Pushing Backwards: Evaluating Effectiveness of Conservative Treatment of Intestinal Intussusception.

OBJECTIVE: Intestinal intussusception (II) is a common cause for acute abdomen in children, occurring in 0.33 to 0.71 per 1000 children per year. Early diagnosis and treatment are fundamental for prevention of irreversible intestinal damage. The first line of treatment is conservative, with saline reduction enema or air reduction enema. Our goal is to evaluate results with conservative treatment of II in children. METHODS: A retrospective single-center review of all patients with diagnosis of II from January 2014 to December 2019 was performed. Demographics, clinical data, treatment option, and results were assessed. RESULTS: Thirty-eight cases were identified. The mean age was 26 months, and 68% were males. Most presented with abdominal pain (95%) and vomiting (66%), after an average of 30 hours. Rectal bleeding was present in 32% of patients. Abdominal ultrasound was performed in all patients for diagnosis. Conservative treatment was first option in 95% of patients, with a global effectiveness of 83% after 1 attempt. Saline reduction enema was more effective than air reduction enema (88% vs 70%), and patients with successful reduction were younger (24 vs 33 months), but neither reached statistical significance. Two patients had a subsequent II episode within 1 week after hospital discharge. Neither age, sex, symptoms and respective duration, rotavirus inoculation, intussuscepted bowel length, nor technique used was predictive of treatment failure or II relapse. CONCLUSIONS: Conservative treatment in II is a safe and effective option, preventing invasive surgical procedures. Effectiveness of such treatments may be as high as 88% after 1 attempt, with rapid diet reintroduction. Same-day discharge after oral feeding toleration is safe.

Immunoglobulin A Vasculitis With Intussusception in Children.

BACKGROUND: Immunoglobulin A (IgA) vasculitis with intussusception is acute and severe vasculitis combined with acute abdomen in children. The diagnosis of the disease depends on the results of imaging examinations, and its treatment mainly includes enema and surgery. The literature summarized the detailed diagnosis and treatment data in previous literature reports. METHODS: We described the clinical manifestations, ultrasonic features, and treatment of patients admitted to a single center and reviewed previous literature regarding cases with detailed clinical data in the PubMed database within the past 20 years. RESULTS: The review included 36 patients, including 22 boys and 14 girls. A total of 32 patients were diagnosed using ultrasound (88.9%). The main sites of intussusception were the ileum and ileocolon in 16 (44.4%) and 11 (30.6%) cases, respectively. Thirteen patients (36.1%) were treated with enema, with 6 responding to the treatment. 26 patients (72.2%) underwent surgical treatment. Patients with ileal intussusception were more likely to be treated with surgery than those with colonic intussusception (P < .05). The single-center clinical data of 23 patients showed that there was no significant difference in laboratory test findings between patients with and without surgical treatment (P > .05). Patients with long insertion lengths were more likely to require surgery and resection (P < .05). CONCLUSIONS: Ultrasonography is the first-line investigation for diagnosis. The main sites of intussusception were ileum and ileocolon. The length of intubation was related to surgery; treatment is according to the intussusception site. Air enema is not suitable for intussusception of the small intestine.

Lymphoma-related intussusception in children: diagnostic challenges and clinical characteristics.

