Outcomes in pediatric patients with documented delays between ileocolic intussusception diagnosis and therapeutic enema attempt: evaluation of reduction efficacy and complication rate.

BACKGROUND: Ileocolic intussusception is considered a pediatric emergency, with concerns for risk of significant morbidity in children with a prolonged intussusception state. Emergent therapy is standard of care, as prior studies have shown poor outcomes in patients with long delays (> 24 h) before intervention. Various factors can result in shorter delays, and there are limited studies evaluating outcomes in these patients. This study aimed to determine if there were differences in reduction success rates associated with short in-hospital time delays. OBJECTIVE: This study is to determine enema success rate and morbidity in patients with documented time delays between intussusception diagnosis and therapeutic enema. MATERIALS AND METHODS: A retrospective evaluation of pediatric patients with intussusception at a single children's hospital between 2007 and 2019 was performed. Patient's records were reviewed for time of symptom onset, radiologic diagnosis, and attempted enema. Ultrasounds and radiographs were reviewed for bowel obstruction, free peritoneal fluid, trapped fluid around the intussusceptum, and absent bowel wall perfusion. Patients were evaluated for efficacy of reduction attempt, requirement for surgical reduction, and complications including bowel resection and bowel perforation. RESULTS: There were 175 cases of ileocolic intussusception requiring enema reduction. Successful reduction occurred in 72.2% (13/18) of cases performed within 1 h of diagnosis; 74.3% (78/105) between 1 and3 h; 73.2% (30/41) between 3 and 6 h; and 81.2% (9/11) with greater than 6 h. Need for bowel resection was not associated with short delays between diagnosis and reduction attempts (p = .07). CONCLUSIONS: There was no difference in intussusception reduction efficacy or complication rate in patients with increasing time between imaging diagnosis of ileocolic intussusception and reduction attempt, including delay intervals up to 8 h.

Measurement and analysis of dose exposure in childhood intussusception reduction / 中国辐射卫生

Objective To investigate the dose of radiation in children under going X-ray-guided air enema reduction, and to provide a basis for reducing the risk of radiation injury in pediatric patients. Methods Data were collected from children with intussusception who were treated with air enema. The experimental conditions of high, medium, and low doses of three age groups were analyzed. Phantoms were used to simulate the operation, and the radiation dose was measured using a thermoluminescence system. Results In children with intussusception, the success rate of air enema under the guidance of X-ray was 88% (including secondary intussusception), with anearly re-intussusception rate of 8%. The effective dose of treatment ranged from 0.57 to 12.33 mSv, and the tissues and organs with high absorbed dose were mainly in the chest and abdomen. Conclusion Children in different groups are exposed to significantly differentand relatively high doses. The operators are recommended to use ultrasonic guidance. With X-ray guidance, the exposure time should be minimized and protective equipment for children should be used.

Intussusception: A 14-year experience at a UK tertiary referral centre.

AIMS: Intussusception is the most common cause of acute intestinal obstruction in infants. First line management in uncomplicated cases at our centre is fluoroscopy guided air enema reduction. This study reports a 14 year UK single centre experience highlighting management and outcomes of intussusception in children. METHODS: All cases of intussusception (ICD 10-code K56.1) at a single tertiary referral centre from 2004 to 2017 were analyzed. Data evaluated included patient demographics, clinical presentation, treatment modality(s), complications and outcome(s). RESULTS: Two hundred ninety confirmed cases (69% male) of intussusception were identified during the study period. The median age at presentation was 9.5 months (range 4 days-15 years). One hundred eighty-six (64%) cases occurred in children who were transferred to Alder Hey from peripheral district hospitals. One hundred ninety-six cases (68%) proceeded directly to air enema reduction and successful reduction was achieved in 129 cases (66%). A single case (0.5%) of attempted air enema reduction was complicated by perforation. Early recurrence rate following air enema reduction was 9%. Operative management was indicated in 140 (48%) cases of which 66 required bowel resection (47%). There were no deaths. CONCLUSIONS: We highlight one of the largest single centre UK studies defining practice outcomes for intussusception across the British Isles. Our centre has achieved a 66% success rate of non-operative reduction over 14 years in line with the British Society Pediatric Radiology (BSPR) recommendations and within 5% of the national median metric (71%). Moreover these outcomes were achieved with a very low complication rate (0.5%) from air enema reduction and no mortality in the series. TYPE OF STUDY: Retrospective study. LEVEL OF EVIDENCE: III.

