Recurrent intussusception with ileal perforation as a complication of Blue Rubber Bleb Nevus Syndrome in a pediatric patient

Blue rubber bleb nevus syndrome (BRBNS) is a rare congenital condition, characterized by multiple venous malformations that may involve any organ system, most commonly the skin or the gastrointestinal tract. These lesions are often responsible for chronic blood loss and secondary anemia, and in rare situations may cause severe complications such as intussusception, volvulus, and intestinal infarction. Intussusception as a complication of BRBNS, although a known complication of the disease, has rarely been reported, especially in the Philippines. In the Philippine Society for Orphan Disorders, only 2 cases of BRBNS are currently included in the organization, including the patient presented in the case report. The treatment of BRBNS that involves the gastrointestinal tract depends on the extent of intestinal involvement and severity of the disease. The treatment aims to preserve the GI tract as much as possible due to the high recurrence in the disease. In this case report, we present a 13 year-old male with BRBNS with previous history of intussusception, successfully managed conservatively;however, upon recurrence, underwent exploratory laparotomy wherein a subcentimeter perforation in the antimesenteric border of the proximal ileum was noted, together with a gangrenous intussuscipiens, and multiple mulberry-like formations on the antimesenteric border of the small bowels. Histopathological findings of the resected bowels showed multiple cavernous hemangiomas consistent with BRBNS. The postoperative course of the patient was unremarkable.Copyright © 2023 The Authors

Inflammation and vascular remodeling in COVID-19 hearts.

A wide range of cardiac symptoms have been observed in COVID-19 patients, often significantly influencing the clinical outcome. While the pathophysiology of pulmonary COVID-19 manifestation has been substantially unraveled, the underlying pathomechanisms of cardiac involvement in COVID-19 are largely unknown. In this multicentre study, we performed a comprehensive analysis of heart samples from 24 autopsies with confirmed SARS-CoV-2 infection and compared them to samples of age-matched Influenza H1N1 A (n = 16), lymphocytic non-influenza myocarditis cases (n = 8), and non-inflamed heart tissue (n = 9). We employed conventional histopathology, multiplexed immunohistochemistry (MPX), microvascular corrosion casting, scanning electron microscopy, X-ray phase-contrast tomography using synchrotron radiation, and direct multiplexed measurements of gene expression, to assess morphological and molecular changes holistically. Based on histopathology, none of the COVID-19 samples fulfilled the established diagnostic criteria of viral myocarditis. However, quantification via MPX showed a significant increase in perivascular CD11b/TIE2 + -macrophages in COVID-19 over time, which was not observed in influenza or non-SARS-CoV-2 viral myocarditis patients. Ultrastructurally, a significant increase in intussusceptive angiogenesis as well as multifocal thrombi, inapparent in conventional morphological analysis, could be demonstrated. In line with this, on a molecular level, COVID-19 hearts displayed a distinct expression pattern of genes primarily coding for factors involved in angiogenesis and epithelial-mesenchymal transition (EMT), changes not seen in any of the other patient groups. We conclude that cardiac involvement in COVID-19 is an angiocentric macrophage-driven inflammatory process, distinct from classical anti-viral inflammatory responses, and substantially underappreciated by conventional histopathologic analysis. For the first time, we have observed intussusceptive angiogenesis in cardiac tissue, which we previously identified as the linchpin of vascular remodeling in COVID-19 pneumonia, as a pathognomic sign in affected hearts. Moreover, we identified CD11b + /TIE2 + macrophages as the drivers of intussusceptive angiogenesis and set forward a putative model for the molecular regulation of vascular alterations.