Intussusception is a common cause of acute abdominal pain in children and the most frequent cause of intestinal obstruction in infants. Although often idiopathic, it can stem from conditions like lymphoma. This study delves into lymphoma-related intussusception in children, aiming to enhance early detection and management. A retrospective review encompassed children admitted from 2012 to 2023 with intussusception due to intestinal lymphoma. Demographic, clinical, and imaging data were meticulously extracted and analyzed. The study included 31 children in the lymphoma-related intussusception group. Contrasted with non-lymphoma-related cases, the patients of lymphoma-related intussusception were notably older (median age: 87 months vs. 18.5 months), predominantly male, and demonstrated protracted abdominal pain. Ultrasound unveiled mesenteric lymph node enlargement and distinct intra-abdominal masses; enema reduction success rates were notably diminished. Detecting lymphoma-related intussusception remains intricate. Age, prolonged symptoms, and distinctive ultrasound findings can arouse suspicion. Timely surgical intervention, based on preoperative imaging, proves pivotal for accurate diagnosis. CONCLUSION:  Swift identification of lymphoma-related intussusception, distinguished by unique clinical and ultrasound features, is imperative for timely intervention and treatment. Further research is warranted to refine diagnostic approaches. WHAT IS KNOWN: • Intussusception in pediatric patients can be caused by a wide spectrum of underlying diseases including lymphoma. • Early Identifying the exact underlying cause of intussusception is crucial for tailored therapy, however often challenging and time-consuming. WHAT IS NEW: • Lymphoma-related intussusception may present with increased abdominal fluid accumulation, intestinal obstruction, and a higher likelihood of failed reduction during enema procedures. • For high-risk children, repeated ultrasound examinations or further investigations may be necessary to confirm the diagnosis.

Diagnostic validation and development of an algorithm for identification of intussusception in children using electronic health records of Ningbo city in China.

BACKGROUND: Monitoring the risk of intussusception after the introduction of rotavirus vaccines is recommended by the World Health Organization (WHO). Although the validity of intussusception monitoring using electronic health records (EHRs) has been confirmed previously, no similar studies have been conducted in China. We aimed to verify the diagnosis and determine an algorithm with the best performance for identification of intussusception using Chinese EHR databases. RESEARCH DESIGN AND METHODS: Using the Regional Health Information Platform in Ningbo, patients aged 0-72 months from 2015 to 2021 with any related visits for intussusception were included. The algorithms were based on diagnostic codes or keywords in different clinical scenarios, and their performance was evaluated with positive predictive value (PPV) and sensitivity in line with the Brighton guidelines. RESULTS: Brighton level 1 intussusception was confirmed in 2958 patients with 3246 episodes. Fine-tuned algorithms combining the appearance of the relevant ICD-10 codes or the Chinese keyword 'Chang Tao' in any diagnostic reports with the results of enema treatments or related surgeries showed the highest sensitivity, while the highest PPV was obtained by further criteria based on typical radiographic appearances. CONCLUSION: Intussusception could be identified and validated internally using EHRs in Ningbo.

A large single-center experience in management of pediatric intussusception.

BACKGROUND: The objective of this study was to present the results of a comprehensive single-center study of the management and outcome of intussusception over a 10-year period and to review the recent literature. METHODS: A retrospective analysis was carried out of all children less than 16 years old, admitted with intussusception to our tertiary center between January 2007 and December 2016. Air enema was attempted routinely, with primary surgery reserved for selected cases. If air enema failed, open surgery was performed. The data collected included age, enema reduction rate, need for laparotomy, detail of bowel resection, hospital stay, and complications noted. RESULTS: One hundred and ninety-one children presented with intussusception, totaling 200 admissions. One hundred and seventy-four patients (87%) underwent air enema. There was a complete reduction in 66% of these cases and a perforation rate of 1.1%. Twenty-six patients (13%) underwent primary surgery. Of the 59 patients with incomplete enema reduction, 50.8% required bowel resection while 49.2% required only manual reduction. Bowel resection was necessitated in 26% of total admissions and 61.2% of those requiring surgery. Hospital stays ranged from 3-97 days (median 7 days). There were four complications (2%). CONCLUSION: This comprehensive study reveals a higher rate of surgical intervention and bowel resection than was anticipated from selective series in published literature. Institutional variation in outcome is likely multifactorial but incomplete data make comparisons difficult.

Neutrophil-to-Lymphocyte Ratio as a Predictor of the Need for Surgical Treatment in Children's Intussusception.

