Hospital-based surveillance of intussusception among infants / Vigilância hospitalar de intussuscepção entre neonatos

Abstract Objective: Intussusception surveillance was initiated after the nationwide introduction of live attenuated monovalent rotavirus vaccine (RV1). The objective is to assess the epidemiology of intussusception and compare the number of cases before and after the introduction of rotavirus vaccine. Methods: Cases of intussusception occurring between March 2006 and January 2008 were identified through a prospective enhanced passive surveillance system established in sentinel state hospitals. Retrospective review of medical records was used to identify cases, which occurred in sentinel hospitals between January 2001 and February 2006. Results: From 2001 to 2008, 331 intussusception cases were identified, 59.5% were male, with peak incidence among those 18–24 weeks of age. Overall <10% of cases were among infants 6–14 weeks of age (when the first dose of RV1 is administered). The most frequently observed signs or symptoms of intussusception included vomiting (89.4%), bloody stool (75.5%), and abdominal distention (71.8%). A majority (92.1%) of the case-patients required surgery for treatment; 31.8% of those who underwent surgery required bowel resection, and 13 (3.9%) died. Among the 21 hospitals that reported cases throughout the entire surveillance period (2001–2008), the number of intussusception events during 2007 (n = 26) and 2008 (n = 19) was not greater than the average annual number (n = 31, range 24–42) during baseline years 2001–2005. Conclusions: Although this analysis did not identify an increase in intussusception cases during the two years after RV1 introduction, these results support the need for special epidemiologic methods to assess the potential link between rotavirus vaccine and this very rare adverse event.

Resumo Objetivo: A vigilância da intussuscepção foi iniciada após a introdução da vacina monovalente viva atenuada contra rotavírus (RV1) em todo o país. O objetivo é avaliar a epidemiologia da intussuscepção e comparar a quantidade de casos antes e depois da introdução da vacina contra rotavírus. Métodos: Os casos de intussuscepção entre março de 2006 e janeiro de 2008 foram identificados por meio de um sistema de vigilância passivo prospectivo aprimorado estabelecido em hospitais-sentinela estaduais. A análise retrospectiva de prontuários médicos foi usada para identificar os casos que ocorreram em hospitais-sentinela entre janeiro de 2001 e fevereiro de 2006. Resultados: De 2001-2008, identificamos 331 casos de intussuscepção, 59,5% dos quais ocorreram em pacientes do sexo masculino, com pico de incidência entre aqueles com 18-24 semanas de idade. Em geral, < 10% dos casos ocorreram entre neonatos com 6-14 semanas de idade (quando a 1a dose de RV1 é administrada). Os sinais ou sintomas de intussuscepção observados com mais frequência incluíam vômito (89,4%), fezes com sangue (75,5%) e distensão abdominal (71,8%). A maioria (92,1%) dos pacientes precisou de cirurgia para o tratamento; 31,8% dos que se submeteram à cirurgia precisaram de ressecção intestinal e 13 (3,9%) vieram a óbito. Entre os 21 hospitais que relataram casos durante todo o período de vigilância (2001-2008), a quantidade de casos de intussuscepção em 2007 (n = 26) e 2008 (n = 19) não foi maior do que a quantidade média anual (31, faixa de 24-42) durante os anos-base de 2001-2005. Conclusões: Embora esta análise não tenha identificado um aumento nos casos de intussuscepção nos dois anos após a introdução da RV1, esses resultados justificam a necessidade de métodos epidemiológicos especiais para avaliar a possível associação entre a vacina contra rotavírus e esse evento adverso muito raro.

Intussusception in Pregnancy: A Rare Case Report.

Intussusception is a surgical emergency characterized by invagination of a segment of bowel into a distal portion. It leads to obstruction and compromise of mesenteric blood flow with resultant inflammation and the potential for ischemia of the bowel wall. It is very rare in pregnancy, and the high fetal and maternal mortality is due to a delay in diagnosis and treatment. We report a case of intussusception at a gestational age of 14 weeks and 6 days, when she presented with severe lower abdominal pain and vomiting. Diagnosis was confirmed by ultrasonography which revealed heteroechoic bowel in bowel appearance. Emergency laparotomy was done. Lead point was a submucosal lipoma at 60 cm from the ileocecal junction. Iloeocecal intussusception reduction and segmental ileal resection and end-to-end anastomosis was done. The post-operative period was uneventful.

