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PubMed1994

Intussusception in infants and children: risk factors leading to surgical reduction.

Intussusception is commonly the etiology of intestinal obstruction in infants and children. To investigate demographic data, clinicopathologic features and therapeutic prognosis of patients with intussusception, we reviewed 361 intussusceptions in 333 patients over an 11-year period. Most patients were below two years of age and there was a male preponderance of 1.6:1. There was no seasonal difference between the number of cases. The clinical triad of vomiting, abdominal colicky pain and bloody stools was manifested in only one-third of our patients. Secondary intussusception contributed to 6.6% of cases and Meckel's diverticulum was the most common pathologic cause. Positive findings were recorded in 82% of 67 patients undergoing sonographic examination. Intussusception of the ileo-colic type was most frequently encountered. Most patients (79%) were diagnosed within 48 hours and almost all cases underwent primary barium enema reduction. The success rate was 45%. Laparotomy was performed in 207 patients (57%) refractory to enema reduction or with critical illness, and intestinal resection was required in 28 (14%). Long-standing duration of illness (> 24 hours), positive clinical triad, positive pathologic lead point, and radiologic finding of bowel obstruction were identified as risk factors leading patients to surgical reduction (p < 0.001). Postoperative complications and recurrent intussusception developed in some patients, and the overall mortality was 0.6%. The clinical characteristics of intussusception in children generally remained unchanged as compared to previous reports. Early identification of patients with risk factors for surgical treatment is important to decrease the need for intestinal resection.

Adolescent↗
PubMed1994

Enteroplication for the prevention of intussusception recurrence in dogs: 31 cases (1978-1992).

Medical records of 31 dogs that had undergone surgery for correction of intussusception during a 14-year period were reviewed. Enteroplication was performed on 9 dogs during the initial surgery, and intussusception did not recur in any of these dogs. Intussusceptions recurred in 6 of 22 dogs without enteroplication. Five of these dogs had undergone resection of the primary lesion and anastomosis and 1 dog had undergone manual reduction of the intussusception. Intussusceptions recurred proximal to the initial lesion in 4 dogs, and at the same site in 2 dogs. Enteroplication was performed in 4 dogs following surgical correction of recurrence of an intussusception, and further recurrences were not seen in any of these dogs. Enteroplication did not cause any apparent adverse effects and decreased the probability of recurrence of intussusception in these dogs.

Anastomosis, Surgical↗
PubMed1994

Intussusception associated with Salmonella typhimurium enterocolitis.

Intussusception in the adult is unusual, and its etiology is mostly neoplastic. In most cases of intussusception, a polypoid tumor located in the terminal ileum invaginates within the cecum. We described an unusual case of adult intussusception associated with Salmonella typhimurium enterocolitis. Preoperative diagnosis of intussusception in the ileocecal region was made by ultrasonography, and the ileocecal region containing the mass in the cecum, causing the intussusception, was resected. Histological features of the mass included an edematous focal wall thickening. Later, the diagnosis of S. typhimurium enterocolitis was made by the preoperative stool cultures. This case demonstrated intussusception as a complication of S. typhimurium enterocolitis. It is worth noting that S. typhimurium enterocolitis is in fact a potential cause of intussusception.

Cecal Diseases↗
PubMed1996

Intussusception in children and adults in Zaria: a comparison.

OBJECTIVES: To compare and contrast the symptomatology and the anatomical type of the intussusception in children and adults in Zaria. DESIGN: Retrospective study. SETTING: Hospital. SUBJECTS: 93 patients with intussusception. MAIN OUTCOME MEASURES: Frequency of intussusception. RESULTS: Colicky abdominal pain featured often enough in both groups with most symptoms and signs decreasing in frequency from infancy to adulthood. The ratio of small bowel to large bowel disease in infants, older children and adults was 1;8:1, 0;6:1 and 1:1 respectively. Infantile intussusception involving the small bowel was more common, and in older children large bowel involvement was commoner, while 50pc of adult intussusceptions were paradoxically small bowel. Overall, small bowel intussusception was most common with the ileocolic variety predominating. CONCLUSIONS: The most common type of intussusception in our environment is the ileocolic variety.

Adolescent↗
PubMed1987

Intussusception in children 5-15 years of age.