"Inside out" - An exceptional intussusception

Introduction: We present the first case of appendiceal intussusception associated with myeloid sarcoma in a young patient. Minimally invasive techniques used along the clinical course are highlighted. Case description: A 2.5-year-old boy was admitted after three weeks of COVID-19 infection with ongoing symptoms of MIS-C. Due to constipation, distended belly and vomiting, US was done which showed ileocolic intussusception. After unsuccessful hydrostatic reduction laparoscopic exploration was performed, where the vermiform appendix was found to be thickened and partially intussuscepted into the coecum. The ileocecal region was exteriorized transumbilically. After manual reduction of the intussusception, a long, thickened, fragile appendix was removed. Histopathology revealed myeloid sarcoma. Bone marrow investigation identified acute myeloid leukemia. During the oncological treatment, laparoscopic cholecystectomy was necessary due to cholecystitis and cholelithiasis. The child recovered uneventfully in terms of surgical complications, with good cosmetic result. Conclusion(s): No similar case in childhood was found in the English literature. Unusual symptoms and radiological findings of intussusception can conceal unexpected disorders. Minimally invasive technique offered advantages in the treatment of the presented patient and can be recommended to treat intussusception or cholelithiasis, if applicable, during an ongoing oncological treatment as well.Copyright © 2023 The Authors

GOSH Conference 2021, Above and Beyond

The proceedings contain 123 papers. The topics discussed include: national study on the risks of COVID-19 for pediatric renal transplant recipients;evaluation of a creative photography workshop for children and young people following a diagnosis of PIMS-TS;reducing blood product usage through technology in transplantation;pharmacokinetic modelling of different tacrolimus formulations in children and adolescents;pediatric laparoscopic splenectomy: a single center 11 years' experience;our people: pursuing positivity in the pandemic - 'pause, power up, push on';delivering digital learning packages to address allied health professionals' skill gaps in research;building Bertie bowel: designing an immersive simulation experience for pediatric radiology teams managing intussusception;development of OctiPAT: a patient-facing mobile and web-based application to provide higher quality, patient-focused, multidisciplinary care to a complex patient cohort;and implementing Speech@Home into clinical practice using a quality improvement (QI) methodology.

Characteristics of intussusception in the period of arbitrary Rotavirus vaccination.

BACKGROUND: In November 2011, rotavirus (RV) vaccine was launched in Japan as a voluntary vaccination to prevent RV-associated gastroenterocolitis. We examined the characteristics of intussusception following RV vaccination in our two centers. METHODS: We investigated intussusception patients <16 years old from January 2006 to September 2020. Patients were categorized according to the period (before [Group A] or after the introduction of arbitrary RV vaccination [Group B]). The patient characteristics and treatment of intussusception were retrospectively investigated. RESULTS: During the study period, 560 patients (group A, n = 233; group B, n = 327) were identified. The distribution of patients who were 0-6 months old was not significantly different between the groups (group A, n = 12, 5.2%; group B, n = 18, 5.5%). Among these 18 patients in Group B, 7 were vaccinated against RV, and 10 were not. One patient was excluded due to incomplete data. On comparing patients with and without RV vaccination, the mean age at the onset of intussusception was 3.3 ± 0.4 versus 4.0 ± 0.3 months (P = 0.19), the mean interval from the onset to treatment was 7.5 ± 2.4 versus 16.0 ± 2.2 h (P = 0.03), the time of the contrast enema for treatment was 9.1 ± 3.3 versus 7.7 ± 2.8 min (P = 0.76), and the final pressure of the contrast enema was 92.5 ± 4.4 versus 92.2 ± 4.4 cmH2 O (P = 0.97). CONCLUSIONS: Arbitrary RV vaccination did not influence the age distribution of intussusception, and the interval from the onset to treatment was significantly shorter in the patients with RV vaccination than in those without it. Recognizing the presence of intussusception following RV vaccination enables accurate treatment.

Is Intussusception in an Adult with Active COVID-19 Infection a Surprise?

