Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
권호 표지
DOI QR코드

DOI QR Code

Identifying Predictive Factors for the Recurrence of Pediatric Intussusception

  • Lee, Dong Hyun (Department of Pediatrics, Keimyung University School of Medicine, Dongsan Medical Center) ;
  • Kim, Se Jin (Department of Pediatrics, Keimyung University School of Medicine, Dongsan Medical Center) ;
  • Lee, Hee Jung (Department of Radiology, Keimyung University School of Medicine) ;
  • Jang, Hyo-Jeong (Department of Pediatrics, Keimyung University School of Medicine, Dongsan Medical Center)
  • Received : 2018.07.26
  • Accepted : 2018.09.27
  • Published : 2019.03.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The aim of the study was to identify factors related to the recurrence of intussusception in pediatric patients. Methods: The medical charts of patients diagnosed with intussusception and treated at Dongsan Medical Center, between March 2015 to June 2017, were retrospectively reviewed. Univariate and multivariate analyses were performed. Results: Among 137 patients, 23 patients (16.8%) had a recurrent intussusception and 8 of these patients (6%) had more than 2 episodes of recurrence. The age at diagnosis was significantly different between the non-recurrence and recurrence group (p=0.026), with age >1 year at the time of diagnosis associated with a greater rate of recurrence (p=0.002). The time interval from symptom onset to the initial reduction (<48 vs. ${\geq}48$ hours) was significantly longer in the recurrence group (p=0.034) and patients in the recurrence group had higher levels of C-reactive protein (CRP) (p=0.024). Bloody stools and a history of infection were significantly more frequent in the non-recurrence group (p=0.001 and p<0.001, respectively). On stepwise regression analysis, age >1 year at the time of presentation (odds ratio [OR], 4.79; 95% confidence interval [CI], 1.56-14.06; p=0.016) and no history of infection (OR, 0.18; 95% CI, 0.06-0.58; p=0.004) were retained as predictors of recurrence. Conclusion: Patients with intussusception who are older than 1 year at diagnosis, have an elevated CRP level, a delay of ${\geq}48$ hours between symptom onset and the initial reduction, an absence of bloody stools, and no history of infection should be closely monitoring for symptoms and signs of a possible recurrence.