Twenty cases of intussusception in children between the ages of 5 and 15 years were compared with intussusception in infancy and early childhood. They accounted for 18.5 per cent of all 108 children treated for intussusception in two large hospitals from 1964 to 1984. Diagnosis of intussusception was delayed, probably due to an unusual presentation. Fifty-five per cent had a definite predisposing factor precipitating the intussusception and 45 per cent had a small bowel intussusception, which warranted early surgical intervention. In the absence of contraindications no child should be disqualified from an attempt at hydrostatic reduction. After hydrostatic reduction careful follow-up is required to exclude an organic lesion, possibly by a small bowel follow-through meal. Surgery is indicated after hydrostatic reduction in case of chronically recurrent abdominal complaints.

Adolescent↗
PubMed1995

Partially reduced intussusception: when are repeated delayed reduction attempts appropriate?

The imaging techniques for diagnosis and monitoring of reduction of intussusception by fluoroscopy and ultrasound continue to evolve. The common goal of all protocols is to reduce the intussusception by enema in as many patients as possible and avoid laparotomy with its potential morbidity. We report two infants in whom the initial attempt at reduction by air enema only achieved partial reduction, from the descending colon to the transverse colon in one, and from the splenic flexure to the caecum in the other. Both patients became asymptomatic and clinically stable. In light of the clinical stability, and in consultation with the surgeons, laparotomy was deferred. Sonography was used to confirm the persistence of the intussusception before repeat air enema several hours later. Following three further air enemas in each child, the intussusceptions were successfully reduced after 20 h and 24 h respectively. Both patients remained asymptomatic and did not require surgery. In infants with partially reduced intussusception we suggest that if the patient becomes asymptomatic and stable, surgery can be safely delayed to permit further attempts at enema reduction. Sonography has a valuable role in determining the persistence of the intussusception prior to repeat enema. Close cooperation with the surgeon and careful clinical monitoring of the patient are essential requirements for this proposal.

Air↗
PubMed1992

The plain abdominal film in intussusception: the accuracy and incidence of radiographic signs.

The incidence of four plain abdominal film features associated with intussusception was recorded by four observers in 180 films of patients with intussusception mixed with 100 films of control subjects. The crescent sign and target sign were the most accurate indicators of intussusception. The target sign was the commoner being seen in 68% of films. Signs of small bowel obstruction were not useful in the diagnosis of intussusception. The soft tissue mass was the commonest indicator of intussusception. The soft tissue mass was found more commonly, however, than small bowel obstruction in the control subjects who did not have intussusception.

Child↗
PubMed1990

Ultrasound in intussusception: a false cystic lead point.

Lead point lesions are very rarely suspected during ultrasound (US) investigation of intussusception. We report a case of idiopathic intussusception where US suggested a cystic lead point. At operation there was no structural abnormality but fluid was noted to be trapped within intussuscepted mesentery. The incidence of 'non-idiopathic' or 'secondary' intussusception is 5-6% with Meckles diverticulum being numerically the most important single entity. The lead point is only rarely identified on ultrasound. A large Chinese series of 377 cases of diagnosis and reduction of paediatric intussusception under US control [1] makes no mention of ultrasonic identification of a secondary cause in any of their cases. A European series of 145 cases [2] noted a causative lesion in 8 (5.6%), of which 2 (lymphoma, intestinal duplication) were identified during the ultrasound study. Adamsbaum [3] recently published a case of an enterogenous cyst as a lead point identified on ultrasound. We present a case with very similar ultrasonic features but which at operation was found to represent fluid trapped within the intussuscepted mesentery rather than a true cystic lead point.

Colonic Diseases↗
PubMed1989

Diagnosis and treatment of adult intussusception.

Twenty adults were treated for intussusception in two large hospitals from 1969 to 1988. Fourteen intussusceptions originated in the small intestine and 6 in the large intestine. Diagnosis was reached preoperatively in only 10 patients, probably due to the atypical clinical picture. In addition to a high degree of suspicion, careful examination of plain abdominal radiograph and ultrasonography are helpful in diagnosing adult intussusception. In 18 of 20 patients, an organic lesion causing intussusception was found. In six patients the cause was a malignancy. In such cases surgical treatment is necessary. In jejunojejunal and ileoileal intussusceptions, an attempt at primary reduction followed by resection or enterotomy is justified. In most cases of ileocolic, ileocecocolic, and colocolic intussusception, primary resection is the treatment of choice, especially in patients over 60 years old because of the high incidence of malignancy.

Adolescent↗
PubMed1991

Intussusception: barium or air?

