Japanese guidelines for the management of intussusception in children, 2011

Abstract

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.

The Frequency of Postreduction Interventions After Successful Enema Reduction of Intussusception

“…Postreduction perforation rates have been previously reported to be low, ranging between 0.14 and 0.75% 4,10,18 with most appreciated during, or immediately after, the reduction.…”

A High Incidence of Intussusception Revealed by a Retrospective Hospital-Based Study in Nha Trang, Vietnam between 2009 and 2011

“…In addition, hospital charts are not necessarily designed for epidemiological investigations. Of 192 cases of intussusception diagnosed by local doctors, 5 were excluded because these cases did not meet with the case definition employed in this study (that of the Japanese Society of Emergency Pediatrics [8]). In at least one case, however, there was a very detailed description of the patient that strongly suggested the presence of intussusception.…”

“…The data collection form was used to collect information on demography, clinical signs, ultrasound findings, radiological findings, method of treatment, medical history and treatment outcome. Based on the information collected from hospital charts, each case was ascertained according to the definitive diagnosis defined by the Japanese Society of Emergency Pediatrics [8]. Patients coded under K56.1 and matched with the definitive diagnosis of the Japanese Society of Emergency Pediatrics, less than 5 years of age and living in Nha Trang city were included in the final analysis.…”

Clinical Manifestations, Vital Signs, and Bowel Viability In Pediatric Intussusception

“…Most of the subjects in this study were male. A Japanese guideline for pediatric intussusception, stated that the ratio of 12 male-to-female was 2:1 , and three other wide-scale epidemiologic studies reported male-to-female ratio 1.6:1 to 4,6,10 2.1:1 . Though the numbers of ratio were different, those studies indicated that predominance of male patients in 21 pediatric intussusception .…”