Invaginación intestinal: aspectos epidemiológicos y clínicos: centro hospitalario Pereira Rossell 2006-2010 / Intussusception: epidemiological and clinical aspects: centro hospitalario Pereira Rossell 2006-2010

Introducción: la invaginación intestinal es la primera causa de oclusión intestinal en niños pequeños. El diagnóstico exige alto grado de sospecha. El tratamiento de elección es la reducción guiada por imagen con un porcentaje de éxito elevado.Objetivo: describir las características clínicas, el tratamiento y la evolución de los niños hospitalizados por invaginación intestinal en el Servicio de Cirugía Pediátrica del Hospital Pereira Rossell en el período 2006-2010.Material y métodos: se incluyeron todos los niños hospitalizados con invaginación intestinal en el período 1/1/2006–31/12/2010. Se analizó: edad, sexo, procedencia, manifestaciones clínicas, métodos diagnósticos, tratamiento y evolución (complicaciones, ingreso cuidados intensivos (CTI), estadía hospitalaria). Para el procesamiento de datos se utilizó Epi Info 2008 versión 3.5.1.Resultados: se incluyeron 64 episodios de invaginación intestinal, 85,9% menores de 2 años. Dolor abdominal, vómitos y enterorragia se presentaron en el 50% de los casos. Se intentó la desinvaginación guiada por imagen en 76%; fue exitosa en 61%. Se realizó cirugía en 34 pacientes (53%), por fracaso de la desinvaginación por imagen en 19. La estadía hospitalaria, la necesidad de ingreso a CTI y la presencia de complicaciones fueron significativamente mayores en los niños sometidos a cirugía...

Introduction:intussusception is the most commoncause of bowel obstruction in young children. Itsdiagnosis requires high level of suspicion. Theprimary treatment is image guided reduction with ahigh success rate.Objective:to describe the clinical characteristics,treatment and evolution of all children with intussuception admitted to the Pediatric SurgeryService of the Hospital Pereira Rossell from 2006 to2010.Methods:all children with intussuception admitedbetween 1/1/2006 and 31/12/2010 were included.The items registered were: age, sex, provenance,clinical manifestations, diagnostic methods,treatment and evolution (complications, admission to intensive care unit, duration of hospitalization). Datawas analysed with Epi Info 2008 3.5.1.Results:64 intussuception cases were registered,85,9% of them younger than 2 years. Abdominal pain, vomiting and enterorrhagia occured in 50% of the cases. Attempt of image guided reduction was made in 76%; with a success rate of 61%. Surgical reduction was made in 34 pacientes (53%), 19 of them as a result of nonsurgical reduction failure.Duration of hospitalization, admission to intensive care unit and duration of hospitalization were significantly higher in children who receive surgical treatment.

Caracterización de una población pediátrica con invaginación intestinal diagnósticada en un hospital de referencia durante un periodo de 8 años / Description of a group of children with intestinal intussusception diagnosed in a reference hospital during a period of 8 years

Objetivo: El objetivo general del estudio fue describir todos los casos documentados de invaginación intestinal en niños menores de 24 meses en el HNN durante el periodo 2001-2008. Métodos: estudio retrospectivo y descriptivo, basado en la información de expedientes clínicos y del Servicio de Estadística, de todos los egresos hospitalarios con el diagnóstico de invaginación intestinal en niños menores de 24 meses durante el periodo: enero 2001 a diciembre 2008. Resultados: durante este periodo de estudio la media de la tasa de incidencia de invaginación intestinal en el HNNH fue de 31 por cada 100000 nacidos vivos. La distribución de pacientes por sexo y grupo de edad fue: 57.7 por ciento hombres y 42.3 por ciento mujeres, p:0.003. El 85.2 por ciento de los episodios de invaginación intestinal ocurrió en niños menores de 12 meses, 14.8 por ciento de 12 a 24 meses, 27/182 pacientes. La edad media de presentación fue de 7.7 meses. 103 pacientes requirieron ser llevados a sala de operaciones para desinvaginación por taxis, de los cuales el 79.61 por ciento, 82, tuvieron un colon por enema fallido. La perforación intestinal fue la complicación más frecuente en un 12.6 por ciento de los casos, 13. Se realizó resección intestinal en 16 casos, 15.50 por ciento. Conclusiones: este estudio brinda información sobre la epidemiología de la invaginación intestinal en Costa Rica siendo éste un estudio base para futuras investigaciones asociadas a la introducción de las vacunas del rotavirus en el esquema de vacunación del país.