OBJECTIVE: Neutrophil-to-lymphocyte ratio (NLR) is an emerging inflammatory marker in abdominal pathologies. Ileocolic intussusception (ICI) involves a progressive intestinal inflammation, and the effectiveness of nonsurgical treatment (enema) might be related to the inflammation degree, although no previous studies have investigated this relationship. Our aim is to identify predictors of the need for surgical treatment in ICI. MATERIALS AND METHODS: A single-center, retrospective, case-control study was performed in children with ICI, who were treated with initial nonsurgical management between 2005 and 2019. Patients were divided in two groups: A (effective enema) and B (need for surgery). Admission demographic and clinical and laboratory data were analyzed. Specificity and sensitivity of the different parameters as predictors of the need for surgical treatment were determined by receiver operating characteristic (ROC) curves. RESULTS: A total of 511 patients were included (410: group A; 101: group B), without statistically significant demographic differences. Group B presented significantly higher frequency of vomiting, bloody stools, and longer median time since symptoms onset (24 vs. 8 hours; p < 0.001). Group B presented higher median laboratory inflammatory markers than group A: NLR (6.8 vs. 1.8; p < 0.001), neutrophils (10,148 vs. 7,468; p < 0.001), and C-reactive protein (CRP; 28.2 vs. 4.7; p < 0.001). In ROC curve analysis, NLR had an area under the curve of 0.925, higher than neutrophil count (0.776; p = 0.001), CRP (0.670; p = 0.001), and time since symptoms onset (0.673; p = 0.001). It was estimated a cut-off point of NLR greater than 4.52 (sensitivity: 73.2%; specificity: 94.5%). CONCLUSION: High NLR values imply a high degree of bowel inflammation and might anticipate the need for surgical treatment in ICI in children. LEVEL OF EVIDENCE: III.

Predicting recurrent cases of intussusception in children after air enema reduction with machine learning models.

PURPOSE: To develop a model to identify risk factors and predict recurrent cases of intussusception in children. METHODS: Consecutive cases and recurrent cases of intussusception in children from January 2016 to April 2022 were screened. The cohort was divided randomly at a 4:1 ratio to a training dataset and a validation dataset. Three parallel models were developed using extreme gradient boosting (XGBoost), logistic regression (LR), and support vector machine (SVM). Model performance was assessed by the area under the receiver operating characteristic curves (AUC). RESULTS: A total of 2469 cases of intussusception were included, where 225 were recurrent cases. The XGBoost (AUC = 0.718) models showed the best performance in the validation dataset, followed by the LR model (AUC = 0.652), while the SVM model (AUC = 0.613) performed worst among the three models. Based on the Shapley Additive exPlanation values, the most important variables in the XGBoost models were air enema pressure, mass size, age, duration of symptoms, and absence of vomiting. CONCLUSIONS: Machine learning models, especially XGBoost, could be used to predict recurrent cases of intussusception in children. The most important contributing factors to the models are air enema pressure, mass size, age, duration of symptoms and absence of vomiting.

Common Conditions II: Acute Appendicitis, Intussusception, and Gastrointestinal Bleeding.

Perforated appendicitis continues to be a significant cause of morbidity for children. In most centers, ultrasound has replaced computed tomography as the initial imaging modality for this condition. Controversies surrounding optimal medical and surgical management of appendicitis are discussed. Management of intussusception begins with clinical assessment and ultrasound, followed by image-guided air or saline reduction enema. When surgery is required, laparoscopy is typically utilized unless bowel resection is required. The differential diagnosis for pediatric gastrointestinal bleeding is broad but often made with age, history, and physical examination. Endoscopy or laparoscopy is sometimes needed to confirm a diagnosis or for treatment.

Significance of MCP-1 in predicting the short-term recurrence of primary intussusception in children: An observational study.

To evaluate the relationship between the expression level of (MCP-1) in peripheral blood and the short-term recurrence of primary intussusception in children, a retrospective analysis of children with primary intussusception under ultrasound-guided hydrostatic reduction in our hospital from June 2019 to June 2021, a total of 412 cases, 37 cases of short-term recurrence. Enzyme-linked immunosorbent assay was used to detect the expression of MCP-1 in peripheral venous blood; receiver operating curve (ROC) was utilized to evaluate the diagnostic efficacy of MCP-1 in predicting short-term recurrence; logistic regression analysis of risk factors for recurrence. MCP-1 increased in the peripheral blood of children with short-term recurrence (P < .05). Logistic regression analysis found that increased MCP-1 was a risk factor for recurrence; ROC showed that 23.24 ng/mL was used as a cut-off value. The sensitivity of MCP-1 for predicting the recurrence of intussusception in children is 82.14%, and the specificity is 75.67%. In primary intussusception, the expression of MCP-1 in the peripheral blood of children with short-term recurrence is raised. Elevated expression of MCP-1 is a risk factor for predicting short-term intussusception recurrence and has certain clinical significance.

