Patterns of recurrence of intussusception in children: a 17-year review

Daneman, Alan; Alton, Douglas J.; Lobo, Edrise; Gravett, Jane; Kim, Peter; Ein, Sigmund H.

doi:10.1007/s002470050497

Cited by 128 publications

(102 citation statements)

References 12 publications

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“…Niramis et al [1] found that the success rates after BE and AE reduction in recurrent cases were as high as 96% and 92%, respectively. Reducibility was 95% for recurrent episodes in the series of Daneman et al [5]. In our study hydrostatic enema was effective in 100% of cases.…”

Section: Discussionsupporting

confidence: 50%

Recurrent Intussusception in Infants

et al. 2014

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Section: Discussionsupporting

confidence: 50%

Recurrent Intussusception in Infants

et al. 2014

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“…Timing of intussusception recurrence can range from hours to years, and reliable predictors of recurrence have not been identified. 5,10,11 The management of recurrent intussusception has been repeat enema reduction with excellent outcome, even after multiple recurrences. It remains a challenge to identify patients at high risk for recurrence.…”

Section: Discussionmentioning

confidence: 99%

Improving Quality and Efficiency for Intussusception Management After Successful Enema Reduction

Raval

Minneci²,

Deans³

et al. 2015

Pediatrics

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The purpose of this project was to implement a protocol facilitating discharge from the emergency department (ED) after successful radiologic ileocolic intussusception reduction in a pediatric referral center.METHODS: A multidisciplinary team identified drivers for successful quality improvement including educational brochures, a standardized radiologic report, an observation period in the ER with oral hydration challenges, and follow-up phone calls the day after discharge. Patient outcomes were tracked, and quarterly feedback was provided.RESULTS: Of 80 patients identified over a 24-month period, 34 (42.5%) did not qualify for discharge home due to need for surgical intervention (n = 9), specific radiologic findings (n = 11), need for additional intravenous hydration (n = 4), or other reasons (n = 7). Of 46 patients who qualified for discharge, 30 (65.2%) were successfully sent home from the ED. One patient returned with recurrent symptoms that required repeat enema reduction. Sixteen patients were observed and discharged within 23 hours. Adherence with discharge from the ED improved over time. Discharge from the ED was associated with cost savings and improved net margins at the hospital level for each encounter. CONCLUSIONS:A sustainable multidisciplinary quality improvement project to discharge intussusception patients from the ED after air-contrast enema reduction was successfully integrated in a high-volume referral center through education, standardized radiologic reporting, and protocoled follow-up.Intussusception remains one of the most common causes of intestinal obstruction in young children and infants. Treatment of intussusception has evolved over time from a predominantly operative disease to one managed nonoperatively most of the time with high success with radiologically guided enema reduction. 1 Traditional practice after successful enema reduction of intussusception includes surgical admission for observation to ensure toleration of enteral diet advancement and to monitor for recurrence of intussusception, which occurs in ,10% of patients. 2 Absolute indications for admission in the setting of intussusception include perforation, failed enema reduction, and successful enema reduction with identification of a lead point that would merit semiurgent resection to prevent recurrent obstruction. Relative indications for admission after successful enema reduction of intussusception are poorly defined but include a prolonged prodrome of symptoms, presence of bloody stools, and dehydration. Several institutions

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“…[6] Özellikle çoklu nükslerde bu ihtimal daha fazladır. [6,7,14] Tander ve ark. [6] üç yaş üzeri hastalarda hidrostatik redüksiyonun başarı oranı düşük olsa bile denenebileceğini, ancak hastanın klinik ve radyolojik olarak iyi bir gözlem altında tutulması gerektiğini belirtmektedirler.…”

Section: Discussionunclassified