How do different presenting and therapeutic modalities change the outcome in intussusception.

OBJECTIVE: To evaluate if a correlation exists between the clinical and radiologic characteristics at presentation; and the success of conservative management, morbidity and outcome of patients with intussusception. METHODS: All patients (total 179) treated for intussusception in our unit between 1993 and 2003, were retrospectively reviewed to find out the effects of physical examination (general appearence, consciousness, body temperature, abdominal distention and tenderness, blood on rectal examination), laborat (leukocyte count) and radiologic (air-fluid level on X-ray, free abdominal fluid on ultrasonography) findings on selection of first step therapeutic modality, conservative management (reduction with barium or air) success rate and surgical complication (serosal defect, intestinal perforation) rate. Additionally, the patients were subdivided into three subgroups as group A (patients for whom surgical management was performed primarily), group B (the ones who were operated after failure of reduction attempt with barium or air), group C (patients who had successful conservative reduction). These groups were compared within each other with regard to duration of nasogastric suction, antibiotic therapy; onset of oral feeding and duration of hospitalization. The chi-square, Kruskal-Wallis and ANOVA tests were used for the statistical analysis and p value less than 0.05 was considered to be significant. RESULTS: Incidence of selecting conservative treatment primarily was lower in patients with moderate general appearence (p=0.02) and with free fluid on ultrasonography (p=0.007). Success rate of conservative treatment was lower in patients with moderate general appearence (p=0.000), lethargy (p=0.011), blood on rectal examination (p=0.004), air-fluid level on X-ray (p=0.039), free fluid on ultrasonography (p=0.001). Surgical complication rate was higher in patients with moderate general appearence (p=0.000), lethargy (p=0.007), air-fluid level on X-ray (p=0.009). In group A; the duration of N/G suction, antibiotic therapy and hospitalization was longer; the onset of oral feeding was later than the other two groups (p=0.000). In group B; the duration of N/G suction, antibiotic therapy and hospitalization was longer; the onset of oral feeding was later than group C (p=0.000). CONCLUSION: Moderate general appearence, lethargy and air-fluid level on X-ray not only decrease the success rate of conservative management, but increase the surgical complication rate as well. Thus, these parameters deserve more importance in the management scheme. Reduction with conservative management is the most important factor which decreases the morbidity. Morbidity is lower in cases who are operated after failure of conservative management than the ones for whom surgery is performed primarily. Thus, conservative management should be tried for all patients unless there is a clear cut contraindication such as peritonitis and/or pneumoperitoneum.

Estudo retrospectivo das itussuscepções em cães / Retrospective study of canine intussusception

Intussuscepção é uma causa comum de obstruções intestinais em pequenos animais. No presente estudo foram analisados, retrospectivamente, prontuários de 97 cães com diagnóstico de intussuscepção intestinal no período de Janeiro de 2000 a Julho de 2007. Foram avaliados dados referentes a raça, idade e sexo do animal, sintomas clínicos, meios de diagnóstico, tratamento e evolução do quadro. Animais com idade inferior a um ano apresentaram maior ocorrência. Diversos fatores foram relacionados como predisponentes, sendo a intoxicação prévia por carbamatos presente em 13 cães. A porção mais acometida foi a junção ileo-cólica e a enterectomia e enteroanastomose foram realizadas em 71% dos animais. Apenas três animais, não submetidos a enterectomia no primeiro procedimento, apresentaram recidiva do quadro. Três animais foram a óbito após a intervenção cirúrgica. O número expressivo de casos analisados associado à ausência de dados regionais até então existentes contribuiu para o conhecimento da afecção e de seu tratamento

