Intussusception: factors related to treatment.

Reijnen, J. A. M.; Festen, C.; Roosmalen, R P van

doi:10.1136/adc.65.8.871

Cited by 45 publications

(31 citation statements)

References 14 publications

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“…Leukocytosis is more frequently seen in moderate‐to‐severe cases. In one study, the incidence of white blood cell count greater than 20 000/µL was significantly higher in the bowel‐resection group compared with those of the operative‐reduction group and the enema‐reduction group 38 (level 3b).…”

Section: Severity Assessmentmentioning

confidence: 97%

“…Duration of symptoms of more than 48 h was significantly correlated with failure of enema reduction and with a high rate of bowel resection 38 (level 3b). The longer the duration of symptoms, the lower the likelihood of successful enema reduction and the higher the rate of bowel perforation 22 (level 3b); however, a long duration of symptoms itself is not a contraindication for attempted enema reduction.…”

Section: Severity Assessmentmentioning

confidence: 98%

“…There is no specific finding in blood tests to diagnose intussusception; however, if a patient is in severe condition due to bowel necrosis, leukocytosis is seen 38 (level 3b). If the duration of symptoms is long, metabolic acidosis is expected.…”

Section: Diagnosismentioning

confidence: 99%

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Japanese guidelines for the management of intussusception in children, 2011

Ito

Kusakawa

Murata

et al. 2012

Pediatrics International

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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.

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Section: Severity Assessmentmentioning

confidence: 97%

Section: Severity Assessmentmentioning

confidence: 98%

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Japanese guidelines for the management of intussusception in children, 2011

Ito

Kusakawa

Murata

et al. 2012

Pediatrics International

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“…1 It has been reported that successful hydrostatic reduction may be less likely in patients with symptoms for more than 48 hours, and consequently patients with prolonged symptoms are nowadays likely to undergo operative reduction as the first line treatment. [1][2][3] Since there is little evidence to support this policy we undertook a prospective study to examine our success with hydrostatic reduction in relation to duration of symptoms.…”

mentioning

confidence: 99%

Success with hydrostatic reduction of intussusception in relation to duration of symptoms

Ende

Allema

Hazebroek

et al. 2005

Archives of Disease in Childhood

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Background: It is widely believed that hydrostatic reduction of intussusception is less successful in children with prolonged symptoms prior to presentation. Aim: To prospectively evaluate success in relation to duration of symptoms. Methods: Prospective study in which children, regardless of symptom duration, underwent an attempt at hydrostatic reduction. Results: Of 113 children presenting with intussusception, 16 had peritonitis and required immediate laparotomy. A hydrostatic reduction was attempted in 97 and was successful in 77 (79%). There were 26 successful reductions with symptoms ,12 hours (81%), 30 with symptoms for 12-24 hours (81%), and 21 with symptoms .24 hours (75%). Conclusion: The success rate with hydrostatic reduction was not significantly influenced by symptom duration.

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“…These transfers from the community predispose these patients to a longer duration of symptoms and delay in intervention which may affect success of a primary reduction, although data are inconsistent in determining if longer duration of symptoms affects the rate of successful enema reduction. [17][18][19] Limitations of this study include its retrospective design. A decision for immediate surgical exploration versus a DRE after a failed primary enema was purely at the discretion of the consulting surgeon, and therefore may bias surgical outcomes.…”

Section: Discussionmentioning

confidence: 99%