Risk factors associated with intestinal necrosis in children with failed non-surgical reduction for intussusception

Huang, Huiya; Huang, Xiaozhong; Han, Yijiang; Zhu, Li; Huang, Kaiyu; Lin, Jing; Li, Zhongrong

doi:10.1007/s00383-017-4060-0

Cited by 23 publications

(14 citation statements)

References 20 publications

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“…Meanwhile, the late diagnosis of intussusception augments the rates of surgical treatments as well as the odds of complications 3 . We found that the rate of intestinal necrosis was significantly higher in younger children, which is consistent with our previous findings 17 . However, multivariable analysis indicated that age (OR 1.07; 95% CI 0.92–1.15, P = 0.300) could not independently predict intestinal necrosis in intussusception cases.…”

Section: Discussionsupporting

confidence: 88%

Haemostatic indexes for predicting intestinal necrosis in children with intussusception

Huang

Lin

Guo

et al. 2021

ANZ Journal of Surgery

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Background To determine risk factors for intestinal necrosis in intussusception cases among children with failed non‐surgical reduction for intussusception. Methods Totally, 540 hospitalized individuals with unsuccessful air‐enema reduction in our hospital between November 2010 and November 2020 were assessed in this retrospective study. The 540 intussusception cases were divided into the intestinal necrosis and non‐intestinal necrosis groups. Haemostatic parameters, demographic and clinical features were assessed. Predictors of intestinal necrosis were examined by univariable and multivariable logistic regression analyses. Results Of the 540 patients included, 113 showed intestinal necrosis. This intestinal necrosis group had a longer duration of symptom or length of illness, younger ages, higher platelet counts, fibrinogen amounts and d‐dimer levels (all P = 0.000) compared with the non‐intestinal necrosis group. Multivariable analysis revealed that duration of symptom (odds ratio (OR) 1.12; 95% confidence interval (CI) 1.16–1.23, P = 0.000), fibrinogen (OR 1.26; 95% CI 1.10–1.31, P = 0.010) and d‐dimer (OR 2.07; 95% CI 1.91–2.28, P = 0.000) independently predicted intestinal necrosis in individuals undergoing surgical reduction for intussusception. Receiver operating characteristic curve analysis showed that d‐dimer amounts had the largest area under the curve for predicting intestinal necrosis. Conclusion On admission, long duration of symptom, high fibrinogen and d‐dimer levels are critical risk factors for intestinal necrosis development in children with unsuccessful non‐surgical reduction. d‐Dimer levels have the best predictive value for intestinal necrosis.

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Section: Discussionsupporting

confidence: 88%

Haemostatic indexes for predicting intestinal necrosis in children with intussusception

Huang

Lin

Guo

et al. 2021

ANZ Journal of Surgery

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“…Khorana et al (9) reported that duration of symptoms >72 h was one of the predictors of failed non-surgery reduction (9). Similarly, Huang et al (16) demonstrated that duration of symptoms was the independent risk factor for surgical reduction of intussusceptions. In this study, we also found that duration of symptoms was an independent predictor for surgical intervention after hydrostatic reduction.…”

Section: Discussionmentioning

confidence: 99%

Developing a nomogram for predicting surgical intervention in pediatric intussusception after hydrostatic reduction

Wang

Xia

et al. 2023

Front. Pediatr.