The severe acute respiratory syndrome coronavirus 2 (SARS COV2) had rapidly spread and caused a global pandemic worldwide. The most common symptoms in adults are respiratory with dry cough, dyspnea, and fever. Occasionally, extra-respiratory presentations may be seen such as gastrointestinal involvement with diarrhea, vomiting or abdominal pain. Acute intestinal intussusception is the most common cause of bowel obstruction in infants (2-4 months of age) but rarely could it be encountered in adult. It is a very rare gastro-intestinal manifestation of COVID-19 with an invagination of a segment of the bowel within a more distal one. The part that prolapses into the other is called the intussusceptum, and the part that receives it is called the intussuscipiens. Most of COVID-19 cases of AII are reported in the pediatric population between 4 and 10 months. Only a single case of small bowel obstruction secondary to ileo-colic intussusception in a COVID-19 infection adult was published on April 2021. We present here a challenging case of intussusception secondary to COVID-19 infection in an adult in the absence of respiratory symptoms. Our study presents the first case in Africa of AII in adult patients due to COVID-19.

CEC01-03 Safety of vaccines: a current perspective

Vaccines are powerful tools for preventing infection or disease from the infectious pathogens they target, but they may induce additional effects unrelated to the intended targets. Similar to other pharmaceutical products, vaccines may cause side effects, but tolerance to these is extremely low due to the use of vaccines in healthy people, particularly children. Redness, swelling or soreness at the site of injection are common for many vaccines under the term of reactogenicity. High fever can be present at a rate of 1/100 to /100 000 as can fever-induced convulsions from vaccines such as measles, mumps or rubella. Rotavirus vaccines are suspected to be associated with intussusception in about 1/100 000 first doses. Allergic reactions are in the same range. The massive H1N1 vaccination in the world has also been potentially associated with an increase in narcolepsia in patients with a risk allele. More recently, the SARS-CoV-2 vaccine ChAdOx1 nCov-19 have been found to cause a thromboembolic complication termed vaccine-induced immune thrombotic thrombocytopenia in very few people. Consequently, vaccines must undergo vigorous assessment before and after licensure to minimize safety concerns. Potential safety concerns should be identified as early as possible during the development for vaccines. In this CEC, along with courses, the attendees will have to work in small groups on real case studies associating non-clinical development and regulatory strategies. Copyright © 2022 Elsevier B.V.

Impact of coronavirus disease 2019 on pediatric intestinal intussusception in the United States.

BACKGROUND: Masking and social distancing to mitigate the spread of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus curbed the spread of other viruses. Given a potential link between viral illnesses and ileocolic intussusception, the purpose of this study is to characterize trends in incidence, diagnosis and management of pediatric intussusception in the United States in the context of the coronavirus disease 2019 (COVID-19) pandemic. MATERIALS AND METHODS: This cross-sectional retrospective study used the Pediatric Hospital Information System and included children (ages 0-17 years) with a primary diagnosis of intussusception (ICD-10 [International Classification of Diseases, Tenth Revision]: K56.1) from January 2018 to December 2021. Descriptive statistics and chi-square analyses were used to characterize and compare proportions pre-COVID (2018 and 2019) to 2020 and 2021. RESULTS: Eight thousand one hundred forty-three encounters met inclusion criteria. Intussusception diagnoses declined in 2020 (n = 1,480) compared to 2019 (n = 2,321) and 2018 (n = 2,171) but returned to pre-COVID levels in 2021 (n = 2,171). Patient age was similar across years (mean age in years: 2018: 2.3; 2019: 2.1; 2020: 2.3; 2021: 2.3). There was no significant change in the proportion of patients who underwent imaging in 2020 (96% [1,415/1,480]) compared to the other years in the study (2018: 96% [2,093/2,171], P = 0.21; 2019: 97% [2,253/2,321], P = 0.80; 2021: 96% [1,415/1,480], P = 0.85). There was a statistically significant but minimal increase in the proportion of cases treated with surgery in 2020 compared to 2019 (2020: 17.8% vs. 2019: 15%, P = 0.02); however, this was not replicated in the pairwise comparison of 2020 to 2018 (2020: 17.8% vs. 2018: 16.4%, P = 0.23). There was a statistically significant increase in the proportion of cases treated with surgery in 2020 compared to 2021 (2020: 17.8% vs. 2021: 14%, P = 0.001). CONCLUSION: Pediatric intussusception diagnoses decreased at a national level in 2020 compared to previous years, with a rebound increase in 2021. This may reflect a secondary benefit of public health interventions imposed to curb the spread of COVID-19.