Epidemiology of intussusception in infants less than one year of age in Ghana, 2012-2016.

INTRODUCTION: we examined the epidemiology, clinical and demographic characteristics of intussusception in Ghanaian infants. METHODS: active sentinel surveillance for pediatric intussusception was conducted at Komfo Anokye Teaching Hospital in Kumasi and Korle Bu Teaching Hospital in Accra. From March 2012 to December 2016, infants < 1 year of age who met the Brighton Collaboration level 1 diagnostic criteria for intussusception were enrolled. Data were collected through parental interviews and medical records abstraction. RESULTS: a total of 378 children < 1 year of age were enrolled. Median age at onset of intussusception was 27 weeks; only 12 cases (1%) occurred in infants < 12 weeks while most occurred in infants aged 22-34 weeks. Median time from symptom onset until referral to a tertiary hospital was 2 days (IQR: 1-4 days). Overall, 35% of infants were treated by enema, 33% had surgical reduction and 32% required surgical reduction and bowel resection. Median length of hospital stay was 5 days (IQR: 3-8 days) with most patients (95%) discharged home. Eleven (3%) infants died. Infants undergoing enema reduction were more likely than those treated surgically to present for treatment sooner after symptom onset (median 1 vs 3 days; p < 0.0001) and have shorter hospital stays (median 3 vs 7 days; p < 0.001). CONCLUSION: Ghanaian infants had a relatively low case fatality rate due to intussusception, with a substantial proportion of cases treated non-surgically. Early presentation for treatment, possibly enhanced by community-based health education programs and health information from various media platforms during the study period might contribute to both the low fatality rate and high number of successful non-surgical treatments in this population.

Clinical presentation and management of childhood intussusception in South Africa.

PURPOSE: We assessed management and outcomes for intussusception at nine academic hospitals in South Africa. METHODS: Patients ≤ 3 years presenting with intussusception between September 2013 and December 2017 were prospectively enrolled at all sites. Additionally, patients presenting between July 2012 and August 2013 were retrospectively enrolled at one site. Demographics, clinical information, diagnostic modality, reduction methods, surgical intervention and outcomes were reviewed. RESULTS: Four hundred seventy-six patients were enrolled, [54% males, median age 6.5 months (IQR 2.6-32.6)]. Vomiting (92%), bloody stool (91%), abdominal mass (57%), fever (32%) and a rectal mass (29%) represented advanced disease: median symptom duration was 3 days (IQR 1-4). Initial reduction attempts included pneumatic reduction (66%) and upfront surgery (32%). The overall non-surgical reduction rate was 28% and enema perforation rate was 4%. Surgery occurred in 334 (70%), 68 (20%) patients had perforated bowel, bowel resection was required in 61%. Complications included recurrence (2%) and nosocomial sepsis (4%). Length of stay (LOS) was significantly longer in patients who developed complications. Six patients died-a mortality rate of 1%. There was a significant difference in reduction rates, upfront surgery, bowel resection, LOS and mortality between centres with shorter symptom duration compared longer symptom duration. CONCLUSION: Delayed presentation was common and associated with low success for enema reduction, higher operative rates, higher rates of bowel resection and increased LOS. Improved primary health-care worker education and streamlining referral pathways might facilitate timely management.

An Unusual Presentation of Intussusception.

This is the case of a 9-month-old female infant who presented to the emergency department with a history of several episodes of nonbilious and nonbloody emesis. The patient was found to be afebrile with normal vital signs and an otherwise normal physical examination. Initial plain film radiography was concern for possible obstruction. Imaging studies with ultrasonogram demonstrated intussusception. This was an unusual case of intussusception because children are typically more ill-appearing with vomiting, diarrhea, fevers, lethargy, and blood in stool. Management options included surgery, pneumatic enema reduction, and barium enema reduction. Pneumatic enema reduction was performed. This procedure has been shown to have superior outcomes in infants with intussusception. Advanced practice providers need to provide a detailed history, complete a thorough physical examination, order the appropriate diagnostics, and be vigilant of the clinical manifestation of intussusception.

