Prospective surveillance study of the management of intussusception in UK and Irish infants

Samad, Lamiya; Marven, Sean; Bashir, Haitham El; Sutcliffe, Alastair; Cameron, J. Claire; Lynn, Richard; Taylor, Brent

doi:10.1002/bjs.7821

Cited by 60 publications

(29 citation statements)

References 24 publications

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“…This finding is somewhat corroborated by prior studies reflecting a higher rate of enema failure or need for surgical intervention in children with symptom duration exceeding 24 hours. [21][22][23] Furthermore, we determined that an intussusception tip at, or proximal to, the hepatic flexure was also predictive of hospital-level interventions, including recurrence. While counterintuitive and never studied previously, bowel wall edema may prevent the intussusceptum from progressing into more distal bowel, whereas less edematous bowel may easily slide distally but allow for pressure reduction despite the longer length.…”

Section: Discussionmentioning

confidence: 99%

The Frequency of Postreduction Interventions After Successful Enema Reduction of Intussusception

Lessenich

Kimia

Mandeville

et al. 2015

Academic Emergency Medicine

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Objectives: The objective was to determine the frequency of postreduction, hospital-level interventions among children with successful reduction of ileocolic intussusception and identify factors that predict the need for such interventions.Methods: This was a retrospective cross-sectional study of children who underwent successful enema reduction for ileocolic intussusception at a single emergency department. Hospital-level interventions were included if they occurred within 24 hours of reduction and were further classified as either major (recurrence or possible perforation) or minor (imaging for suspected recurrence or administration of parenteral narcotics or antiemetics). Binary logistic regression was used to identify predictors for hospital-level interventions.Results: A total of 464 children underwent enema reduction. The median age was 1.7 years (interquartile range [IQR] = 0.8 to 2.5 years), and 66% were male. A total of 435 (94%) were hospitalized with a median hospital stay of 25 hours (IQR = 19 to 34 hours). Nineteen percent (95% confidence interval [CI] = 15% to 22%) needed postreduction interventions, including 6% (95% CI = 4% to 9%) who required major interventions. The median time to any hospital intervention was 9.9 hours (IQR = 6.3 to 16.4 hours). We identified two independent predictors for hospital-level interventions: duration of symptoms > 24 hours (adjusted odds ratio [OR] = 2.1, 95% CI = 1.3 to 3.4) and location of the intussusception tip at (or proximal to) the hepatic flexure (adjusted OR = 1.9, 95% CI = 1.1 to 3.3); the latter factor was also a predictor of a major intervention. None of the children (95% CI = 0 to 1.0%) had an acute decompensation after an initially successful enema reduction.Conclusions: Clinical decompensation is rare and recurrence is relatively low after an uncomplicated reduction of ileocolic intussusception. However, one in five children required hospital-level interventions after reduction. Children with the intussusception tip at (or proximal to) the hepatic flexure, and those with symptoms for longer than 24 hours, are more likely to require subsequent interventions. Although outpatient management appears safe after a period of observation, caregivers should be counseled about the risk of ongoing symptoms and recurrence.

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Section: Discussionmentioning

confidence: 99%

The Frequency of Postreduction Interventions After Successful Enema Reduction of Intussusception

Lessenich

Kimia

Mandeville

et al. 2015

Academic Emergency Medicine

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“…Surgery was performed on 19.5% of patients, and bowel resection on one third of these, with transmural bowel necrosis having been found in 56% of the resected specimens. In a prospective study of intussusception in 261 infants in the United Kingdom and Ireland [10], radiologic reduction was performed on 92% of patients, and 98.8% underwent pneumatic reduction with a success rate of 61.2%. Surgery was performed on 35% of patients after unsuccessful enema reduction and in 17.1% as a primary procedure.…”

Section: Surgeon Availability For Intussusception Reductionmentioning

confidence: 99%

Intussusception Revisited: Is Immediate On-Site Surgeon Availability at the Time of Reduction Necessary?

Nguyen

Kan

Guillerman³

et al. 2014

American Journal of Roentgenology

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In this series, complications requiring immediate medical or surgical attention were rare, occurring in 1.6% of cases (five bowel perforations, two cases of hemodynamic instability without perforation). On-site surgeon presence may not be necessary at the time of radiologically guided reduction attempts provided that the attending physician is facile with percutaneous needle decompression and management of hemodynamic instability and that ultimate surgical care can be arranged expeditiously.

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“…Symptoms include sudden onset of vomiting, abdominal pain, intermittent lethargy and irritability, and rectal bleeding that has been described as ''currant jelly'' [3][4][5][6]. Reduction is usually accomplished by air or barium enema, and in some cases by surgery, with or without bowel resection [3,4,6]. Intussusception primarily affects young children, with the highest incidence in infants aged 4-10 months [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for pediatric intussusception complicated by loss of intestine viability in China from June 2009 to May 2014: a retrospective study

et al. 2014

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Prospective surveillance study of the management of intussusception in UK and Irish infants

Abstract: This study described current treatment patterns for intussusception in infancy; these represent a benchmark for improved standards of care for this condition.

Cited by 60 publications

References 24 publications

The Frequency of Postreduction Interventions After Successful Enema Reduction of Intussusception

The Frequency of Postreduction Interventions After Successful Enema Reduction of Intussusception

Intussusception Revisited: Is Immediate On-Site Surgeon Availability at the Time of Reduction Necessary?

Risk factors for pediatric intussusception complicated by loss of intestine viability in China from June 2009 to May 2014: a retrospective study

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