Intussusception and COVID-19 in Children: A Systematic Review and Meta-Analysis.

BACKGROUND: Intussusception (ISN) post-COVID-19 infection in children is rare but can occur. SARS-CoV-2 may play a role in the pathogenesis of ISN and trigger immune activation and mesenteric adenitis, which predispose peristaltic activity to "telescope" a proximal bowel segment into the distal bowel lumen. OBJECTIVES: To estimate the prevalence of SARS-CoV-2 infection in ISN children and analyze the demographic parameters, clinical characteristics and treatment outcomes in ISN pediatric patients with COVID-19 illness. METHODS: We performed this systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies reporting on the incidence of ISN post-SARS-CoV-2 infection in children, published from 1 December 2019 until 1 October 2022, in PROQUEST, MEDLINE, EMBASE, PUBMED, CINAHL, WILEY ONLINE LIBRARY, SCOPUS and NATURE, with a restriction to articles available in the English language, were included. RESULTS: Of the 169 papers that were identified, 34 articles were included in the systematic review and meta-analysis (28 case report, 5 cohort and 1 case-series studies). Studies involving 64 ISN patients with confirmed COVID-19 (all patients were children) were analyzed. The overall pooled proportions of the ISN patients who had PCR-confirmed SARS-CoV-2 infection was 0.06% (95% CI 0.03 to 0.09, n = 1790, four studies, I2 0%, p = 0.64), while 0.07% (95% CI 0.03 to 0.12, n = 1552, three studies, I2 0%, p = 0.47) had success to ISN pneumatic, hydrostatic and surgical reduction treatment and 0.04% (95% CI 0.00 to 0.09, n = 923, two studies, I2 0%, p = 0.97) had failure to ISN pneumatic, hydrostatic and surgical reduction treatment. The median patient age ranged from 1 to 132 months across studies, and most of the patients were in the 1-12 month age group (n = 32, 50%), p = 0.001. The majority of the patients were male (n = 41, 64.1%, p = 0.000) and belonged to White (Caucasian) (n = 25, 39.1%), Hispanic (n = 13, 20.3%) and Asian (n = 5, 7.8%) ethnicity, p = 0.000. The reported ISN classifications by location were mostly ileocolic (n = 35, 54.7%), and few children experienced ileo-ileal ISN (n = 4, 6.2%), p = 0.001. The most common symptoms from ISN were vomiting (n = 36, 56.2%), abdominal pain (n = 29, 45.3%), red currant jelly stools (n = 25, 39.1%) and blood in stool (n = 15, 23.4%). Half of the patients never had any medical comorbidities (n = 32, 50%), p = 0.036. The approaches and treatments commonly used to manage ISN included surgical reduction of the ISN (n = 17, 26.6%), pneumatic reduction of the ISN (n = 13, 20.2%), antibiotics (n = 12, 18.7%), hydrostatic reduction of the ISN (n = 11, 17.2%), laparotomy (n = 10, 15.6%), intravenous fluids (n = 8, 12.5%) and surgical resection (n = 5, 7.8%), p = 0.051. ISN was recurrent in two cases only (n = 2, 3.1%). The patients experienced failure to pneumatic (n = 7, 10.9%), hydrostatic (n = 6, 9.4%) and surgical (n = 1, 1.5%) ISN treatment, p = 0.002. The odds ratios of death were significantly higher in patients with a female gender (OR 1.13, 95% CI 0.31-0.79, p = 0.045), Asian ethnicity (OR 0.38, 95% CI 0.28-0.48, p < 0.001), failure to pneumatic or surgical ISN reduction treatment (OR 0.11, 95% CI 0.05-0.21, p = 0.036), admission to ICU (OR 0.71, 95% CI 0.83-1.18, p = 0.03), intubation and placement of mechanical ventilation (OR 0.68, 95% CI 0.51-1.41, p = 0.01) or suffering from ARDS (OR 0.88, 95% CI 0.93-1.88, p = 0.01) compared to those who survived. CONCLUSION: Children with SARS-CoV-2 infection are at low risk to develop ISN. A female gender, Asian ethnicity, failure to ISN reduction treatment (pneumatic or surgical), admission to ICU, mechanical ventilation and suffering from ARDS were significantly associated with death following ISN in pediatric COVID-19 patients.

