Recurrent intussusception in infants

Aim: Clinical features to identify infants at increased risk of recurrence after a primary episode of intussusception (IS) are poorly defined. Methods: Prospective study of the clinical presentation, treatment and outcome in infants <2 years presenting with acute IS to the National Hospital of Pediatrics, Hanoi, over a 14‐month period (1 November 2002 to 31 December 2003). A retrospective review of medical records was performed to verify complete patient ascertainment. Results: Five hundred ninety‐eight children were recruited, including 513 (86%) with a primary episode only and 53 (9%) with ≥1 recurrent episodes. Another 32 (5%) infants presented with recurrent IS, but the primary episode of IS occurred outside the study period. Estimated recurrence risk at 6 months following a primary episode was 14%. A pathological lead point was rare in primary (n= 1) and recurrent IS (n= 1). Most infants were successfully treated with enema reduction. Conclusions: This study describes the natural history of recurrent IS in infants and may assist in interpreting data from post‐marketing surveillance following introduction of rotavirus vaccines.     

Four-country surveillance of intestinal intussusception and diarrhoea in children

Aim:   Establishment of baseline epidemiology of intussusception in developing countries has become a necessity with the possibility of reintroduction of rotavirus vaccine. The current study assessed the seasonal trend in cases admitted with intussusceptions and dehydrating acute watery diarrhoea in children aged 2 months to 10 years.
Methods:   In a prospective surveillance study, teaching and research hospital sites in India (Lucknow and Nagpur), Brazil (Fortazela), Egypt (Ismailia) and Kenya (Nairobi) established a surveillance where a network of hospitals with surgical facilities catered to a reference population of about 1–2 million for reporting of intussusception. One large hospital per site also recruited admitted cases of acute watery diarrhoea.
Results:   From April 2004 to March 2006, 173 and 2346 cases of intussusception and diarrhoea, respectively, were recruited. Cases of intussusception had no apparent seasonality. Most cases of intussusception (61.3%) (107/173) were in the ≤1 year age group, with males comprising 68.8% (119/173) of all cases. Hospital mortality of intussusception was 4.2% (4/96). Cases of diarrhoea peaked in March, with 56.6% (1328/2346) of admitted cases being males. Majority (83.1%) of cases of diarrhoea had received antibiotics, and the hospital mortality was 0.8% (18/2280).
Conclusion:   Intussusception in the four participating countries exhibited no seasonal trend. We found that it is feasible to establish a surveillance network for intussusception in developing countries. Future efforts must define population base before the introduction of rotavirus vaccine and continue for some years thereafter.     

儿童继发性结肠套叠临床分析

目的 总结结肠息肉继发结肠套叠的临床特点,指导临床诊治.方法 回顾我院诊治的12例结肠息肉继发结肠套叠临床表现、影像学检查和治疗经过.结果 12例患儿通过超声或CT结合低压空气灌肠得到结肠套叠的诊断并且复位,肠镜的检查证实在套叠部位有息肉.11例在纤维肠镜下作息肉切除,1例开腹手术.结论 继发性结肠套叠的临床症状具有可...     

某市级医院儿童急性肠套叠流行病学特征及分析

目的通过分析珠海市10年间儿童急性肠套叠病例,探讨儿童急性肠套叠的流行病学特点及一般规律,为预防、诊断和治疗提供理论依据。方法对2004——2013年本院收治的儿童肠套叠病例进行回顾性研究,并结合珠海地区的气候、卫生条件等对患儿的临床资料、治疗方法、治疗效果、复发特点进行分析。结果 10年间本院共收治儿童肠套叠患儿1 045例,其中男性706例,女性339例,男:女=2.08:1。生后12~4个月为发病高峰年龄。全部病例均予空气灌肠治疗,获成功829例,需手术治疗216例,空气灌肠成功率79.33%。复发133例。术中发现继发性肠套叠23例。年龄2岁以上的15例。结论珠海地区儿童肠套叠好发于秋冬季,2岁以内儿童高发。多为原发性,2岁以上患儿需警惕继发性的可能。6个月内是肠套叠空气灌肠复位成功后复发的高发期。彩超是重要的诊断手段,空气灌肠是较有效的治疗方法,也是复发性肠套叠首选的治疗手段。     

Jejunal atresia associated with pyloric stenosis

Jejunal atresia and hypertrophic pyloric stenosis are relatively common pathologies in the neonatal period, but their occurrence together in the same baby must be very rare. We report one such case; this is the first reported case of these two conditions in the same patient in the English literature. Offprint requests to: S. Cywes     

The role of steroids in children with multiple recurrences of intussusception

We describe the case of a boy who had 9 recurrences of intussusception, for which no pathological lesion at the leadpoint was identified. A contrast follow-through study revealed a follicular/nodular mucosal pattern, particularly prominent in the terminal ileum and caecum. Patients with multiple recurrences usually have an identifiable lesion at the leadpoint, but sometimes recurrences may be due to lymphoid hyperplasia, as presumed in our case. No further recurrences occurred after a two month tapering course of oral prednisolone.     