Emergency department discharge following successful radiologic reduction of ileocolic intussusception in children: A protocol based prospective observational study.

PURPOSE: Pediatric intussusception's first line treatment consists of fluoroscopic guided air enema reduction. Postprocedure, these patients are usually admitted overnight for observation. The purpose of our study was to document the results of emergency department (ED) observation and discharge protocol after successful reduction of ileocolic intussusception. METHODS: A prospective observational study was conducted after implementation of an ED protocol for ileocolic intussusception from 10/2014 to 7/2017 and compared these patients to a historical cohort immediately prior to protocol initiation (10/2011-9/2014). Data collected included demographics, total time in the ED and hospital, enema reduction, recurrence, and requirement for operative intervention. Results reported as means with standard deviation and medians reported with interquartile ranges (IQR). RESULTS: 115 patients were treated with the prospective protocol and were compared to a 90 patient historical cohort. Reduction was successful in 84%-89% of cases. Median hospital time after enema was shorter in the protocol group [4.8 h (4.25, 14.97) versus 19.7 h (13.9, 33.45), p < 0.01]. Only 33% of patients were admitted following the protocol; the most common admission reason was persistent abdominal discomfort. CONCLUSION: ED observation and discharge after successful air enema reduction in children with ileocolic intussusception are safe, facilitate early discharge, and reduce hospital resource utilization. LEVEL OF EVIDENCE: III.

Intussusception in children presenting to the emergency department.

A retrospective chart review of children diagnosed with intussusceptions from March 2005 to March 2007 was conducted at a tertiary care pediatric hospital. There were 152 children with 170 episodes of intussusceptions during the study period. Around one third (30%) of children diagnosed with intussusceptions had a concurrent infection. There were 114 large bowel intussusceptions, with a mean age of 27 months (SD = 25) and a success rate of 91% for air enema reductions. Bowel resection was performed in 8.8% of children with large bowel intussusceptions. Small bowel intussusceptions (n = 38) were associated with gastrostomy tubes in 42% (n = 16) of patients, and 81% needed tube shortening. The varying age range of many children diagnosed with intussusceptions and the high incidence of intercurrent illnesses and fever in our study alert health professionals to suspect intussusceptions in children presenting with abdominal pain or crying.

A Comparison of Air Reduction and Operation in Childhood Intussusception

PURPOSE: Intussusception is one of the most common cause of childhood intestinal obstructions. Early diagnosis is essential to avoid treatment delays, which can increase morbidity and mortality. METHODS: In order to evaluate the factors contributing to air-reduction failure, we reviewed cases of childhood intussusception admitted via the ER and managed by air enema reduction from 1994 to 1998. They were divided into two groups and compared retrospectively by using medical records. Group I was the operation group after air-reduction failure, and group II was the air-reduction group. RESULTS: In 319 cases (279 patients), group I consisted of 112 cases (110 patients), and group II consisted of 207 cases (169 patients). No differences in age, sex, body weight, location of intussusception, laboratory findings (leukocytosis and thrombocytosis), presence of bloody stool, and body temperature were noted between the two groups. Factors significantly contributing to air-reduction failure were duration of symptoms, type of intussusception and a few physical findings (abdominal distension, palpable mass, lethargy, and vomiting). The recurrence rate of group I was significantly lower than that of group II, and most recurrences developed in the first postoperative month. CONCLUSION: Childhood intussusceptions of a non-ileocolic type with longer durations of symptoms and severe clinical findings have a higher chance of air-reduction failure.