Current Success in the Treatment of Intussusception at Queen Sirikit National Institute of Child Health between 1999 and 2008
Keywords:
intussusception, pneumatic reduction, air enema reduction, pathologic lead pointAbstract
Back ground/Objective: Intussusception remains the most common cause of intestinal obstruction inchildren under 2 years of age. Results of the treatment of this disease have continuously improved with better
outcome in the world literature. The aim of this study was to review the management outcome in children with
intussusception at one tertiary hospital for pediatrics in Thailand.
Methods: Medical records of patients treated for intussusception from January 1,1999 to December
31,2008 (at Queen Sirikit National Institute of Child Health) were reviewed. Information about clinical
manifestations, radiological findings and results of the treatment were obtained. The statistical differences
were analyzed by the Chi-square test with significance at a p-value less than 0.05.
Results: A total of 572 patients with 605 episodes of intussusception were available for the review . Male
to female ratio was 350:222(1.5:1). About 78 % of the patients was under one year of age with the peak incidence
at 6 months. The disease was found in every month of the year with the highest incidence in January. Vomiting
was the most common symptom, being found in 92.4% of the patients. Mucous bloody stool, abdominal pain
and palpable abdominal mass were noted in 73.2%, 71.6% and 68.1%, respectively. Radiological findings
revealed complete intestinal obstruction and soft tissue mass in 52.7% and 24.3% of the cases. Pneumatic or
air enema (AE) reduction was attempted in 496 episodes and found to be successful in 333 (67.1%) with a colonic
perforation in 3 cases (0.6%). Surgical intervention was needed in 274 episodes. Of these, manual reduction
was successful in 191 and intestinal resection was required in 64. Appendectomy only was done in the remaining
9 cases because complete reduction was noted during exploration. Pathologic lead points were recorded in 23
patients (4.0%). Intestinal polyps (13 cases) and Meckel’ s diverticulum (7 cases) were the most common causes.
Of the total 572 patients, only one died due to mesenteric vein thrombosis and extensive ileocolic necrosis
within one week after manual reduction and appendectomy. The overall mortality rate was 0.2%.
Conclusions: Management outcomes of intussusception have been continuously improved with the
mortality rate less than 0.5 %. AE reduction should be the initial management, unless the patients had
contraindications for such intervention. Adequate preoperative preparation and prompt definitive treatment,
both AE reduction or surgical intervention, have much influence on the successful management outcomes of
intussusception.
References
1. West KM, Stephens B, Vane DW, et al. Intussusception:
current management in infants and childhood. Surgery
1987;102:704-10.
2. Saxena AK, Hollwarth ME. Factors influencing management
and comparison of outcomes in pediatric intussusceptions.
Acta Pediatr 2007;96:1099-102.
3. Kaiser AD, Applegate KE, Ladd AP. Current success in the
treatment of intussusception in children. Surgery
2007;142:469-77.
4. Ravitch MM, Mc Cune RM Jr. Reduction of intussusception
by barium. Ann Surg 1948;128:904-17.
5. Fiorito ES, Recalde Cuestas LA. Diagnosis and treatment of
acute intestinal intussusception with controlled insufflation
of air. Pediatrics 1959;24:241-4.
6. Guo J, Ma X, Zhou Q. Results of air pressure enema reduction
of intussusception: 6396 cases in 13 years. J Pediatr Surg
1986;21:1201-3.
7. Stringer MD, Pledger HG, Drake DP. Childhood deaths from
intussusception in England and Wales 1984-1989. Br Med J
1992;304:737-9.
8. Giak CL, Singh HA, Nallusamy R, et al. Epidemiology of
intussusception in Malaysia: a three - year review. Southeast
Asian J Trop Med Public Health 2008;39:848-55.
9. Tan N, Teoh YL, Phua KB, et al. An update of pediatric
intussusception incidence in Singapore:1997-2007. Ann
Acad Med 2009;38:690-3.
10. Parashar UD, Holman RC, Cummings KC, et al. Trends in
intussusception-associated hospitalization and deaths
among US infants. Pediatrics 2000;106:1413-21.
11. Buettcher M, Bear G, Bonhoeffer J, et al. Three - year
surveillance of intussusception in children in Switzerland.
Pediatrics 2007;120:473-9.
12. Gardener PS, Knox EG, Count SDM, et al. Virus infection and
intussusception in children. Br Med J 1962;2:677-700.
13. Bell TM, Steyn JH. Virus in lymph nodes of children with
mesenteric lymphadenitis and intussusception. Br Med J
1962;2:700-2.
14. Ross JG, Potter CW, Zachary RW. Adinovirus infection in
association with intussusception in infancy. Lancet 1962;11:
211-23.
15. Hamby LS, Fowler CL, Pokorny WJ. Intussusception. In:
Donnellan WL, Burrington JD, Kimur K, et al, editors.
