Childhood Intussusception: A Literature Review

Abstract

BackgroundPostlicensure data has identified a causal link between rotavirus vaccines and intussusception in some settings. As rotavirus vaccines are introduced globally, monitoring intussusception will be crucial for ensuring safety of the vaccine programs.MethodsTo obtain updated information on background rates and clinical management of intussusception, we reviewed studies of intussusception in children <18 years of age published since 2002. We assessed the incidence of intussusception by month of life among children <1 year of age, seasonality, method of diagnosis, treatment, and case-fatality.FindingsWe identified 82 studies from North America, Asia, Europe, Oceania, Africa, Eastern Mediterranean, and Central & South America that reported a total of 44,454 intussusception events. The mean incidence of intussusception was 74 per 100,000 (range: 9–328) among children <1 year of age, with peak incidence among infants 5–7 months of age. No seasonal patterns were observed. A radiographic modality was used to diagnose intussusception in over 95% of the cases in all regions except Africa where clinical findings or surgery were used in 65% of the cases. Surgical rates were substantially higher in Africa (77%) and Central and South America (86%) compared to other regions (13–29%). Case-fatality also was higher in Africa (9%) compared to other regions (<1%). The primary limitation of this review relates to the heterogeneity in intussusception surveillance across different regions.ConclusionThis review of the intussusception literature from the past decade provides pertinent information that should facilitate implementation of intussusception surveillance for monitoring the postlicensure safety of rotavirus vaccines.

Intussusception and Monovalent Rotavirus Vaccination in Singapore: Self-Controlled Case Series and Risk-Benefit Study

“…This is especially worrying in Africa where mortality from intussusception was found to be much higher than in other parts of the world (9% vs <1%). 38 Our findings provide reassurance from a safety perspective for the implementation of rotavirus vaccination, particularly RV1 in Asia, which as a region has lagged behind in introducing the vaccine despite high rotavirus childhood mortality. Unlike other causes of childhood gastroenteritis, improvements in sanitation conditions and water quality are unlikely to reduce the burden of rotavirus in children.…”

Intussusception following rotavirus vaccination in the Valencia Region, Spain

“…Intussusception risk varies across population and regions, 12 and some studies have shown high background rates of intussusception in Spain; 13, 14 a potential association with rotavirus vaccination could cause concern. Thus, our aim was to investigate such association in the Valencia Region, Spain.…”

Giant Pseudopolyp as a Cause of Life-Threatening Anemia and Colocolic Intussusception in an Infant: A Case Report and Review of the Literature

“…Juvenile polyps become symptomatic in early childhood, with a peak incidence between 5 and 9 years and, usually, not before the age of two (1). Occurrence is sporadic or within defined syndromes, like Peutz-Jeghers syndrome (mainly small bowel) or juvenile polyposis syndrome (2,3).…”

“…Intussusception is a common entity in early childhood, with a peak incidence between 5 and 7 months of age (1). However, most cases are ileocolic and idiopathic.…”