Atypical ileocolic intussusception diagnosed by barium follow-through

Barium follow-through studies of the bowel demonstrated clinically undiagnosed ileocolic intussusception in two children. Because intussusception may present with atypical symptoms a high index of suspicion for this entity is mandatory.     

Japanese guidelines for the management of intussusception in children, 2011

Background: The Japanese Society of Emergency Pediatrics has formulated evidence‐based guidelines for the management of intussusception in children in order to diagnose intussusceptions promptly, to initiate appropriate treatment as early as possible, and to protect intussuscepted children from death. Methods: Literature was collected systematically via the Internet using the key words “intussusception” and “children.” The evidence level of each paper was rated in accordance with the levels of evidence of the Oxford Center for Evidence‐based Medicine. The guidelines consisted of 50 clinical questions and the answers. Grades of recommendation were added to the procedures recommended on the basis of the strength of evidence levels. Results: Three criteria of “diagnostic criteria,”“severity assessment criteria,” and “criteria for patient transfer” were proposed aiming at an early diagnosis, selection of appropriate treatment, and patient transfer for referral to a tertiary hospital in severe cases. Barium is no longer recommended for enema reduction (recommendation D) because the patient becomes severely ill once perforation occurs. Use of other contrast media, such as water‐soluble iodinated contrast, normal saline, or air, is recommended under either fluoroscopic or sonographic guidance. Delayed repeat enema improves reduction success rate, and is recommended if the initial enema partially reduced the intussusception and if the patient condition is stable. Conclusions: The guidelines offer standards of management, but it is not necessarily the purpose of the guidelines to regulate clinical practices. One should judge each individual clinical situation in accordance with experiences, available devices, and the patient's condition.     

Twenty-one cases of small bowel intussusception: the pathophysiology of idiopathic intussusception and the concept of benign small bowel intussusception

Ultrasonography (US) was used to study intussusceptions prospectively at Kiyama Hospital in 1999 and 2000 under the classification of small bowel intussusception (SBI) and large bowel or ileo-ileo-colic intussusception (LBI). The clinical features, management, outcome and etiology were analyzed. All LBIs and SBIs with ischemic symptoms and SBIs complicated by LBI were treated by enema reduction, whereas SBIs considered to be nonischemic were observed. SBI was seen in 21 patients with a mean age of 62.6±31.2 months. Four cases (19.0%) were diagnosed during the course of LBI. US showed mesenteric lymphoid hyperplasia in 15 (71.4%). Hydrostatic enema reduction was successful in 9/9, and SBI reduced naturally in the other 12 (benign SBI). LBI occurred in 38 patients with a mean age of 27.8±21.2 months. Mesenteric lymphoid hyperplasia was observed in 29 (76.3%). Hydrostatic enema reduction was successful in 37/38. SBI occurs more frequently and in a wider age group than previously considered. Many SBIs reduced naturally, suggesting that they were only transient invagination phenomena and should be called benign SBI. The frequent association of SBI with LBI and also the frequent association of mesenteric lymphoid hyperplasia with both SBI and LBI seem the key to the pathophysiology of intussusception.     

Preputial intussusception or acquired megaprepuce

Preputial intussusception, or acquired megaprepuce, is a clinical condition whose incidence is increasing. It results from infolding of the outer preputial skin, obstruction of urinary flow, and the development of a phimosis. With time the process continues, resulting in a distinctive clinical picture. Treatment by early circumcision cures the problem and allows resolution of the sequelae. Accepted: 3 June 1997     

Postoperative intussusception: a diagnostic dilemma

Intussusception as a cause of intestinal obstruction in the postoperative period is still a perplexing problem to most surgeons. From 1980 to 1988, four cases of postoperative intussusception (POI) were seen at the Kobe Children's Hospital, representing 5.4% of all intussusceptions managed during this period. There were two females and two males, ages ranging from 1 to 18 months. In two, the initial operation was nephrectomy; one had operative reduction of an ileocolic intussusception (postoperative intussusception was ileo-ileal); and the fourth had a laparotomy performed for suspected pyloric stenosis. All four presented with bilious vomiting, abdominal distension, and increasing bile-stained aspirate via a nasogastric tube during the 1st week following surgery. Radiological and laboratory parameters were not helpful in arriving at a correct diagnosis. Ileo-ileal intussusception was found at operation in all four, with no evidence of a pathological lead point. In all cases manual reduction was carried out successfully and the convalescence was unevenful. In view of the difficulty in establishing the diagnosis of POI, a literature review has been made that enables a common pattern of symptomatology to be identified. It is hoped that this will serve as a guide permitting earlier recognition of this postoperative complication.This paper is partially supported by a Hyogo Prefectural Grant Offprint request to: C. Tsugawa     

Transanal and intraperitoneal prolapse in intussusception

An infant with intussusception who developed an unusual complication of transanal and intraperitoneal prolapse is reported. Complete venous occlusion of the intussusceptum for a prolonged period in a patient with congenital anomalous vascular supply of the colon is suggested as a mechanism responsible for rupture of the intussuscepiens.     