Abdominal surgery of infancy and childhood. Australia:
Harwood Academic Publishers;1996. p. 3-19.
16. Dennison WM, Shaker M. Intussusception in infancy and
childhood. Br J Surg 1970;57:679-84.
17. Hutchison IF, Olayiwola B, Young DG. Intussusception in
infancy and childhood. Br J Surg 1980;67:209-12.
18. Bruce J, Huh YS, Cooney DR, et al. Intussusception:evolution
of current management. J Pediatr Gastroenterol Nutr 1987;
6:663-74.
19. Winstanley JHR, Doig CM, Brydon H. Intussusception: the
case for barium reduction. J R Coll Surg Edinb 1987;32:285-
7.
20. Wilson - Storey D, MacKinlay GA, Prescotts, et al. Intussusception:
a surgical condition. J R Coll Surg Edinb 1988;33:273-7.
21. Beasley SW, Auldist AW, Stokes KB. Recurrent intussusception:
barium or surgery? Aust N Z J Surg 1987;57:11-4.
22. Stringer MD, Pablot SM, Brereton RJ. Pediatric intussusception.
Br J Surg 1992;79:867-76.
23. Turner D, Rickwood AMD, Brereton RJ. Intussusception in
older children. Arch Dis Child 1980;55:544-6.
24. Singer J. Altered consciousness as an early manifestation of
intussusception. Pediatrics 1979;64:93-5.
25. Reijnen JAM. Intussusception - a clinical and experimental
study. Thesis, Catholic University of Nijmegen, Nijmegen the
Netherlands, 1990.
26. Branski D, Shatsberg G, Gross-Kieselstein E, et al. A neurological
dysfunction as a presentation of intussusception in
an infant. J Clin Gastroenterol 1986;8:604-5.
27. Shaoul R, Gazit A, Weller B, et al. Neurological manifestations
of an acute abdomen in children. Pediatr Emerg Care 2005;
21:594-7.
28. Kleizen KJ, Hunck A, Wijnen MH, et al. Neurological symptoms
in children with intussusception. Acta Pediatr 2009;98:1822-
4
29. Jinzhe Z, Yenxia W, Linchi W. Rectal inflation reduction of
intussusception in infants. J Pediatr Surg 1986;21:32-3.
30. Tamanaha K, Wimbish K, Talwalker YB, et al. Air reduction of
intussusception in infants and children. J Pediatr 1987;111:733-
6.
31. Stringer DA, Ein SH. Pneumatic reduction:advantages, risks
and indications. Pediatr Radiol1990;20:475-7.
32. Glover JM, Beasley SW, Phelan E. Intussusception of gas
enema. Pediatr Surg Int 1991:6:195-7.
33. Shiels WE, Maves CK, Hedlund GL, et al. Air enema for
diagnosis and reduction of intussusception: clinical
experience and pressure correlates. Radiology 1991;6:195-
7.
34. Palder SB, Ein SH, Stringer DA, et al. Intussusception : barium
or air ? J Pediatr Surg 1991 ;26 :277-85.
35. Renwick AA, Beasley SW, Phelan E. Intussusception: recurrence
following gas (oxygen) enema reduction. Pediatr
Surg Int 1992;7:361-3.
36. Ramachandran P, Gupta A, Vincent P, et al. Air enema for
intussusception :is predictioning the outcome important ?
Pediatr Surg Int 2008;24:311-3.
current management in infants and childhood. Surgery
1987;102:704-10.
2. Saxena AK, Hollwarth ME. Factors influencing management
and comparison of outcomes in pediatric intussusceptions.
Acta Pediatr 2007;96:1099-102.
3. Kaiser AD, Applegate KE, Ladd AP. Current success in the
treatment of intussusception in children. Surgery
2007;142:469-77.
4. Ravitch MM, Mc Cune RM Jr. Reduction of intussusception
by barium. Ann Surg 1948;128:904-17.
5. Fiorito ES, Recalde Cuestas LA. Diagnosis and treatment of
acute intestinal intussusception with controlled insufflation
of air. Pediatrics 1959;24:241-4.
6. Guo J, Ma X, Zhou Q. Results of air pressure enema reduction
of intussusception: 6396 cases in 13 years. J Pediatr Surg
1986;21:1201-3.
7. Stringer MD, Pledger HG, Drake DP. Childhood deaths from
intussusception in England and Wales 1984-1989. Br Med J
1992;304:737-9.
8. Giak CL, Singh HA, Nallusamy R, et al. Epidemiology of
intussusception in Malaysia: a three - year review. Southeast
Asian J Trop Med Public Health 2008;39:848-55.
9. Tan N, Teoh YL, Phua KB, et al. An update of pediatric
intussusception incidence in Singapore:1997-2007. Ann
Acad Med 2009;38:690-3.
