Background
Intussusception remains a common cause of bowel obstruction in young children and
results in significant morbidity and mortality if not promptly treated. The goal of
this study was to determine the current success rate of radiologic reduction, the
requirements for operative intervention, and the effect of delay in presentation on
outcome.
Methods
Children treated for intussusception over a 15-year period were reviewed after treatment
at a tertiary children’s hospital. Records were reviewed for patient outcomes from
radiologic evaluation and surgical intervention.
Results
Two hundred forty-four children with intussusception were identified. Median age was
8.2 months (range, 16 days to 12.7 years). Eighty-seven percent of patients had ileocolic
or ileoileocolic intussusception. The most common presenting symptoms were emesis
(81%), hematochezia (61%), and abdominal pain (59%). Contrasted enemas were performed
in 190 children, with successful reduction in 46%. Air-contrasted enema reduction
was more successful than liquid-contrasted techniques (54% vs 34%; P = .017). Success in reduction was greater if symptom duration was <24 hours compared
with >24 hours (59% vs 36%; P = .001). Despite failed prior attempts at reduction, 48% were reduced on reattempted
enema reduction. One hundred forty children required surgical intervention for intussusception
with 50% requiring bowel resection. Children with symptom duration >24 hours had a
greater risk of requiring surgery (73% vs 45%; P < .001) and bowel resection (39% vs 17%; P = .001) than those with symptoms for <24 hours. Pathologic lead points were encountered
in 14%. There were 2 deaths and complications occurred in 19%. Length of stay after
surgical reduction was 3.9 days, but 6.1 days if bowel resection was required.
Conclusions
Success of intussusception reduction is improved with air-contrasted techniques and
is not affected by previously failed, outside attempts. Delay in presentation decreases
success in radiologic reduction and increases risk of operative intervention and bowel
resection.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Trends in intussusception: associated hospitalizations and deaths among US infants.Pediatrics. 2000; 106: 1413-1421
- Intussusception in early childhood: a cohort study of 1.7 million children.Pediatrics. 2004; 114: 782-785
- Intussusception: a three-year review.Ann Acad Med Singapore. 2002; 31: 81-85
- Two year review of intestinal intussusception in six large public hospitals of Santiago, Chile.Pediatr Infect Dis J. 2003; 22: 717-721
- Intussusception part 2: an update on the evolution of management.Pediatr Radiol. 2004; 34: 97-108
- Intussusception part 1: a review of diagnostic approaches.Pediatr Radiol. 2003; 33: 79-85
- Unsuccessful air-enema reduction of intussusception: is a second attempt worthwhile?.Pediatr Surg Int. 1999; 15: 214-216
- Intussusception in children: reduction with repeated, delayed air enema.Radiology. 1998; 206: 721-724
- Hydrostatic reduction of ileocolic intussusception: a second attempt in the operating room with general anesthesia.J Pediatr. 1989; 115: 204-207
- Intussusception: a repeat delayed gas enema increases the nonoperative reduction rate.J Pediatr Surg. 1994; 29: 588-589
- Partially reduced intussusception: when are repeated delayed reduction attempts appropriate?.Pediatr Radiol. 1995; 25: 104-107
- Intussusception: hospital size and risk of surgery.Pediatrics. 2001; 107: 299-303
- Intussusception in children: international perspective.World J Surg. 1996; 20: 1035-1040
- Intussusception: current management in infants and children.Surgery. 1987; 102: 704-710
- Intussusception in infancy and childhood.Int Surg. 1989; 74: 114-118
- The diagnosis of intussusception.Clin Pediatr. 2004; 43: 343-347
- Intussusception in children: diagnostic imaging and treatment.in: Blackmore C.C. Medina S. Evidence-based imaging. Springer, New York2006: 475-492
- Is barium enema reduction safe and effective in patients with a long duration of intussusception?.Pediatr Surg Int. 1999; 15: 105-107
- Childhood intussusception: a comparative study of nonsurgical management.J Pediatr Surg. 1999; 34: 304-307
- Air and liquid contrast agents in the management of intussusception: a controlled, randomized trial.Radiology. 1993; 188: 507-511
- Are hydrostatic and pneumatic methods of intussusception reduction comparable?.Pediatr Radiol. 1991; 21: 346-349
- Intracolonic pressure measurements during hydrostatic and air contrast barium enema studies in children.Radiology. 1995; 196: 55-58
- Results of air pressure enema reduction of intussusception: 6,396 cases in 13 years.J Pediatr Surg. 1986; 21: 1201-1203
- Intussusception in children: US-guided pneumatic reduction—initial experience.Radiology. 2001; 218: 85-88
- Intussusception: the use of delayed, repeated reduction attempts and the management of intussusceptions due to pathologic lead points in pediatric patients.Am J Radiol. 2004; 182: 1169-1176
Article info
Publication history
Accepted:
July 13,
2007
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