Intussusception is a common cause of bowel obstruction in small animals. In this study, 97 records of dogs with diagnosis of intestinal intussusceptions between the period of January/2000 and July/2007 were retrospectively reviewed. Analyzed data included symptoms, predisposing factors, means of diagnosis, treatment and evolution. Animals with less than one year showed more occurrences. Many findings could be related to predisposing factor, where previous intoxications with carbamates showed to be the most important (13dogs). The most affected portion by intussusceptions was the ileum-colic junction and enterectomy was necessary in 71% of the animals. Only three animals, not submitted to enterectomy in the first procedure, showed recurrence of intussusception. Three animals came to death after surgery. The expressive number of analyzed cases allied to absence of regional data contributed to the knowledge of the disease and its treatment.

Invaginación de intestino delgado: aspectos ultrasonográficos y clínicos en pacientes pediátricos / Invagination of the small intestine: ultrasonographic and clinical aspects in pediatric patients

Intussusceptions in children have been considered a medical-surgical emergency. This concept relates to ileocolic invagination, which rarely remits spontaneously; it involves a vascular risk for affected intestine, and requires a prompt resolution. The increased use of ultrasound in abdominal pain evaluation has resulted in ever rising frequency rates in detection of small intestine intussusceptions, a phenomenon that is often self-limited. To analyze relevant clinical and ultrasonographic aspects of these patients, a retrospective study of medical records and ultrasound findings of 43 pediatric patients (7 months-10 years) presenting with intussusceptions of the small intestine, was conducted. The most frequent symptoms were abdominal pain (72 percent) and vomiting (36 percent). Ten patients presented more than one intussusceptions, adding up to 55 invaginations in the series. Predominantly they were located in the periumbilical region, while transverse and longitudinal diameters ranged from 0.9 and2.7cm (1.6 average), and 3.9 and 1.0 cm (2.2 cm average), respectively Intussusceptions was self-limited in all the cases, disappearing during the examination period in 64 per cent of patients, whereas remission of invagination in the remaining 36 per cent occurred subsequently during ultrasound exams performed from 45 minutes to 22 hours afterwards. Nineteen per cent of patients were hospitalized and none of them required surgery. The most common final diagnosis in these children were acute gastroenteritis, enterovirosis, and acute diarrheal syndrome. Being aware of this pathology seems of relevance since the radiologist plays an important role in the conservative management of these patients.

La invaginación intestinal en niños se ha considerado una urgencia médico-quirúrgica. Este concepto tiene relación con la invaginación ileocólica, que raramente se reduce en forma espontanea, implica un riesgo vascular para el intestino afectado y requiere pronta resolución. El mayor uso del ultrasonido en la evaluación del dolor abdominal ha determinado la detección cada vez más frecuente de invaginaciones de intestino delgado, fenómeno que con frecuencia es autolimitado. Para objetivar los aspectos clínicos y ultrasonográficos relevantes de estos pacientes, revisamos retrospectivamente fichas y ultrasonografías de 43 niños (7 meses-10 años) con invaginaciones de intestino delgado. Los síntomas más frecuentes fueron: dolor abdominal (72 por ciento) y vómitos (36 por ciento). En 10 de estos pacientes fue posible detectar más de una invaginación, contabilizando un total de 55 invaginaciones en la serie. La localización más frecuente fue la región periumbilical y sus diámetros: transverso entre 0,9 y 2,7cm (1,6promedio) y longitudinal entre 1,0 y 3,9 cm (2,2 cm promedio). La invaginación fue autolimitada en todos los pacientes. Se objetivó su desaparición durante el examen en el 64 por ciento de los pacientes y en controles ecográficos realizados 45 minutos a 22 horas más tarde, en los restantes. El 19 por ciento de los pacientes fue hospitalizado y ninguno de ellos requirió cirugía. Los diagnósticos finales más frecuentes en estos niños fueron: gastroenteritis aguda, enterovirosis y síndrome diarreico agudo. Consideramos necesario conocer esta patología, ya que el radiólogo tiene un importante rol en el manejo conservador de estos pacientes.