Haemostatic indexes for predicting intestinal necrosis in children with intussusception.

BACKGROUND: To determine risk factors for intestinal necrosis in intussusception cases among children with failed non-surgical reduction for intussusception. METHODS: Totally, 540 hospitalized individuals with unsuccessful air-enema reduction in our hospital between November 2010 and November 2020 were assessed in this retrospective study. The 540 intussusception cases were divided into the intestinal necrosis and non-intestinal necrosis groups. Haemostatic parameters, demographic and clinical features were assessed. Predictors of intestinal necrosis were examined by univariable and multivariable logistic regression analyses. RESULTS: Of the 540 patients included, 113 showed intestinal necrosis. This intestinal necrosis group had a longer duration of symptom or length of illness, younger ages, higher platelet counts, fibrinogen amounts and d-dimer levels (all P = 0.000) compared with the non-intestinal necrosis group. Multivariable analysis revealed that duration of symptom (odds ratio (OR) 1.12; 95% confidence interval (CI) 1.16-1.23, P = 0.000), fibrinogen (OR 1.26; 95% CI 1.10-1.31, P = 0.010) and d-dimer (OR 2.07; 95% CI 1.91-2.28, P = 0.000) independently predicted intestinal necrosis in individuals undergoing surgical reduction for intussusception. Receiver operating characteristic curve analysis showed that d-dimer amounts had the largest area under the curve for predicting intestinal necrosis. CONCLUSION: On admission, long duration of symptom, high fibrinogen and d-dimer levels are critical risk factors for intestinal necrosis development in children with unsuccessful non-surgical reduction. d-Dimer levels have the best predictive value for intestinal necrosis.

Early diagnosis and treatment for intussusception in children is mandatory.

INTRODUCTION: In some cases, surgical treatment is necessary to manage intussusception despite advances in enema reduction. The purpose of this study was to analyse treatment in two tertiary referral university centres for paediatric surgery to identify time-related factors influencing treatment of intussusception. METHODS: This was a retrospective two-centre chart review, performed for all patients under the age of 16 years who underwent treatment for intussusception during the period from 2005 to 2015. Demographic data and data on different time intervals from symptom debut to end of treatment and compliacations were retrieved from the medical record. RESULTS: A total of 158 children were included. Non-surgical reduction was used as the primary treatment modality in 48% and intussusception was successfully reduced in 32% of these cases. The non-surgical success rate was found to be significantly higher when the diagnosis was confirmed within four hours of hospitalisation (p = 0.003). A lower rate of bowel resection was observed when the diagnosis was confirmed within four hours of hospitalisation (p = 0.026) and treatment was initiated within six hours of hospitalisation (p = 0.033). CONCLUSIONS: This study found a relatively low utilisation rate for enema reduction and an overall low enema success rate. The success rate of enema was significantly higher and the intestinal resection rate lower when the diagnosis was confirmed within four hours of hospitalisation, which underpins the importance of a quick and timely diagnosis. FUNDING: none. TRIAL REGISTRATION: not relevant.

Preoperative sonographic diagnosis of McSwain type V appendiceal intussusception: A case report (with video).