At The Hospital For Sick Children, the use of air has recently replaced the use of barium in the reduction of intussusceptions. The purpose of this study was to review the results from 200 consecutive patients with intussusceptions, 100 patients treated with barium enema and 100 patients treated with air enema. The groups were similar with regard to sex, average and median ages, and presenting symptoms and signs. Successful reduction was achieved in 75% of episodes of intussusception treated with barium enema and 76% treated with air enema. Failure of either modality showed a high association with the presence of either a lead point or an ileoileal or ileoileocolic intussusception. Among those cases of unsuccessful reduction, operation was performed in all 59 cases; resection in 30 cases, manual reduction in 19, and spontaneous reduction was found in 10. There were three perforations during attempted reduction with barium and two with air. All perforations were treated by resection and primary anastomosis. There were 18 recurrent intussusceptions following barium enema reduction and nine following air enema reduction. Therefore, with the lower absorption of x-rays by air and the relatively inert nature of air (compared with barium in the event of a perforation), we feel that air enema is the treatment of choice in the initial management of intussusception.

Air↗
PubMed1992

Nonischemic intussusception in childhood.

The classical presentation of intussusception consisting of severe abdominal pain, bloody stool, and a palpable abdominal mass leads to the correct diagnosis in majority of the patients. However, an atypical presentation often results in a delayed diagnosis as is commonly seen in nonischemic intussusception. The nonischemic intussusception is a distinct clinical entity that is characterized by a long history of less severe symptoms commonly noticed in older children. The incidence of diarrhea in this group is higher than in the acute variety of intussusception. This variant of intussusception requires a high degree of suspicion for the diagnosis in atypical clinical presentation. The present study summarises our experience treating 31 such cases of nonischemic intussusception during a period of 25 years from 1966 to July 1990.

Child↗
PubMed1993

Indications for laparotomy after hydrostatic reduction for intussusception.

A criterion for successful hydrostatic reduction of intussusception is reflux into the terminal ileum. In our practice, absence of reflux into the terminal ileum is not an indication for laparotomy if the radiographic appearances suggest edema of the ileocecal valve. The aim of this study was to validate our approach. We reviewed the case notes of patients with a diagnosis of intussusception (n = 107; age 11.74 +/- 1.48 months; mean +/- SEM) treated from 1987 to 1991. Eleven required primary laparotomy for peritonitis. Ninety-six patients who had a contrast enema were studied. Edema of the ileocecal valve was defined as a persistent filling defect in the cecum after apparently complete hydrostatic reduction, without reflux of contrast into the distal small bowel. In 59 patients hydrostatic reduction was successful: 11 (18.6%) had edema of the ileocecal valve and no reflux contrast into the terminal ileum (group B). All improved clinically after the enema and needed no further treatment. In 37 patients hydrostatic reduction of the intussusception was unsuccessful and an operation was performed: 26 (70.3%) required manual reduction of the intussusception (group C) and 11 (29.7%) underwent bowel resection (group D). None of the patients with edema of ileocecal valve required further treatment or developed recurrent intussusception. In none of the patients who had an operation was the intussusception found to have been reduced by the contrast enema. There were no deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

Barium Sulfate↗
PubMed1986

Hydrostatic reduction of intussusceptions caused by lead points.

It is generally accepted that an intussusception caused by a lead point will not be reduced by hydrostatic barium enema. This was reported several years ago, and has continued to be a consistent finding, prompting us to attempt hydrostatic barium enema reductions of recurrent intussusceptions in infants and children and also in older children with a first intussusception. However, in the last 9 years we have treated five children whose ileocolic intussusceptions were caused by lead points but which were reduced by hydrostatic barium enema. The histories and physical examinations were not any different than those of the average pediatric patient with an intussusception. The ileocolic intussusceptions diagnosed by barium enema were reduced with adequate reflux of barium into the terminal ileum. However, a residual and persistent filling defect in the colon or ileocecal area made laparotomy mandatory. In all five cases, a lead point was found and resected. This experience has suggested to us that a residual intraluminal filling defect in the barium column following what appears to be adequate flooding of the terminal ileum should be interpreted as a lead point, and an indication for a laparotomy.

Adolescent↗
PubMed1983

Sonographic diagnosis of intussusception in childhood.

The diagnosis of intussusception was established in 26 children by sonography alone. In 23 cases barium enema confirmed the diagnosis; two cases because of longstanding intussusception and one case after intestinal anastomosis were confirmed by surgery alone; in two additional cases barium enema ruled out the sonographically suspected intussusception. No positive finding was missed by sonography, which proved to be an accurate method for the diagnosis of intussusception. The sonographic findings of idiopathic intussusception and intussusception caused by lymphosarcoma are presented.