Cystic duplication of the cecum presenting with intussusception in a 7-day-old boy

A case of ileocolic intussusception due to cystic duplication of the gut near the ileocecal valve in a 7-day-old neonate is presented. A review of the literature on both intussusception and duplications of the intestine reveals the extreme rarity of this entity. Moreover, the very young age at clinical presentation is remarkable. The contribution of ultrasonography in the diagnostic work-up is emphasized. Correspondence to: T. De Backer     

Retrograde intussusception after Roux-en-Y hepaticojejunostomy for choledochal cyst

The authors report the first documented case of a retrograde jejunojejunal intussusception after a Roux-en-Y hepaticojejunostomy for choledochal cyst in a 2-year-old girl. She suffered from obstructive jaundice and ileus; the jaundice was alleviated but the ileus worsened after conservative treatment, and abdominal computed tomography demonstrated an intussusception and gangrene of the bowel. Surgery confirmed the presence of a retrograde jejunojejunal intussusception at the previous end-to-side anastomosis, with a dilated Roux limb and proximal duodenojejunal segment. Intestinal obstruction in a jaundiced child following Roux-en-Y anastomosis may be due to a retrograde intussusception as well as a stricture of the hepaticojejunostomy or adhesive ileus.     

Postoperative intussusception after surgery for malrotation and appendicectomy in a newborn

Postoperative intussusception in the newborn is an infrequent condition. A 17-day-old female with duodenal stenosis and malrotation underwent excision of the membrane in the duodenum and incidental appendicectomy. Postoperatively, a ceco-colic type of intussusception occurred, necessitating a right hemicolectomy. We speculate that the causative factors are twofolds: the embedded appendiceal stump, a polyp-like protrusion that became a lead point, and the non-fixation of the ileocecal mesentery, which facilitated a ceco-colic type of invagination.     

Changing epidemiology of intussusception in Australia

OBJECTIVES: Oral rotavirus vaccines are expected to become available in Australia within the next 2 years. In light of evidence for an association between a rotavirus vaccine and intussusception, it is important to define the baseline epidemiology of intussusception in Australia and establish a system for intussusception surveillance in the immediate post-licensure period. This study reports on incidence and epidemiology of intussusception in Australia. METHODS: Data were obtained from the Australian Institute of Health and Welfare on all patients with a discharge diagnosis of intussusception from public and private hospitals in each state and territory of Australia from 1994 to 2000. We examined age at presentation, sex, month and year of presentation, indigenous status and clinical outcomes. The incidence of intussusception was calculated and annual trends examined. Surveillance data on rotavirus gastroenteritis hospitalizations over the same time period were also obtained to compare seasonal patterns. RESULTS: From 1994 to 2000, a 39% reduction in intussusception incidence in infants aged <1 year was observed in Australia (13.1/10,000 to 8.1/10,000; P < 0.001). The incidence of intussusception was lower in indigenous infants (3.3/10,000 <1 year) compared to non-indigenous infants (10.4/10,000 <1 year; P < 0.001). There was no association between the seasonality of rotavirus infection and intussusception. Only one of 12 deaths due to intussusception was reported in an infant <1 year. CONCLUSIONS: This study documents the epidemiology of intussusception in Australia from 1994 to 2000 and provides important baseline information for future rotavirus vaccines. A lower risk of intussusception was identified in indigenous compared to non-indigenous infants.     

Yersinia intussusception: Case report and review

Intussusception is a recognised paediatric presentation in emergency department and primary care settings. The aetiology of intussusception is multifactorial and largely unknown but includes infection in some cases. Yersinia has been the most frequently cited bacterial association in children. Identifying Yersinia affects the role and choice of antibiotics in a child's treatment regimen. This article reports on Australia's first proven case of Yersinia enterocolitica intussusception, and reviews the clinical epidemiology of all known reported cases world‐wide.     

An unusual pyloric obstruction: gastroduodenal mucosal intussusception

Gastroduodenal mucosal intussusception was recently observed in a baby girl born with esophageal atresia. After ligation of the tracheoesophageal fistula, a gastrostomy tube was inserted. At 3 months of age an esophagoesophageal anastomosis was performed and oral feeding was begun that resulted in vomiting. An upper gastrointestinal endoscopy confirmed the normal viability of the esophagus and showed intussusception of gastric mucosa into the duodenum. At laparotomy, a wide pylorotomy was done and the intussuscepted mucosa was resected and a pyloroplasty performed. Ten days postoperatively oral feeding was restarted successfully. Offprint requests to: C. Del Rossi