Postoperative intussusception in childhood

Abstract

Over a period of 10 years, five children developed postoperative intussusception after intra-abdominal procedures at the Department of Pediatric Surgery of the Johannes Gutenberg University Mainz. Two appendectomies, one ileal resection for a Meckel's diverticulum, one operative procedure for Hirschsprung's disease plus intestinal neuronal dysplasia type B, and one hiatoplasty with jejunostomy preceded the intussusception. Three of the five children were older than 2 years. The clinical symptoms consisted primarily of abdominal distension, diffuse abdominal pain, bilious vomiting, and rectal bleeding in one case. Preoperative diagnosis was achieved in four cases by abdominal ultrasound. Plain abdominal radiographs demonstrated dilated loops of small intestine with air-fluid levels in four of the five cases. In the case without radiographic findings, the jejunojejunal intussusception was missed even by a bowel follow-through. The intussusceptions were ileocolic (3), ileoileal (1), and jejunojejunal (1). A hydrostatic procedure to reduce an ileocolic intussusception was not successful. Operative treatment of the intussusception was performed in three cases within 5 days, once at 32 days, and once 3 months after the primary operation, in all cases by laparatomy and simple manual reduction without intestinal resection. In contrast to idiopathic intussusception, noninvasive hydrostatic procedures are not indicated in postoperative intussusception, since protection of intestinal anastomoses from hydrostatic pressure and exclusion of other causes of postoperative ileus are mandatory.

Small Bowel Intussusception Causing a Postoperative Bowel Obstruction Following Laparoscopic Low Anterior Resection in an Adult

“…Although it has been previously described in the pediatric population (Table) (4)(5)(6)(7)(8)(9)(10)(11)(12), to our knowledge this is the fi rst report of a small bowel intussusception masquerading as a postoperative ileus in an adult. Whereas the time from surgery to diagnosis appears to average about 1 week for children, for our patient the diagnosis was made 22 days after surgery.…”

“…In children, initial attempts at reduction of the intussusception with barium or air are often suggested, but in adults surgery is the defi nitive treatment (3). Postoperative intussusception has unique challenges, as hydrostatic reduction may compromise bowel anastomoses (4). In adults, delay in diagnosis and defi nitive treatment may be a direct result of common symptomatology between postoperative ileus and intussusception.…”

Intussusception Following the Ladd Procedure

“…In a group of collected series, the diagnosis was made before reexploration in only 3% to 5% of cases. 5 In our series, upper gastrointestinal tract with small bowel follow-through showed partial small bowel obstruction in 4 of 5 cases. In the fifth case, the study was interpreted as normal.…”

“…Other investigators report good results with abdominal ultrasound. In one series, 5 ultrasound was 80% sensitive for enteric intussusception. However, even the radiology literature states that intussusception cannot be ruled out by a negative ultrasound finding, and other findings can mimic the "doughnut" or "pseudokidney" sign, including necrotizing enterocolitis or volvulus.…”

“…It is reportedtooccurafter0.08%to0.8%ofalllapa-rotomies 1,2 and to account for 5% to 15% of postoperative bowel obstructions in children. 3,4 Recent series 2,3,5,6 have described the typical clinical course of these patients. Most had undergone a major abdominal or retroperitoneal procedure within the last 2 weeks.…”