Keywords

References

  1. Bruce J, Huh YS, Cooney DR, Karp MP, Allen JE, Jewett TC Jr. Intussusception: evolution of current management. J Pediatr Gastroenterol Nutr 1987;6:663-74. https://doi.org/10.1097/00005176-198709000-00003
  2. Saka R, Sasaki T, Matsuda I, Nose S, Onishi M, Fujino T, et al. Chronic ileocolic intussusception due to transmural infiltration of diffuse large B cell lymphoma in a 14-year-old boy: a case report. Springerplus 2015;4:366. https://doi.org/10.1186/s40064-015-1157-6
  3. Dias AR, Lopes RI, do Couto RC, Bonafe WW, D'Angelo L, Salvestro ML. Ileal duplication causing recurrent intussusception. J Surg Educ 2007;64:51-3. https://doi.org/10.1016/j.cursur.2006.09.003
  4. Siminas S, Qasem E, Shukla R, Turnock R. Inflammatory fibroid polyp: a rare benign tumor of the alimentary tract in children presenting as intussusception-case report and review of literature. European J Pediatr Surg Rep 2014;2:16-9.
  5. Kim KH, Kang KA, Lim JH, Lee KG, Kwon TJ. Inverted Meckel diverticulum as a lead point of small bowel intussusception: misinterpreting case as a lipoma. Clin Imaging 2016;40:840-2. https://doi.org/10.1016/j.clinimag.2016.03.009
  6. Daneman A, Alton DJ, Lobo E, Gravett J, Kim P, Ein SH. Patterns of recurrence of intussusception in children: a 17-year review. Pediatr Radiol 1998;28:913-9. https://doi.org/10.1007/s002470050497
  7. Lee YW, Yang SI, Kim JM, Kim JY. Clinical features and role of viral isolates from stool samples of intussuception in children. Pediatr Gastroenterol Hepatol Nutr 2013;16:162-70. https://doi.org/10.5223/pghn.2013.16.3.162
  8. Esmaeili-Dooki MR, Moslemi L, Hadipoor A, Osia S, Fatemi SA. Pediatric intussusception in Northern Iran: comparison of recurrent with non-recurrent cases. Iran J Pediatr 2016;26:e3898. https://doi.org/10.5812/ijp.3898
  9. Ksia A, Mosbahi S, Brahim MB, Sahnoun L, Haggui B, Youssef SB, et al. Recurrent intussusception in children and infants. Afr J Paediatr Surg 2013;10:299-301. https://doi.org/10.4103/0189-6725.125414
  10. Guo WL, Hu ZC, Tan YL, Sheng M, Wang J. Risk factors for recurrent intussusception in children: a retrospective cohort study. BMJ Open 2017;7:e018604. https://doi.org/10.1136/bmjopen-2017-018604
  11. Kim SH, Kim BC, Choi WJ, Lee JM. A clinical evaluation of the pediatric recurrent intussusception. Ann Surg Treat Res 1995;48:548-57.
  12. Yoo ES, Seo JW, Lee SJ. The risk factors related to recurrent intussusception by ultrasonography. Korean J Pediatr 1996;39:1707-16.
  13. Orloff MJ. Intussusception in children and adults. Surg Gynecol Obstet 1956;102:313-29.
  14. Carty HM. Paediatric emergencies: non-traumatic abdominal emergencies. Eur Radiol 2002;12:2835-48. https://doi.org/10.1007/s00330-002-1499-7
  15. Buettcher M, Baer G, Bonhoeffer J, Schaad UB, Heininger U. Three-year surveillance of intussusception in children in Switzerland. Pediatrics 2007;120:473-80. https://doi.org/10.1542/peds.2007-0035
  16. Niramis R, Watanatittan S, Kruatrachue A, Anuntkosol M, Buranakitjaroen V, Rattanasuwan T, et al. Management of recurrent intussusception: nonoperative or operative reduction? J Pediatr Surg 2010;45:2175-80. https://doi.org/10.1016/j.jpedsurg.2010.07.029
  17. Chen SC, Wang JD, Hsu HY, Leong MM, Tok TS, Chin YY. Epidemiology of childhood intussusception and determinants of recurrence and operation: analysis of national health insurance data between 1998 and 2007 in Taiwan. Pediatr Neonatol 2010;51:285-91. https://doi.org/10.1016/S1875-9572(10)60055-1
  18. Park MR, Lim MS, Seo JK, Ko JS, Chang JY, Yang HR, et al. Small bowel intussusception in children: spontaneous resolution vs. surgical intervention. Korean J Pediatr Gastroenterol Nutr 2010;13:128-33. https://doi.org/10.5223/kjpgn.2010.13.2.128
  19. Wang Z, He QM, Zhang H, Zhong W, Xiao WQ, Lu LW, et al. Intussusception patients older than 1 year tend to have early recurrence after pneumatic enema reduction. Pediatr Surg Int 2015;31:855-8. https://doi.org/10.1007/s00383-015-3726-8
  20. Bines JE, Liem NT, Justice FA, Son TN, Kirkwood CD, de Campo M, et al. Risk factors for intussusception in infants in Vietnam and Australia: adenovirus implicated, but not rotavirus. J Pediatr 2006;149:452-60. https://doi.org/10.1016/j.jpeds.2006.04.010
  21. Champoux AN, Del Beccaro MA, Nazar-Stewart V. Recurrent intussusception. Risks and features. Arch Pediatr Adolesc Med 1994;148:474-8. https://doi.org/10.1001/archpedi.1994.02170050032006
  22. Eklof O, Reiter S. Recurrent intussusception. Analysis of a series treated with hydrostatic reduction. Acta Radiol Diagn (Stockh) 1978;19:250-8. https://doi.org/10.1177/028418517801901B11
  23. Simon AK, Hollander GA, McMichael A. Evolution of the immune system in humans from infancy to old age. Proc Biol Sci 2015;282:20143085.
  24. Clarke EJ Jr, Phillips IA, Alexander ER. Adenovirus infection in intussusception in children in Taiwan. JAMA 1969;208:1671-4. https://doi.org/10.1001/jama.1969.03160090031007
  25. May AN, Piper SM, Boutlis CS. Yersinia intussusception: case report and review. J Paediatr Child Health 2014;50:91-5. https://doi.org/10.1111/jpc.12240
  26. Minney-Smith CA, Levy A, Hodge M, Jacoby P, Williams SH, Carcione D, et al. Intussusception is associated with the detection of adenovirus C, enterovirus B and rotavirus in a rotavirus vaccinated population. J Clin Virol 2014;61:579-84. https://doi.org/10.1016/j.jcv.2014.10.018
  27. Nylund CM, Denson LA, Noel JM. Bacterial enteritis as a risk factor for childhood intussusception: a retrospective cohort study. J Pediatr 2010;156:761-5. https://doi.org/10.1016/j.jpeds.2009.11.026
  28. Williams K, Koyama T, Schulz D, Kaluza GL, Pautler RG, Weisbrodt N, et al. Use of fluoroscopy to study in vivo motility in mouse pups. J Pediatr Gastroenterol Nutr 2011;52:679-85. https://doi.org/10.1097/MPG.0b013e31820a0e86
  29. Killoran KE, Miller AD, Uray KS, Weisbrodt NW, Pautler RG, Goyert SM, et al. Role of innate immunity and altered intestinal motility in LPS- and MnCl2-induced intestinal intussusception in mice. Am J Physiol Gastrointest Liver Physiol 2014;306:G445-53. https://doi.org/10.1152/ajpgi.00264.2013
  30. Ravitch MM. The nonoperative treatment of intussusception: hydrostatic pressure reduction by barium enema. Surg Clin North Am 1956;36:1495-500. https://doi.org/10.1016/S0039-6109(16)35034-4
  31. Fallon SC, Lopez ME, Zhang W, Brandt ML, Wesson DE, Lee TC, et al. Risk factors for surgery in pediatric intussusception in the era of pneumatic reduction. J Pediatr Surg 2013;48:1032-6. https://doi.org/10.1016/j.jpedsurg.2013.02.021
  32. Smith JL, Helwig EB. Malignant lymphomas of the stomach. its diagnosis, distinction and biologic behavior. Am J Pathol 1958;34:553.
  33. Hasegawa T, Ueda S, Tazuke Y, Monta O, Sakurai T, Takahara N, et al. Colonoscopic diagnosis of lymphoid hyperplasia causing recurrent intussusception: report of a case. Surg Today 1998;28:301-4. https://doi.org/10.1007/s005950050126
  34. Bhisitkul DM, Todd KM, Listernick R. Adenovirus infection and childhood intussusception. Am J Dis Child 1992;146:1331-3.

Cited by

  1. Pediatric ileocolic intussusception vol.16, pp.3, 2019, https://doi.org/10.4103/am.am_46_19
  2. Laparoscopic Ileopexy Versus Laparoscopic Simple Reduction in Children with Multiple Recurrences of Ileocolic Intussusception: A Single-Institution Retrospective Cohort Study vol.30, pp.5, 2019, https://doi.org/10.1089/lap.2019.0641