Intussusception, A Rare Presentation of MIS-C

Intussusception refers to the invagination of one part of intestine into itself. It is the most common abdominal emergency encountered in children younger than 2 years of age. Multisystem inflammatory syndrome in children or pediatric inflammatory multisystem syndrome temporally associated with covid -19{PIMS-TS} is a relatively rare complication of COVID 19 infection occurring in<1% of children who may have a past history of confirmed covid-19 infection. Many cases of intussusception are reported when a child suffers from acute covid 19 infection. But a case of intussusception which itself is a manifestation of MIS-C is not reported so far. A 7-year-old boy presented with fever, abdomen pain was found to have ileocolic intussusception. It was then successfully reduced pneumatically. But he continued to have high temperatures and later developed mucocutaneous manifestations and shock. Keeping the current pandemic in view, he was investigated and was found to be suffering from MIS-C. He was then treated by our hospital protocol successfully. This is a rare presentation of MIS-C, and so is reported here. This 7year old boy presented with fever, abdomen pain and was found to have ileocolic intussusception. It was then reduced pneumatically. He continued to have high temperature and later developed mucocutaneous manifestations and shock. With the investigations, he was found to be suffering from MIS-C. He was then treated by our hospital MISC-C protocol successfully. This is a rare presentation of MIS-C, which warrants a high index of suspicion.

COVID-19-Related Intussusception: A Case Series and Review of the Literature.

Background: Ileocolic intussusception is a common gastrointestinal emergency that occurs in infancy. Many cases are caused by anatomic lead points, such as hypertrophied Peyer's patches. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, which causes coronavirus disease 2019 (COVID-19), commonly presents with respiratory symptoms, however, its relation to intussusception remains unknown. Methods: Two cases are reported as well as a review of pertinent English-language literature on the topic. Results: We present two cases of intussusception in COVID-19-positive patients, including the first known case of a lead point with tissue polymerase chain reaction (PCR) confirming COVID-19 positivity, and compare these findings to a review of the recent literature. Intussusception in COVID-19-positive patients is becoming more prevalent and more often requires operative treatment. Discussion: We offer evidence that intussusception can be the presenting symptom in the absence of COVID-19-related respiratory symptoms. There also seems to be a trend toward the need for operative intervention compared with COVID-19-negative intussusception. The presence of SARS-CoV-2 can be confirmed via PCR in specific lead points (lymph nodes), directly causing the intussusception. Conclusions: Providers should have a low threshold to suspect and diagnose intussusception as operative treatment is more readily used in COVID-19-positive pediatric patients with gastrointestinal symptoms.

How Does the COVID-19 Pandemic Affect Pediatric Patients with Intussusception Treated by Ultrasound-Guided Hydrostatic Enema Reduction?

