Surgical approach to intussusception in older children: influence of lead points.

Abstract:

BACKGROUND:The likelihood of a lead point as the cause of ileocolic intussusception increases as children get older. This study looks at whether a different management strategy should be employed in older patients. METHODS:7 year multi-institutional retrospective study of intussusception in patients aged <12 years. RESULTS:Ileocolic intussusception with complete data was found in 153 patients: 109 0-2 years, 34 3-5 years, and 10 6-12 years, respectively. Bloody stools occurred in 42/143 of 0-5 years and 0/10 of 6-12 years, p<0.001. Combined hydrostatic and/or surgical reduction was successful in 113/143 0-5 year olds vs 5/10 6-12 year olds, p<0.001. Enemas were safe but reduced only 1 patient over age 5. Resections were required in 29 patients (15 idiopathic, 14 lead points). Lead points were found in 4/109 children under 3 years, in 5/34 aged 3-5 years and 5/10 aged 6-12 years (p=0.04 vs 3-5 years and p <0.001 vs 0-5 years). Lead points consisted of 7 Meckel's diverticula and 7 others. CONCLUSION:Children older than 5 years are much more likely to have a pathologic lead point and early surgical intervention should be considered. In this study, enema reduction was safe but minimally beneficial in this age group.

journal_name

J Pediatr Surg

authors

Banapour P,Sydorak RM,Shaul D

doi

10.1016/j.jpedsurg.2014.09.078

subject

Has Abstract

pub_date

2015-04-01 00:00:00

pages

647-50

issue

4

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(14)00648-4

journal_volume

50

pub_type

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