Acute intussusception in children seen at El Obeid Hospital, Western Sudan

To study the pattern, clinical presentations and management outcomes of childhood intussusception seen at El Obeid Hospital, Western Sudan. This is a retrospective descriptive study. The medical records of children who presented with intussusception during 2004 to 2007 at the University Surgical Unit, in El Obeid Teaching Hospital were reviewed. The data were analyzed for gender, age, clinical presentations and treatment outcomes. There were 24 children, males were 14. Infants constituted 71% of the study group. Patients came from rural areas, mainly during the dry season. They had their symptoms for more than 36 hours, were seen and initially treated elsewhere and only 41% presented with classical clinical features. All patients were operated and found to have ileocolic intussusceptions, with no pathologic lead point. 54.2% of cases had resection and anastomosis for bowel ischaemia, while in 45.8% manual reduction was done. The post-operative mortality was 16.7%. Conclusions: Childhood intussusception was common in male infants from rural areas in the dry season. Late presentation to the surgeon necessitated major operative procedures for bowel ischaemia with considerable morbidity and mortality

Aspectos clínicos y epidemiológicos de la invaginación intestinal en niños menores de 2 años, de la provincia de Mendoza, Argentina / Clinical and epidemiological aspects of intestinal intussusception in children younger than two years old, in Mendoza, Argentina

Introducción. La invaginación intestinal es una enfermedadgrave, generalmente idiopática. Constituyela principal causa de obstrucción intestinal enniños, en especial en menores de 1 año. El objetivoes describir características clínicas y epidemiológicasde la invaginación intestinal y calcular su incidenciaanual en menores de 1 y 2 años de edad.Población, material y método. Estudio descriptivo,observacional. Se analizaron las historias clínicasde menores de 2 años, internados con diagnósticode invaginación, entre el 1/01/2003 y el 31/12/2005 en la provincia de Mendoza. Se evaluó edad, sexo, mes de diagnóstico, enfermedad previa, clínica, localización, tratamiento, complicaciones, tiempo de internación. Se calculó incidencia anual por edad y por año.Resultados. Se enrolaron 77 sujetos, rango de edad:1 a 22 meses, mediana: 6 meses. Menores de 1 año:88 por ciento. El mayor número de casos se presentó entreoctubre y marzo (68 por ciento). Veintinueve refirieron enfermedad previa (respiratoria 69 por ciento, diarrea 17 por ciento). Manifestaciones abdominales más frecuentes: vómitos 87 por ciento, dolor abdominal 79 por ciento, deposiciones con sangre 67 por ciento. La localización más frecuente fue ileocecoapendiculocólica en 30 (39 por ciento). Se indicó tratamiento quirúrgico en 72 pacientes (93,5 por ciento). La incidencia en menores de 1 año fue 0,77, 0,82 y 0,67/1.000 y en menores de 2 años; 0,41, 0,51 y 0,39/1.000, para los años 2003, 2004 y 2005, respectivamente.Conclusiones. La mayor incidencia se observó enmenores de 1 año y la localización leocecoapendiculocólicafue la más frecuente. Más del 90 por ciento de lospacientes requirió cirugía, con buena evolución

Impact of age and delayed presentation on outcome of intussusception in children

To evaluate the impact of age, weight. delayed presentation on outcome. Retrospective study Period: 7 Years period [January 1997 - December 1999 and January 2001 - December 2004]. Setting: Department of Pediatric Surgery, Mayo Hospital and The Children's Hospital, Lahore. During 7 years period total 130 cases of intussusception were admitted. Most of patients presented under 1 year of age. Majority of patients presented after 72 hours of duration. All were operated and ileocolic was the most common type followed by ileoileal intussusception. Below 1 year 58.25% patients required resection anastomosis and after 5 years 27.7% patients required resection. Before 72 hours 25% patients required resection and after 72 hours 74% patients required resection. We conclude that duration and age have definite impact on outcome of intussusception