BACKGROUND: The pandemic of COVID-19 has significantly influenced the epidemiology of intussusception. Nevertheless, the effects of the COVID-19 pandemic on the operation of ultrasound-guided hydrostatic enema reduction (USGHER) for intussusception have been largely unknown. METHODS: The data of pediatric patients with intussusception who were treated by USGHER from January to March of 2019 (Control Group), 2020 (Study Group 1), and 2021 (Study Group 2) in a large Chinese medical institution were retrospectively collected and analyzed. RESULTS: We enrolled 246 patients, including 90 cases in Control Group, 70 in Study Group 1, and 86 in Study Group 2 (p = 0.042). The time from the onset of symptoms to the hospital visit and the time from the hospital visit to performing the ultrasound in Study Group 1 was significantly longer than that in Control Group and Study Group 2 (p = 0.036, p = 0.031, respectively). The number of patients with bloody stool and the longest invaginated length of intussusception in Study Group 1 increased significantly compared with patients in the other two groups (p = 0.007, p = 0.042, respectively). Comparisons of neither the pressure of enema nor the time of duration when performing USGHER present statistical significance among the three groups (p = 0.091, p = 0.085, respectively). For all enrolled pediatric patients, there was no perforation case involved, and recurrence of intussusception occurred in few cases. CONCLUSIONS: Besides the negative impacts on the incidence of intussusception, the COVID-19 pandemic might have led to the diagnostic delay of intussusception and the deterioration of patients' clinical manifestations, but it did not significantly affect the operation of USGHER and patients' clinical outcome.

A Rare Case of Intussusception in A COVID-19 Positive Patient with Nephrotic Syndrome

Background and Objective: Intussusception is one of the most common causes of intestinal obstruction in children 5 months to 3 years, which is the most common cause of acute abdominal pain and its prevalence increases as a result of viral infection. In this report, were present a case of intussusception in a 17-years-old boy following COVID-19. Case Report: A 17-year-old adolescent boy with a known case of steroid-dependent nephrotic syndrome from the age of two has been referred to the emergency department with severe abdominal pain and vomiting. On ultrasound, renal mass and free fluids were shown. Ileocecal intussusception was observed and was repaired without any complications. Conclusion: Based on the results of this study, intussusception should be considered in every patient with nephrotic syndrome with COVID-19 infection.

Pediatric Intussusception Following COVID-19 Infection: A Rare Presentation.

Pediatric intussusception has been reported to be associated with coronavirus disease 2019 (COVID-19) infection in the literature since the start of the pandemic in the past two years. Although this occurrence is exceptionally rare, rapid diagnosis based on recognition of gastrointestinal manifestations, clinical examination, and ultrasound confirmation can expedite appropriate care and prevent delayed complications. Intussusception is the most common cause of intestinal obstruction and acute abdomen in pediatric patients. Without prompt identification, the disease process can lead to necrosis, bowel perforation, shock, and, subsequently, multiorgan failure. Intussusception has previously been associated with viral upper respiratory infections, which can cause mesenteric lymphadenopathy as a lead point to allow the bowel to telescope upon itself. The mechanism of how COVID-19 can contribute to intussusception without respiratory symptoms remains unknown. Here, we present a case of pediatric intussusception associated with COVID-19.

Spontaneous resolution of intussusception after COVID-19 infection found at laparoscopy in a 6-year-old.

The incidence of intussusception is 2.5 per 1000 live births, and infants between 4 and 10 months of age represent the highest frequency peak. Cases of intussusception with acute COVID-19 infection have been reported in infants under one year of age and with one death associated with MIS-C. However, we have not found reports of intussusception in schoolchildren. We report the case of a 6-year-old male with two days of illness that began with a sensation of temperature rise, headache, abdominal pain, liquid stools with mucus and no blood, hyporexia, chills, and food vomiting. He presented a negative result for the detection of SARS-CoV-2 antigen, negative SARS-CoV-2 IgM/IgG serology positive (lateral flow immunochromatography test), in addition to total IgM/IgG antibodies in 11.88 COI by means of a test of electrochemiluminescence. An abdominal ultrasound was performed that concluded invagination, for which an exploratory laparoscopy was performed and the patient evolved favorably. 13 cases of intussusception associated with acute COVID-19 infection have been described in this group. However, no reports of intussusception have been described after COVID-19 infection in school age. We recommend ruling out active or past SARS-CoV-2 infection in children with gastrointestinal symptoms and, if it exists, ruling out invagination by means of abdominal ultrasound.

Intussusception in the setting of severe acute respiratory syndrome coronavirus 2 infection following rotavirus vaccination.

