Elsevier

Surgery

Volume 142, Issue 4, October 2007, Pages 469-477
Surgery

Central Surgical Association
Current success in the treatment of intussusception in children

https://doi.org/10.1016/j.surg.2007.07.015Get rights and content

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.

Section snippets

Methods

Patients treated for intussusception at Riley Hospital for Children from January 1, 1990 through December 31, 2004, were reviewed for this study. A hospital admissions database was searched for patients with either a primary or secondary International Classification of Disease, 9th revision code for intussusception (560.0). Electronic and paper medical records were reviewed for data on demographics, comorbidities, presenting signs and symptoms, imaging procedures, results of reduction

Population

Two hundred forty-four children were diagnosed and treated for intussusception over the 15-year period. There were 162 boys and 82 girls (2:1) who ranged in age from 16 days to 12.7 years (median, 8.2 months). Thirty-four percent were <6 months old, 68% were <1 year, and 79% were <2 years at the time of diagnosis. There were 16 (7%) children over the age of 4. Eighty-two percent of children were Caucasian and 16% were African American.

Signs and symptoms

The most common presenting sign or symptom in children with

Discussion

Intussusception is a common childhood problem that results in serious morbidity and mortality throughout the world. In developing nations, the mortality may be as high as 20%.13 The diagnosis of intussusception continues to rely on a high clinical suspicion owing to a large portion of children presenting with nonspecific signs and symptoms. In fact, the classic triad of emesis, pain, and bloody stools is reported to occur in fewer than one quarter of patients.3, 4 This is echoed in the present

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