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PurposeThe aim of this study was to develop and validate a nomogram for predicting surgical intervention in pediatric intussusception after hydrostatic reduction.MethodsChildren with intussusception who had treated with sonographically guided saline hydrostatic reduction as an initial treatment were enrolled in this study. The enrolled patients were randomly selected for training and validation sets, and the split ratio was 7:3. The medical records of enrolled patients were retrospectively reviewed. The patients were divided into a surgery and a non-surgery group according to the results of the nonsurgical reduction. A model for predicting the risk of surgical treatment was virtualized by the nomogram using logistic regression analysis.ResultsThe training set consisted of 139 patients and the validation set included 74. After logistic regression analysis using training set, duration of symptoms, bloody stools, white blood cells (WBCs), creatine kinase isoenzyme (CK-MB), long-axis diameter, poor prognostic signs by ultrasound and mental state were identified as the independent predictors of surgical intervention for intussusception. A model that incorporated the above independent predictors was developed and presented as a nomogram. The C-index of the nomogram in the validation set was 0.948 (95% CI, 0.888–1.000). The calibration curve demonstrated a good agreement between prediction and observation. The decision curve analysis (DCA) curve showed that the model achieved a net benefit across all threshold probabilities.ConclusionBased on the predictors of duration of symptoms, bloody stools, WBCs, CK-MB, long-axis diameter, poor prognostic signs by ultrasound and mental state, we developed a nomogram for predicting surgical intervention after hydrostatic reduction. This nomogram could be applied directly to facilitate pre-surgery decision for pediatric intussusception.

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“…Persistent GEI can cause blood flow obstruction and subsequent complications such as Mallory-Weiss syndrome or esophageal perforation [ 1 ]. While there have been no relevant studies carried out on patients with GEI, a study of patients with bowel intussusception who required surgery for reduction suggested that patients with intestinal necrosis have significantly longer durations before reduction compared with corresponding patients without intestinal necrosis [ 11 ]. Thus, an immediate reduction is essential.…”

Section: Discussionmentioning

confidence: 99%

Intra-Abdominal Hypertension-Induced Gastroesophageal Intussusception: A Rare Complication of Transurethral Resection of a Bladder Tumor

et al. 2021

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Patient: Male, 81-year-old Final Diagnosis: Gastroesophageal intussusception Symptoms: Diffuse tenderness and distension of the abdomen Medication:— Clinical Procedure: — Specialty: Critical Care Medicine Objective: Rare disease Background: Gastroesophageal intussusception (GEI) generally develops in patients with risk factors. However, intra-abdominal hypertension (IAH) rarely causes sudden GEI in patients without known risk factors. Endoscopic or surgical intervention is generally performed to reduce GEI. However, when GEI is induced by IAH, intra-abdominal pressure (IAP) decompression can contribute to GEI reduction. Case Report: An 81-year-old man who underwent transurethral resection of bladder tumor (TURBT) for hematuria from a bladder tumor located at the left lateral wall had a deteriorated general status and bladder perforation during surgery in February 2020. The perforated portion was coagulated and treated conservatively using a urinary tract catheter. He was admitted to our Intensive Care Unit (ICU) following surgery after undergoing computed tomography (CT). CT revealed free air, ascites, and intra/retroperitoneal edema due to perfusion fluid leakage, and a new GEI was documented. The GEI required reduction; however, since his IAP increased to 21 mmHg, IAH-induced GEI was diagnosed; ascites drainage for IAP decompression was performed. IAP decreased to 12 mmHg after drainage; on subsequent gastrointestinal endoscopy, the GEI had reduced. His condition improved with no recurrence of GEI, and he was discharged from the ICU on day 8. Since cystography findings on day 26 showed no leakage of the bladder, he was discharged from our hospital on day 31. Conclusions: We report a case of IAH-induced GEI as a complication of perfusion fluid leakage during TURBT. GEI was reduced by IAP decompression by ascites drainage without endoscopic or surgical intervention.

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Risk factors associated with intestinal necrosis in children with failed non-surgical reduction for intussusception

Cited by 23 publications

References 20 publications

Haemostatic indexes for predicting intestinal necrosis in children with intussusception

Haemostatic indexes for predicting intestinal necrosis in children with intussusception

Developing a nomogram for predicting surgical intervention in pediatric intussusception after hydrostatic reduction

Intra-Abdominal Hypertension-Induced Gastroesophageal Intussusception: A Rare Complication of Transurethral Resection of a Bladder Tumor

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