10. Parashar UD, Holman RC, Cummings KC, et al. Trends in
intussusception-associated hospitalization and deaths
among US infants. Pediatrics 2000;106:1413-21.
11. Buettcher M, Bear G, Bonhoeffer J, et al. Three - year
surveillance of intussusception in children in Switzerland.
Pediatrics 2007;120:473-9.
12. Gardener PS, Knox EG, Count SDM, et al. Virus infection and
intussusception in children. Br Med J 1962;2:677-700.
13. Bell TM, Steyn JH. Virus in lymph nodes of children with
mesenteric lymphadenitis and intussusception. Br Med J
1962;2:700-2.
14. Ross JG, Potter CW, Zachary RW. Adinovirus infection in
association with intussusception in infancy. Lancet 1962;11:
211-23.
15. Hamby LS, Fowler CL, Pokorny WJ. Intussusception. In:
Donnellan WL, Burrington JD, Kimur K, et al, editors.
Abdominal surgery of infancy and childhood. Australia:
Harwood Academic Publishers;1996. p. 3-19.
16. Dennison WM, Shaker M. Intussusception in infancy and
childhood. Br J Surg 1970;57:679-84.
17. Hutchison IF, Olayiwola B, Young DG. Intussusception in
infancy and childhood. Br J Surg 1980;67:209-12.
18. Bruce J, Huh YS, Cooney DR, et al. Intussusception:evolution
of current management. J Pediatr Gastroenterol Nutr 1987;
6:663-74.
19. Winstanley JHR, Doig CM, Brydon H. Intussusception: the
case for barium reduction. J R Coll Surg Edinb 1987;32:285-
7.
20. Wilson - Storey D, MacKinlay GA, Prescotts, et al. Intussusception:
a surgical condition. J R Coll Surg Edinb 1988;33:273-7.
21. Beasley SW, Auldist AW, Stokes KB. Recurrent intussusception:
barium or surgery? Aust N Z J Surg 1987;57:11-4.
22. Stringer MD, Pablot SM, Brereton RJ. Pediatric intussusception.
Br J Surg 1992;79:867-76.
23. Turner D, Rickwood AMD, Brereton RJ. Intussusception in
older children. Arch Dis Child 1980;55:544-6.
24. Singer J. Altered consciousness as an early manifestation of
intussusception. Pediatrics 1979;64:93-5.
25. Reijnen JAM. Intussusception - a clinical and experimental
study. Thesis, Catholic University of Nijmegen, Nijmegen the
Netherlands, 1990.
26. Branski D, Shatsberg G, Gross-Kieselstein E, et al. A neurological
dysfunction as a presentation of intussusception in
an infant. J Clin Gastroenterol 1986;8:604-5.
27. Shaoul R, Gazit A, Weller B, et al. Neurological manifestations
of an acute abdomen in children. Pediatr Emerg Care 2005;
21:594-7.
28. Kleizen KJ, Hunck A, Wijnen MH, et al. Neurological symptoms
in children with intussusception. Acta Pediatr 2009;98:1822-
4
29. Jinzhe Z, Yenxia W, Linchi W. Rectal inflation reduction of
intussusception in infants. J Pediatr Surg 1986;21:32-3.
30. Tamanaha K, Wimbish K, Talwalker YB, et al. Air reduction of
intussusception in infants and children. J Pediatr 1987;111:733-
6.
31. Stringer DA, Ein SH. Pneumatic reduction:advantages, risks
and indications. Pediatr Radiol1990;20:475-7.
32. Glover JM, Beasley SW, Phelan E. Intussusception of gas
enema. Pediatr Surg Int 1991:6:195-7.
33. Shiels WE, Maves CK, Hedlund GL, et al. Air enema for
diagnosis and reduction of intussusception: clinical
experience and pressure correlates. Radiology 1991;6:195-
7.
34. Palder SB, Ein SH, Stringer DA, et al. Intussusception : barium
or air ? J Pediatr Surg 1991 ;26 :277-85.
35. Renwick AA, Beasley SW, Phelan E. Intussusception: recurrence
following gas (oxygen) enema reduction. Pediatr
Surg Int 1992;7:361-3.
36. Ramachandran P, Gupta A, Vincent P, et al. Air enema for
intussusception :is predictioning the outcome important ?
Pediatr Surg Int 2008;24:311-3.
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Published
2010-03-31
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Niramis R, Anuntkosol M, Kruatrachue A, Tongsin A, Chivapraphanant S, Watanatittan S, Buranakitjaroen V, Rattanasuwan T, Mahatharadol V. Current Success in the Treatment of Intussusception at Queen Sirikit National Institute of Child Health between 1999 and 2008. Thai J Surg [Internet]. 2010 Mar. 31 [cited 2024 Apr. 18];31(1). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/227837
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