Most cases of intussusception are thought to be idiopathic, related to viral infections, structural abnormalities, or certain vaccinations. In this report, we present the development of intussusception in a pediatric patient who was coronavirus 2019 (COVID-19) positive. Although the most common gastrointestinal symptoms of COVID-19 virus are diarrhea and vomiting, there recently have been rare case reports of intussusception in patients throughout the world who are severe acute respiratory syndrome coronavirus 2 positive. This case is only the second known report in the United States and the second case reported globally that required surgical intervention for definitive management.

Unusual presentation of COVID-19 as intussusception

COVID-19, caused by novel coronavirus SARSCoV- 2, presents with varied clinical manifestations in pediatric age group. Gastrointestinal (GI) symptoms with/without respiratory manifestations are increasingly reported in children. This infant presented with features of intussusception and fever. Further evaluation showed RT PCR positivity for COVID-19 in the nasopharyngeal swab. Child did not develop any other respiratory manifestations or features of hyperinflammatory syndrome. It is extremely difficult to distinguish if this a manifestation of COVID-19 or an associated illness.

Changes in the Incidence of Intussusception and Infectious Diseases After the COVID-19 Pandemic in Korea.

BACKGROUND: Intussusception refers to the invagination of a part of the intestine into itself. The exact cause for this condition is unknown in most cases. The active implementation of coronavirus disease 2019 (COVID-19) infection control guidelines has reduced the spread of COVID-19 and the incidence of other infectious diseases in children. The current study aimed to identify changes in pediatric intussusception and infectious diseases after the implementation of infection control guidelines and confirm the association between intussusception and contagious diseases. METHODS: We analyzed the electronic medical records of pediatric patients diagnosed with intussusception from seven hospitals in Korea between January 2017 and December 2020. We used open data from the Korea Disease Control and Prevention Agency to investigate changes in infectious diseases over the same period. RESULTS: Altogether, we evaluated 390 children with intussusception. There was a statistically significant decrease in the incidence of monthly visits with intussusception in the COVID-19 period group (9.0 vs. 3.5, P < 0.001). When the monthly incidence of infectious diseases was compared between the pre-COVID-19 and the COVID-19 periods, a statistically significant decrease in respiratory viruses (7979.0 vs. 815.2, P < 0.001), enterovirus infection (262.2 vs. 6.6, P < 0.001), and viral enteritis (916.2 vs. 197.8, P < 0.001) were confirmed in the COVID-19 period. Through interrupted time series analysis, it was confirmed that the incidence of intussusception and viral infectious diseases have drastically decreased since March 2020, when COVID-19 infection control guidelines were actively implemented. CONCLUSION: We confirmed that implementing infection control guidelines during the COVID-19 pandemic resulted in a decrease in intussusception and viral infectious diseases. Through this result, it was possible to indirectly confirm the existing hypothesis that viral infections play a significant role in the pathophysiologic mechanism of intussusception.

Impact of the COVID-19 Pandemic on Emergency Care Utilization and Outcomes in Pediatric Patients with Intussusception.

BACKGROUND: We determined whether a decrease in healthcare utilization patterns during the COVID-19 pandemic affected the treatment process of pediatric patients with intussusception. METHODS: Patients with suspected intussusception who had ICD-10 code K561 as their discharge diagnosis from the national database were selected, and those who underwent either radiologic and/or surgical reduction were defined as true intussusception patients. We compared the time periods from patients visiting the ED to ultrasound, radiologic reduction and/or surgical reduction between the study group (first half of 2020, COVID-19 period) and the control groups (control group 1: first half of 2019, control group 2: second half of 2019). RESULTS: The number of suspected intussusception patients in each group was 1223, 1576, and 624, and the incidence rates were 7.85, 11.30, and 4.19 per 100,000 person-half-years (control group 1, control group 2, study group, respectively, p < 0.05). No differences in terms of the time from the ED visit to ultrasound, radiological reduction and/or surgical reduction were noted between the study group and the control groups. CONCLUSIONS: In Korea, the COVID-19 pandemic did not significantly affect the ED treatment process or the results of patients with intussusception.