RATIONALE: Appendiceal intussusception is a rare disease. The definite preoperative diagnosis of appendiceal intussusception is rare and challenging. Here, we present a case of McSwain type V appendiceal intussusception in a 10-year-old boy. To our best knowledge, this is the first case report of a type V appendiceal intussusception that was preoperatively confirmed with sonography. Here, we have described in detail the ultrasound features and differential diagnosis of this rare disease. PATIENT CONCERNS: A 10-year-old boy presented with 3 days of recurrent intermittent mild abdominal pain. The result of ultrasonography suggested an ileocolic intussusception and a therapeutic air-contrast enema was requested to reduce the intussusception but failed at a local hospital. DIAGNOSES: Physical exam revealed mild tenderness in the lower right quadrant of the abdomen. However, ultrasonography showed a target-sign in cross section and a finger-like appearance in the longitudinal view. A diagnosis of McSwain type V appendiceal intussusception was made. INTERVENTIONS: The patient underwent an appendectomy after successful manual reduction on laparotomy. The appendix was successfully resected. OUTCOMES: Intraoperatively, the appendix was completely inverted in the cecum, and the preoperative sonographic findings were confirmed. During follow-up, there were no signs of recurrence. LESSONS: Pre-operatively, on ultrasound a type V appendiceal intussusception is usually misdiagnosed as an ileocolic intussusception. Radiologists must execute caution to avoid over reliance on the sonographic findings of intussusception, especially when there is a mismatch with clinical symptoms. It is especially important to accurately understand the surgical-anatomic configuration of type V appendiceal intussusception that creates a "target-sign" and a "finger-like" layout on ultrasonography.

Meckel Diverticulum Presenting as Abdominal Pain and Subsequent Bowel Perforation.

BACKGROUND: Abdominal pain is a common presenting symptom with a broad array of potential etiologies. Meckel diverticulum (MD), the most common congenital gastrointestinal malformation, classically presents with painless gastrointestinal bleeding. However, it can also lead to diverticulitis, intussusception, or obstruction, manifesting as abdominal pain. CASE REPORT: A 2-year-old boy presented to the emergency department with intermittent abdominal pain, vomiting, and loose stools. Abdominal ultrasound findings were consistent with ileitis and ileocolic intussusception, but no such intussusception was seen during fluoroscopic air enema. The patient was admitted for serial abdominal examinations and subsequently developed an acute abdomen. Emergent laparotomy revealed a perforated MD. Small bowel resection and primary anastomosis were performed and no complications developed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The presence of an MD can lead to diverticulitis, intussusception, or obstruction, putting the patient at risk of bowel perforation. As such, it is important to consider MD in the differential diagnosis of patients with abdominal pain. In cases in which sonographic findings are ambiguous or transient, additional observation or alternative imaging, such as computed tomography, should be strongly considered.

Lactic acid level as an outcome predictor in pediatric patients with intussusception in the emergency department.

BACKGROUND: Intussusception decreases blood flow to the bowel, and tissue hypoperfusion results in increased lactic acid levels. We aimed to determine whether lactic acid levels are associated with pediatric intussusception outcomes. METHODS: The electronic medical records of our emergency department pediatric patients diagnosed with intussusception, between January 2015 and October 2018, were reviewed. An outcome was considered poor when intussusception recurred within 48 h of reduction or when surgical reduction was required due to air enema failure. RESULTS: A total of 249 patients were included in the study, including 39 who experienced intussusception recurrence and 11 who required surgical reductions; hence, 50 patients were included in the poor outcome group. The poor and good outcome groups showed significant differences in their respective blood gas analyses for pH (7.39 vs. 7.41, P = .001), lactic acid (1.70 vs. 1.30 mmol/L, P < .001), and bicarbonate (20.70 vs. 21.80 mmol/L, P = .036). Multivariable logistic regression analyses showed that pH and lactic acid levels were the two factors significantly associated with poor outcomes. When the lactic acid level cutoff values were ≥ 1.5, ≥2.0, ≥2.5, and ≥ 3.0 mmol/L, the positive predictive values for poor outcomes were 30.0, 34.6, 50.0, and 88.9%, respectively. CONCLUSION: Lactic acid levels affect outcomes in pediatric patients with intussusception; higher lactic acid levels are associated with higher positive predictive values for poor outcomes.

Diagnosis and treatment of childhood intussusception from 1997 to 2016: A population-based study.

