Radiographic and Clinical Factors in Pediatric Patients With Surgical Small-bowel Intussusception

Abstract

Background: When evaluating a pediatric patient with abdominal pain, identification of a small-bowel to small-bowel intussusception (SBI) on radiologic imaging can create a diagnostic dilemma. The clinical significance and need for surgical exploration of SBI is highly variable, as most of them are considered clinically insignificant. We hypothesize that combination of clinical and radiologic factors in an exclusively SBI population will yield factors that guide the clinician in making operative decisions. Methods: A comprehensive database from a pediatric tertiary hospital was reviewed from 1/1/2011 to 12/31/2016 for any radiographic study mentioning intussusception. Results were reviewed for patients having only SBI (i.e. not ileo-colic intussusception) and this comprised the study cohort. The electronic medical records for these patients were reviewed for clinical presentation variables, need for operative intervention, and identification of the intussusception during surgery. Patients with SBI due to enteral feeding tubes were excluded from the study. Results: Within the study period, 139 patients were identified with a small-bowel intussusception (SBI) on radiologic imaging. Univariate analysis yielded numerous clinical and radiologic factors highly predictive for need for surgical intervention. However upon multivariate analysis, only a history of prior

Liberal surgical laparoscopy reduction for acute intussusception: experience from a tertiary pediatric institute

“…Based on our experience and previously identified risk factors, air reduction was only applied to patients with ileocolic intussusception presenting symptoms within a 48-h window. Other studies have linked the duration of onset of intussusception symptoms to the likelihood of bowel loss 18 , 19 , a finding congruent with our observation that timely laparoscopic intervention could curtail intestinal resection.…”

Shear wave elastography evaluation in predicting the success of ultrasound-guided saline enema hydrostatic reduction technique in ileocolic intussusception

“…Concurrent with current literature, in our study, the length of intussusception was negatively correlated with the USGSE success rate (10,11); however, there was no statistically relevant association with the diameter. This may have been due to the small number of patients.…”

“…During the sonographic and SWE evaluation, the length and the diameter of the invaginated bowel segment were measured along with stiffness through the anterior wall to predict the success of the USGSE. Concurrent with current literature, in our study, the length of intussusception was negatively correlated with the USGSE success rate (10,11); however, there was no statistically relevant association with the diameter. This may have been due to the small number of patients.…”

“…In other studies, it was found that the success rate of USGSE was significantly lower for patients who had intussusceptions on the left compared to those who had them on the right and in the presence of the entrapped, fluid focal abdominal pain and a history of prior abdominal surgery (2,10); however, we did not observe these parameters in our cases.…”

“…A barium enema was the gold standard for diagnosis; however, for the last three decades, an ultrasound has become the gold standard in diagnosis and the primary choice for diagnosis. In this modern era, USGSE is the primary treatment of choice if it is otherwise contraindicated (2,3,10).…”