Small Bowel Intussusception in Children: Spontaneous Resolution vs. Surgical Intervention

Abstract

Purpose: Intussusception is one of the most common causes of an acute abdomen in infancy. The majority of pediatric cases of intussusception are of the ileocolic type and usually idiopathic. Small bowel intussusception is rarely diagnosed in children, and few cases have been reported. The purpose of this study was to determine the clinical features and causes of small bowel intussusception in children. Methods: We retrospectively reviewed the clinical and radiologic findings of 21 children with small bowel intussusception who were admitted to Seoul National University Children's Hospital between March 2005 and January 2010. Results:The clinical presentation of small bowel intussusception included abdominal pain or irritability (85%), vomiting (23%), fever (14%), bloody stools (14%), and abdominal masses (4%). Six patients required surgical management. Ultrasonography showed that the mean diameter of the lesions and mean thickness of the outer rims were 1.6±0.7 and 1.7±1.8 mm, respectively. Eleven lesions were located in the left abdominal or paraumbilical regions. Children who underwent surgical management were older than children with transient small bowel intussusception (mean age, 51 vs. 109 months). The mean diameter of the lesions and mean thickness of the outer rims were greater in the surgically-managed group. The location of intussusception was not significantly different between the two groups. Conclusion: Small bowel intussusception was spontaneously reduced in a large number of pediatric patients. However, sonographic demonstration of larger size, older age, and pathologic lead point warrant surgical intervention. (Korean J Pediatr Gastroenterol Nutr 2010; 13: 128∼133)

Identifying Predictive Factors for the Recurrence of Pediatric Intussusception

“…We found that most of the intussusceptions were ileocolic, with only 1 small bowel case. Small bowel intussusception is known to be rare, representing about 1.68% to 17% of all intussusceptions [18]. This agrees with our result, which showed only 1 small bowel intussusception (0.7%) among all the cases.…”

Rapidly Progressive Small Bowel Necrosis in a Previously Healthy Child without Proven Mechanical Obstruction

“…Therefore, given that our patient underwent the surgical intervention only after 2 days of hospitalization, we have to consider the possibility of a missed diagnosis that could have led to strangulation of the small bowel that occurred during that time period. However, spontaneously reduced small bowel intussusception is presented as a benign disease in most patients, and usually is not associated with bowel ischemia or necrosis [9]. As has been noted, Meckel's diverticulum (MD), a vitelline duct remnant, shows no symptoms in most cases but rather causes complications in the patient such as hemorrhage, intestinal obstruction, inflammation, and perforation in less than 5% of cases [1011] Considering its frequency, MD could be thought as a possible cause of SBO in this patient.…”