Adult intussusception - asurgical dilemma

Adult intussusception is rare. It is expected to be found in 1/30,000 of all hospital admissions, 1/1300 of all abdominal operations, 1/30'1/100 of all cases operated for intestinal obstruction and one case of adult intussusception for every 20 childhood ones. The authors encountered 4 cases of adult intussusception. M:F ratio was 1:1. Mean age was 47years. Small bowel obstruction was documented in all. They were investigated by radiographs, ultrasound exam, barium studies, endoscopy and CT scan. All however were diagnosed at operation although some pre-operative suspicion was raised in one case. All had a laparotomy. Two were ileo-ileal and two ileo-caecal intussusceptions. One was chronic intussusceptions and three sub-acute. One intussusception had a malignancy [lymphoma] as a lead point. Two had a submucous lipoma at the apex. In an interesting case the suture knot from a recent small bowel anastomosis [2-3 weeks prior] was forming the lead point of the intussusception! The 2 ileo-ileal intussusceptions had segmental resection. Right hemicolectomy was done for the 2 ileo-caecal cases. 'Target lesion' and leumen-within-leumen were the CT hallmarks on review. Retrospective barium enema review failed to show the intussusception. This may suggest the intussusception may have been recurrent or chronic. All 4 recovered uneventfully and remained well. One patient was referred for chemotherapy for intestinal lymphoma. Adult intussusception remains a rare cause of abdominal pain. The treatment almost always is surgical

Invaginación intestinal: estudio de su incidencia durante un año en Uruguay / Intestinal intussusception: study of incidence in Uruguay for a one year

Objetivo: estudiar en forma prospectiva, durante un año, en todo el país, la incidencia de invaginación intestinal en menores de 2 años. Se considera importante contar con datos de la incidencia de invaginación intestinal para la posible introducción de una vacuna para rotavirus que en su primera experiencia demostró un incremento de esta enfermedad. Material y método: en cada uno de los 19 departamentos en que está dividido políticamente el país, se encargó a un pediatra la vigilancia de casos de invaginación intestinal en menores de dos años. Se utilizó una ficha de recolección de datos precodificada; el diagnóstico se basó en las evidencias clínicas e imagenológicas y se confirmó con la intervención quirúrgica o con los procedimientos de desinvaginación. Resultados: en el período comprendido entre el 1 de julio de 2003 y el 30 de junio de 2004, se constataron 26 casos de invaginación intestinal. Las edades de los pacientes oscilaron entre los 3 y los 21 meses; la mediana de edad fue de 7,5 meses; cinco fueron mayores de 72 meses. El 58 por ciento fueron varones; no se observó distribución estacional. La mayor cantidad de pacientes fue de Montevideo (14), capital del país. En 23 de los casos el tratamiento se realizó en el Centro Hospitalario Pereira Rossell (Montevideo); un caso se resolvió en el interior del país. La resolución de la invaginación fue en el 69 por ciento de los casos quirúrgica; en cinco casos hubo un segundo episodio de invaginación. Todos fueron dados de alta. No hubo relación temporal con la vacunación previa; en cuatro casos hubo diarrea en los 10 días previos a la invaginación, de etiología desconocida. Se encontró un caso de invaginación intestinal cada 3.903 menores de dos años, o 25 casos por 100.000 niños/año. Comentarios: la incidencia de los casos de invaginación intestinal es menor a la descrita en la mayoría de los países de la región. No se encontró relación temporal con la vacuna de la poliomielitis que es la única de utili...

Perfil epidemiológico y clínico de la invaginación intestinal en lactantes de la Región Metropolitana / Clinical and epidemiological profile of intestinal intussusception among infants of Metropolitan Santiago

Background. Intussusception (IS) is a potentially severe disease that affects an undetermined number of Chilean infants. The withdrawal of a rotavirus vaccine in 1999 due to its association with IS, highlighted the need for updated information on IS worldwide including Chile, before introduction of new vaccines. Aim: To estimate the incidence and to describe the epidemiology and clinical presentation of IS in the Metropolitan Area of Chile. Material and methods. IS cases occurring between 1996 and 2001 in the seven public pediatric hospitals and in six private clinics (during 2000 and 2001) were identified. Incidence rates were calculated using updated population estimates. A systematic review of the medical charts of IS cases occurring in the public hospitals for 2000-2001 was performed. Results. IS incidence rates for the Public Sector ranged from 32 to 39 per 100.000 children < 2 years of age. These figures did not vary significantly among the different Health Care Services, nor after inclusion of the private clinics. IS was more common in males (66%) and infants younger than 12 months (83%), with 67% of cases occurring between 3 and 8 months of age. The most common presenting symptoms were abdominal pain (90%), vomiting (86%), and rectal bleeding (75%). Ileocolic IS predominated (83%) and surgical correction was the preferred treatment (81%). No death occurred in this series. Conclusions: IS incidence rates were intermediate compared to other series, stable over time, and similar between the public and private sector. Clinical characteristics were similar to those previously reported with a disproportionately high use of surgical correction over enema, currently considered the preferred treatment option. (Rev MÚd Chile 2004; 132: 565-72).

