Leading Points in Infancy and Childhood Intussusception

Abstract

Background: The etiology of most intussusception is idiopathic. However, some cases may have leading
points.
Objectives: The purpose of this study is to analyze and discuss the cases of intussusception in children
with pathologic leading points.   Materials and Methods: A retrospective review of medical records of the patients who were treated at
the Queen Sirikit National Institute of Child Health, formerly Children’s Hospital, for intussusception during
the 19-year period between January 1988 and December 2006 was carried out.
Results: There had been 1,025 episodes of intussusception in 956 children with 37 patients having
leading points. The incidence of intussusception with leading points was 3.8%. Twenty three were males and
14 were females. The average age was 45 months (ranging from 14 days to 12 years). Barium enema study was
done in 16 patients. Hydrostatic barium enema reduction was attempted in 12 patients and two cases were
successfully reduced. Pneumatic reduction was used in 11 patients with 13 episodes and two had successful
reduction. The non-operative reduction was not attempted in 12 patients due to poor condition or unavailability
of non-operative reduction. All of the 37 patients underwent laparotomy except one case using colonoscopy and
polypectomy. Intestinal polyps and Meckel’s diverticulum were the most common leading points and found in
14 cases each. Duplication cysts and lymphoma were noted in 3, and 2 cases, respectively. The others were
tuberculosis of the intestine, ectopic pancreatic tissue and pseudotumor of the colon. All of the leading points
were resected and the postoperative courses were uneventful.
Conclusions: Children with intussusception having leading points could be present in all age groups.
Attempted non-operative reductions were not successful in most cases. Surgical resection should be done in all
of the cases when the leading point was seen.