Adolescent↗
PubMed1992

The changing pattern of infantile intussusception in northern Nigeria: a report of 47 cases.

Infantile intussusception is not rare in Africa, but was reported to be relatively uncommon. This retrospective review of 47 infants with the diagnosis of intussusception included 38 boys and nine girls. Surprisingly, the clinical presentation is at variance with previous reports and beliefs about intussusception in tropical Africa, but is similar to those from Europe and North America. Contrary to expectation, about 70% of infants presented with the classical clinical picture of intussusception with the complete features of vomiting, 'colicky abdominal pain', blood mucoid stools and palpable abdominal mass. The other 30% presented with various combinations of the components of the tetrad. The small bowel was the leading point in 30 infants and the colon in 17. Of the small bowel variety, the two main types were the ileo-ileal and the ileocolic, while the ileocaecal and the various types of colo-colic intussusception were of large bowel origin. Morbidity was minimal. There were four deaths. Intussusception in this series differs in many respects from previous experience in Zaria.

Colonic Diseases↗
PubMed1987

Intussusception following abdominal trauma.

We reviewed the charts of 21 patients on the Trauma Service who were operated on for intestinal obstruction for the years 1983 through 1985. Six (28.6%) of the 21 patients had intussusception as the cause of their obstruction post-laparotomy for trauma. All were males ages 17 to 25 years. The mechanisms of injury were gunshot wounds in three, stab wounds in two, and blunt trauma in one. Five patients were hypotensive on admission with systolic BP less than 70, and two patients received uncrossmatched blood preoperatively. Injuries at exploration included liver laceration (six patients), gastric perforation (two patients), and diaphragmatic lacerations, splenic laceration, renal injury, and ventricular injury, one each. No patient suffered small intestinal injuries and we cannot explain the occurrence of intussusception. Intussusception occurred in the first 8 postoperative days in four patients and at 21 days, and 10 months, in the remaining two. The diagnosis was made twice by CT scan preoperatively. Jejunojejunal intussusception was common (five patients), jejunoileal in one and ileocolic in one (who also had a jejunojejunal intussusception). All patients were treated with manual reduction alone and none recurred. There were no postoperative complications and all patients were discharged by the eighth postoperative day. Our study suggests that early postoperative obstruction is caused by intussusception with unexpected frequency in trauma patients, and can be diagnosed by CT scan in some cases. Treatment with operative reduction has an excellent prognosis.

Abdominal Injuries↗
PubMed1996

Suspected intussusception: is ultrasound a reliable diagnostic aid?

BACKGROUND: Infantile intussusception often presents with symptoms more common to less dangerous conditions, and diagnosis must be established as early as possible. Clinical diagnosis is often wrong and contrast enema is invasive. Sonography is painless and harmless and if it provides a reliable method of diagnosis or exclusion of intussusception, diagnostic delay will be avoided. METHODS: In the John Hunter Hospital, Newcastle, between 1993 and 1994, the names of all children referred for abdominal sonography with a degree of suspicion of intussusception were recorded, and the histories were subsequently reviewed. RESULTS: Fifty patients were studied. Forty-one patients had no sonographic evidence of intussusception and nine patients had positive findings. None of the 41 patients who had negative sonograms proved to have intussusception. The nine patients who had positive findings were subjected to air enema. In two patients the sonographic diagnosis was proved wrong. In the other seven patients it was confirmed. Thus there were two false positives and no false negatives. CONCLUSION: Sonography is a reliable aid to the clinical diagnosis of intussusception.

Child↗
PubMed1992

Ileal intussusception in 16 young thoroughbreds.

The paper describes the outcome of 16 cases of short-ileal-ileal intussusception in young Thoroughbred horses. The intussusception was often associated with chronic or intermittent low grade abdominal pain. At laparotomy, only the intussusception was reduced in one horse; in another, a myotomy of the thickened stenosed intussusception was carried out after reduction. In 11 cases as ileocaecal bypass anastomosis was performed proximal to the intussusception after its reduction. One horse was subjected to euthanasia during operation because of irreversible intestinal wall damage and another because of intestinal rupture. One foal had a cardiac arrest following reduction of the intussusception. One horse was subjected to euthanasia 4 months post-operatively because of intractable abdominal pain caused by intestinal adhesions. Although several horses suffered episodes of post-operative abdominal pain, and 2 were subjected to a second laparotomy, 12 horses made an eventual complete recovery.

Abdominal Pain↗