OBJECTIVES: Describe changes in the diagnostic approach and treatment for pediatric intussusception over two decades. STUDY DESIGN: Administrative universal healthcare data were used to conduct a population-based cohort study of intussusception between January 1997 and December 2016 in Ontario, Canada. A validated case definition was used to identify all patients (<18 years) treated for intussusception in the province at community or tertiary care centers. Treatment modality was determined using physician billing data and databases linked at ICES; it was categorized as nonoperative alone, surgical alone, or failed nonoperative. Descriptive statistics, Cochrane-Armitage for trend analyses, and graphical and multinomial logistic regression were performed. RESULTS: Over 20 years, 1895 pediatric patients were treated for intussusception. Pretreatment imaging use rose from 57.5% to 99.3%. Nonoperative management increased from 23.4% to 75.2%. However, 43% of children who presented to a community hospital underwent immediate surgical management, compared with just 11% of children at tertiary centers (RR 0.39, 95% CI: 0.25-0.62). Among children who underwent surgery, there was an increase in bowel resection over time (41.7% to 57.6%). CONCLUSIONS: Over the 20 year period of study, pretreatment imaging became universal, and management shifted from predominantly surgical to nonoperative reduction in Ontario. The rate of surgical intervention remains higher in community versus tertiary centers. LEVEL OF EVIDENCE: Treatment study, III.

[Hydrostatic enema outcome in patients with long history of ileocolic intussusception]. / Resultados del enema hidrostático en pacientes con clínica prolongada de invaginación ileocólica.

PURPOSE: Hydrostatic enema is the gold standard treatment for ileocolic intussusception in stable patients without radiologic complication. There is no consensus about the influence of long history of symptoms in the outcome of this treatment. The aim of this study is to determine whether hydrostatic enema is effective and safe in patients with history of ileocolic intussusception of over 24 hours. MATERIAL AND METHODS: Retrospective review of all patients with ileocolic intussusception admitted to our hospital between 2014 and 2017. We divided the patients in whom enema was attempted on into two groups according to the length of history: over or under 24 hours. Statistical analysis was done by using the Fisher's exact test. RESULTS: In this study period 59 children presented with ileocolic intussusception. Duration of symptoms was variable (range 2 hours-7 days). Of the total of patients, initial hydrostatic enema was attempted on 49, with a success rate of 91.8% (45 patients). In the group of history <24 hours (33 patients, 67.3%) we observed a 93.9% effectiveness and in the group >24 hours (16 patients, 32.7%) effectiveness was 87.5%. Success rate showed no significant difference when comparing both groups (p=0.588). No complications were seen after enema reduction. CONCLUSIONS: The use of hydrostatic enema in patients with long history of intussusception is successful and safe. We consider it to be the first-line treatment in stable patients with no radiologic complication, regardless the duration of symptoms.

OBJETIVOS: El gold standard para el tratamiento de la invaginación ileocólica en el paciente estable sin complicación radiológica es el enema hidrostático. No hay unanimidad sobre si la sintomatología prolongada de invaginación influye en los resultados de dicho tratamiento. El objetivo de este estudio es determinar si el enema hidrostático es efectivo y seguro en pacientes con clínica de invaginación ileocólica mayor de 24 horas. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes diagnosticados de invaginación ileocólica en nuestro hospital entre 2014 y 2017. Hemos dividido en 2 grupos a los pacientes a los que se realizó enema en función del tiempo de clínica, mayor o menor de 24 horas. El análisis estadístico se realizó mediante el test exacto de Fisher. RESULTADOS: En este periodo se atendieron 59 niños con invaginación ileocólica con duración variable de los síntomas (2 horas a 7 días). Del total de pacientes, en 49 se realizó enema hidrostático inicial con una efectividad del 91,8% (45 pacientes). En el grupo de clínica <24 horas (33 pacientes, 67,3%) se objetivó una efectividad del 93,9% y en el grupo de clínica >24 horas (16 pacientes, 32,7%) se objetivó una efectividad del 87,5%. No hubo diferencias significativas al comparar la efectividad entre ambos grupos (p=0,588). En ningún paciente hubo complicaciones tras el enema. CONCLUSIONES: El empleo del enema hidrostático en pacientes con clínica prolongada de invaginación es efectivo y seguro. Consideramos que debería ser la primera herramienta terapéutica en el paciente estable sin complicación radiológica, independientemente del tiempo de evolución.