

Management and outcomes of paediatric ileocolic intussusception at a paediatric tertiary care hospital: A retrospective cohort study

Background Rapid reduction of ileocolic intussusception is important to minimize the compromise in blood flow to the affected bowel segment. This study aimed to quantify the potentially modifiable time between diagnosis and initiation of pneumatic reduction, identify factors associated with delays, and characterize the outcomes of pneumatic reduction in a recent cohort. Methods This retrospective observational study occurred at a tertiary care paediatric hospital with a consecutive sample of all children with ileocolic intussusception September 2015 through September 2018. The primary outcome was the time between ultrasound diagnosis of intussusception and the beginning of pneumatic reduction. Independent variables were age of the patient, time of day of arrival, transfer from another facility, and intravenous access prior to ultrasound. Outcomes of pneumatic reduction were expressed as proportions. Results There were 103 cases of ileocolic intussusception (among 257,282 visits) during the study period. The median time between diagnostic confirmation and initiation of reduction was 36 minutes. This was shorter for transferred patients and children with intravenous access prior to ultrasound. One perforation was identified at the beginning of reduction, without hemodynamic instability. Six children (5.8%) underwent either open (n=4) or laparoscopic surgery (n=2) for reduction failure. Conclusion The median delay between diagnosis and initiation of reduction at this paediatric hospital was short, especially among patients transferred with a suspicion of intussusception and children with intravenous access prior to diagnosis. Complications from pneumatic reduction were infrequent.

STUDY OF VARIOUS TYPES OF TREATMENT MODALITIES IN CHILDREN WITH INTUSSUSCEPTION

Background:Intussusception is a condition in which one part of gut enters into another part of gut known as telescoping. Ultrasonography of abdomen is highly specific and sensitive for diagnosis. Most of the ileo-ileal and fewer ileo-colic intussusceptions may reduce spontaneously. Ultrasound guided reduction is an alternative to surgery. If intussusception is not treated timely it may cause intestinal ischemia, gangrene, perforation peritonitis, shock and death. Method:This is a hospital based prospective study including 96 patients over a period of 18 months. Detailed proforma was used, including name, age, sex, weight, presenting complaints, duration of complaints, abdominal sign & symptoms, signs of the sepsis & shock, peritonitis, perforation, USG finding, and type of surgery performed. The presence of the complications also noted. Results:Maximum patients (63.5%) of intussusception diagnosed were between 6 months to two years. Out of total 96 patients, 21 were treated by pneumatic reduction successfully. In 46 patient exploratory laparotomy and intra-operative reduction done, while in 29 children required resection anastomosis. Most common complaint was abdominal pain (100%) followed by Excessive cry (92.7%). Most common type of intussusception was Ileo-colic(88.5%). Respiratory distress (23.9%) followed by septicemia (20.8%) was the most common complications. Conclusions:Intussusception is a common surgical problem in childhood. Children of age 6 month to 2 years of age are affected most commonly. Ileo-colic is the most common type. Ultrasonography is diagnostic as well as therapeutic tool for intussusception. USG guided pneumatic reduction is a simple and good technique, if patient comes to hospital earlier. Early diagnosis of signs and symptoms may help clinician to take early interventions to save the gut as well life of the patient.

Nghiên cứu các yếu tố xác định tháo lồng bằng phẫu thuật ở trẻ em dưới 2 tuổi bị lồng ruột cấp

FACTORS DETERMINING OF OPERATIVE REDUCTION IN ACUTE INTUSSUSCETION OF CHILDREN Background: Intussusception is the common cause of small intestinal obstruction in children under two years old. Late diagnosis can lead to a potentially worse condition. This prospective study aims to describe the clinical manifestation and develop the conservative management protocol for acute ileocaecal intussusception in children undertwo years old. Methods: This prospective study was carried out in 118 consecutive patients under two years old. Patients presented with symptoms and signs of acute intestinal obstruction and 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 less than 24 hours were accounted for 80.5% of 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 which correlated to the surgical management outcome. All patients were well recovery without any complication. The median of postoperative hospital stay was two days for pneumatic reduction group and six days for operation group. Conclusion: Early diagnosis of intussusception contributes the success of pneumatic reduction and reduces the requires of surgical intervention. Key words: intussusception, pneumatic reduction, surgical intervention.