Recurrent Intussusception in Children

Abstract

Background / Purpose : The etiology of intussusception in most cases of children is unknown. This makes the problem of recurrent intussusception even more puzzling. The purpose of this study was to present our experience of recurrent intussusception in our institute and to analyse the correlation of modes of treatment and the recurrence rate.

Methods: Medical records of patients treated for intussusception at the Queen Sirikit National Institute of Child Health from January 1988 to December 1998 were reviewed. The information about clinical manifestation, radiological findings and results of treatment were obtained. Clinical data of the patients with recurrent intussusception were assessed. The statistical differences were analysed by the Z test.

Results: Five hundred and seven patients were treated for 549 episodes of intussusception. Recurrent attacks of 42 episodes in 32 patients were noted. The total recurrence rate was about 8.2 per cent. Of the 32 patients, 17 were male and 15 were female. Their ages at the first episode was noted from 3 months to 11 years (average 14 months). Time interval before recurrence ranged from I day to 2 years (average 5 months). Numbers of the recurrence were recorded in 1-4 attacks. Seven cases recurred in the same admission, 2 cases after barium enema (BE), 3 cases after pneumatic and 2 cases after manual reduction. Non-operative management was successful in 313 episodes of intussusception. Recurrent attacks occurred in 35 of the 313 episodes of successfully non-operatively treated intussusception (11.2%), 18 of 135 episodes (13.3%) after BE reduction and 17 of 178 episodes (9.5%) after pneumatic or air reduction. There was no statistical difference between the recurrence rates after the two non-operative procedures (p = 0.123). Operative management was needed in 226 occurrences, successful manual reduction in 158 and intestinal resection was required in 68 cases. Recurrent attacks developed in 7 of the 226 surgically treated episodes (3.1%). All of them occurred after manual reduction only. The difference of the recurrence rates after the operative and non-operative managements of intussusception was statistically significant (p<.001). Of the 42 episodes of recurrence, 34 (80.1%) were successfully treated by BE and pneumatic reduction, although 4 of these 34 recurrences developed after previously successful manual reduction. The remaining 8 episodes of recurrence underwent manual reduction with or without ileocolopexy. Three of the 32 recurrent patients had leading points: Meckel's diverticulum, ileal and colonic polyp in one case each. There was no mortality among these 32 patients.

Conclusions: There was no statistical difference between the incidences of recurrent intussusception after successful management by BE and pneumatic reduction (p>.05), but the operative treatment had a lower incidence of recurrences than the non-operative procedures (p<.05). No recurrence was noted in any of the cases treated by manual reduction with ileocolopexy. It is concluded that the principle of management of recurrent intussusception should be similar to that of the primary intussusception in general.