Intussusception in southern Indian children: lack of association with diarrheal disease and oral polio vaccine immunization.

BACKGROUND: Intussusception is the most common cause of intestinal obstruction in young children and has been reported as a complication of a recently withdrawn tetravalent reassortant rotavirus vaccine. METHODS: We studied the history, clinical presentation, management and outcome of intussusception presenting to a tertiary care hospital in southern India over a 10-year period, in order to assess potential association with diarrheal disease and immunization. RESULTS: Data from 137 index cases and 280 control subjects indicated that the risk of diarrheal disease or oral polio vaccine administration in the month prior to presentation was similar in the index cases and controls. Mean time to presentation to hospital after developing symptoms was 1.8 days, and 77.3% of patients required surgery, with 47.4% undergoing intestinal resection. Mortality was 0.006%. CONCLUSIONS: No association could be demonstrated between gastroenteritis or oral poliovirus vaccine immunization and intussusception in southern Indian children. These children presented later and required operative intervention more frequently than has been reported in other studies, but had a good outcome with low mortality.

Intususcepción intestinal del adulto / Adult's intestinal intususcepotion

Antecedentes: A diferencia de lo que sucede en el niño, la intususcepción intestinal del adulto es una patología de baja frecuencia y que obedece generalmente a una causa demostrable. Objetivos: Analizar las características clínicas, diagnósticas y terapéuticas de una entidad poco frecuente. Diseño: Descriptivo, observacional, retrospectivo. Material y método: Se presentan 14 casos de intususcepción intestinal tratados en el Hospital J. M. Penna de Buenos Aires y la Clínica Modelo de Lanús durante los últimos 10 años. Resultados: Seis pacientes pertenecieron al sexo masculino y ocho al femenino. El motivo de consulta fue un cuadro oclusivo completo en 8 casos (57 por ciento), episodios suboclusivos en 4 (29 por ciento), y abdomen agudo peritoneal en los 2 restantes (14 por ciento). Los cuadros oclusivos y peritoníticos fueron resueltos en la urgencia y el resto en forma electiva. El hallazgo intraoperatorio fue de invaginación ileocólica en 8 casos, ileoileal en 4 y colocólica en 2. En ningún caso se efectuó el diagnóstico preoperatorio de invaginación intestinal. Las operaciones efectuadas fueron 8 hemicolectomías derechas, 4 enterectomías parciales y 2 operaciones tipo Hartmann. La evolución fue favorable en todos los casos. Conclusiones: La intususcepción intestinal es de rara presentación en el adulto, y habitualmente lo hace como un abdomen agudo obstructivo. La radiología contrastada es el método clásico para su diagnóstico preoperatorio. En cuanto a su tratamiento, no debe demorarse la indicación de laparotomía dada la etiología mayoritariamente secundaria de ésta entidad

Surgical and epidemiological study of intussusception in first and second decade life

Twenty cases of intussusception in children between the ages of 5 and 15 years were compared with intussusception in infancy and early childhood. They accounted for 18.5 percent of all 108 children treated for intussusception in El Minia University hospitals from 1992 to 1996. Diagnosis of intussusception was delayed, probably due to an unusual presentation. Fifty-five per cent had a definite predisposing factor precipitating the intussusception and 45 percent had a small bowel intussusception, which warranted early surgical intervention. In the absence of contraindications no child should be disqualified from an attempt at hydrostatic reduction. After hydrostatic reduction careful follow-up is required to exclude an organic lesion, possibly by a small bowel follow-through meal. Surgery is indicated after hydrostatic reduction in case of chronically recurrent abdominal complaints