Surgical Management of Intussusception in Children: A Retrospective Review of 212 Cases

Abstract

Objectives The primary objective of this study was to analyze and review the demographics of children operated upon for intussusception. Secondary objectives were to review the clinical characteristics, surgical procedures performed, postoperative complications, and outcome. Materials and Methods It is a single-institution, retrospective study and consists of children below the age of 12 years. This study was conducted at the author’s department of pediatric surgery for the past 21 years, from January 1, 2000 to December 31, 2020. Results During the study period, 212 children were operated upon for intussusceptions and included 146 (68.86%) boys and 66 (31.13%) girls. This review consisted of infants 158 (74.52%), and children of 1 to 5 years of age (30; 14.15%), and 6 to 12 years of age (24; 11.32%). Clinically, 177 (83.49%) children presented with the features of acute intestinal obstruction, and the remaining 35 (16.5%) presented with features of perforation peritonitis. Primary (idiopathic) intussusception was documented in 188 (88.67%) of the cases. Gangrenous bowel was evident in 98 (46.22%) children. Sixty-two percent of the cases required bowel resection. Surgical procedures were executed in children for intussusception in the following order of frequency: (1) operative reduction with or without serosal tear/bowel perforation repair, n = 81 (38.2%); (2) resection of diseased ileum and ileoileal anastomosis, n = 52 (24.52%); (3) resection of diseased ileum ± part of colon and an ileostomy, n = 36 (16.98%); and (4) resection of diseased ileum, cecum, part of colon, and ileocolic (ileo-ascending or ileo-transverse) anastomosis, n = 43 (20.28%). Postoperatively, 9 (4.24%) children required reexploration for the management of their complications. Twenty-one (9.9%) children died during the postoperative period. Conclusion Intussusception remains the most common cause of acute intestinal obstruction in infants and young children. Delay in the referral, diagnosis, and seeking treatment were significantly associated with bowel gangrene, required bowel resection during the surgical therapy, and also culminated in significantly higher mortalities.

The Relationship between Neutrophil-Lymphocyte Ratio to Intestinal Viability in Invagination Patients at Dr. M. Djamil General Hospital, Padang, Indonesia

“…In addition, mortality rates related to surgical treatment for childhood intussusception are also reported to be less than 1% in developed countries. 11,16 Contrary to previous data, in developing countries, mortality associated with the management of intussusception in infants and children is much Most invaginations can be treated by nonoperative reduction via barium enema with fluoroscopy guidance and pneumatic reduction, and emergency surgery should still be performed in cases where nonoperative reduction fails. 17 In terms of surgical planning and patient management, it is critical to detect potential complications early, as delays can result in impaired intestinal circulation, which can lead to life-threatening secondary intestinal necrosis, perforation, or peritonitis, resulting in bowel resection and death.…”

“…10 Based on Ghritlaharey's (2021) retrospective study on pediatric invagination surgery <12 years in India for the period 2000-2021, it was found that ileocolic/colo-colic is the most common type of anatomy and was documented in n = 183 (86.32%) children, followed by ileo-ileal, n = 27 (12.73%), jejunojejunal, n = 1 (0.47%), and postoperative type, n = 1 (0.47%). 11 For pediatric patients who present with suspected SBO, an early surgical evaluation should be performed. 12 Conservative treatment, including fasting, nasogastric suction, and fluid therapy, is the first choice in adult patients and has a success rate of 16%-63%.…”

“…These modalities were chosen because they have the added advantage of shorter hospitalization times1 as well as lower morbidity rates. 11 Batebo et al 13 showed that children with SBO who underwent surgical intervention within 24 hours of symptom onset had fewer incurable incidences of intestinal ischemia and postoperative complications.…”

Unusual presentation of ileal intussusception due to submucosal lipoma in a child and its management

“…Meckel's diverticulum (inverted) is the most common lead point in 20%–50% of intussusceptions associated with PLPs. [ 2 ] Lipomas of the gastrointestinal tract (GIT) are the second most common benign lesions seen in colon (65%–75%), small intestine (20%–25%), stomach, and esophagus with a peak incidence in sixth or seventh decade. [ 3 ] Most GIT lipomas are asymptomatic and <50% of adult patients who have intestinal lipomas become symptomatic (intussusception, obstruction, or hemorrhage).…”

Prevalence, Surgical Management, and Outcome of Intussusception in Children : A Comprehensive Systematic Review

“…Present study consisted of 212 children below the age of 12-years, who were operated upon for intussusception during the study period of 21 years, with a brief review of the literature. [6][7][8]…”