Differences in Clinical Findings Based on the Duration of Symptoms and Age of Children With Ileocolic Intussusception

Abstract

Objectives:The objective of this study was to determine whether the rates of abdominal pain or irritability, vomiting, and hematochezia differ depending on the duration of symptoms and age of the children with ileocolic intussusception. Methods:We retrospectively investigated the charts of ileocolic intussusception children between January 2008 and December 2017 at a rural general hospital in Japan. Children were separated into 2 groups: the early visiting group, including children examined within 6 hours after onset, and the late visiting group, including children examined more than 6 hours after onset. We further separated them into 2 groups based on age: the infant group (age, <18 months) and the child group (age, ≥18 months). We compared clinical features, such as abdominal pain or irritability, vomiting, and hematochezia, between each group.Results: Among 105 children with ileocolic intussusception, 51 were in the early visiting group and 49 were in the infant group. Hematochezia less frequently occurred in the early visiting group than in the late visiting group (29% vs 50%, P = 0.046). Furthermore, abdominal pain or irritability occurred less frequently in the infant group than in the child group (79.6% vs 98.2%, P = 0.003). Conversely, vomiting and hematochezia were more frequent in the infant group than in the child group (83.7% vs 51.8%, P < 0.001; 55.1% vs 26.8%, P = 0.005).Conclusions: Clinical features of pediatric ileocolic intussusception may depend on symptom duration and age.

Clinical Characteristics According to Age and Duration of Symptoms to Be Considered for Rapid Diagnosis of Pediatric Intussusception

“…The second most common symptom was vomiting (46.1%, n = 247). Vomiting was significantly more common in younger children ( P < 0.001), similar to previous studies ( 3 , 15 ). Vomiting is caused by a vagal reflex and ileus condition.…”

“…In our study, post-enema bloody stool was also more common in younger children ( P < 0.001), and children older than 2 years tended to have a normal stool (no blood in the stool) even after glycerin enema (77.1%). Bloody stool may occur as a result of the compression of the mesenteric vessels, mucosal edema, hemorrhage, and ischemia of the bowel, and may not be detected in early cases ( 15 , 19 ). Bloody stool was significantly more common in the late than in the early group ( P = 0.023).…”

“…In the current study, 9.3% (50/536) of children showed the classic triad of symptoms, and only two (1.1%) of them were over 2 years. Harrington et al reported that the combination of the classic triad symptoms showed a positive predictive value of 93% ( P < 0.001) ( 22 ), but in many children, especially in early cases and older children, the classic triad cannot be the sole diagnostic criteria for intussusception ( 3 , 15 , 16 ).…”

Comparison of Clinical Features of Intussusception in Terms of Age and Duration of Symptoms

“…Thus, we could not show any relationship between symptom duration and bloody stools in our study, in contrast to most other studies. 9,25 Some authors have reported that symptom duration and door-to-diagnosis time are longer in patients aged older than 2 years. 9 We found no relationship between patient age and symptom duration.…”

“…Similarly, Park et al 9 reported that abdominal pain was less frequent in patients aged younger than 2 years. Aoki et al 25 noted that in infants younger than 18 months, abdominal pain or irritability were less frequent and vomiting and bloody stool were more frequent.…”