Operative indications in recurrent ileocolic intussusception

Operative indications in recurrent ileocolic intussusception JOURNAL OF PEDIATRIC SURGERY Fisher, J. G., Sparks, E. A., Turner, C. B., Klein, J. D., Pennington, E., Khan, F. A., Zurakowski, D., Durkin, E. T., Fauza, D. O., Modi, B. P. 2015; 50 (1): 126-130

Abstract

Air-contrast enema (ACE) is standard treatment for primary ileocolic intussusception. Management of recurrences is less clear. This study aimed to delineate appropriate therapy by quantifying the relationship between recurrence and need for bowel resection, pathologic lead points (PLP), and complication rates.After IRB approval, a single institution review of patients with ileocolic intussusception from 1997 to 2013 was performed, noting recurrences, outcomes, and complications. Fisher's exact and t-tests were used.Of 716 intussusceptions, 666 were ileocecal. Forty-four underwent bowel resection, with 29 PLPs and 9 ischemia/perforation. Recurrence after ACE occurred in 96 (14%). Recurrence did not predict PLP (P=0.25). Recurrence (=3) was associated with higher resection rate (P=0.03), but not ischemia/perforation (P=0.75). ACE-related complications occurred in 4 (0.5%) patients. Successful initial ACE had 98% negative predictive value for resection and PLP (e.g., after successful ACE, 2% had resections, 2% PLP). After failed initial ACE, 36% received resection, and 23% had PLP (P<0.001).Recurrence is associated with a greater risk of resection but not PLP or ACE-complication. Failed ACE is associated with increased risk for harboring PLP and receiving resection. ACE should be the standard treatment in recurrent intussusception, regardless of number of recurrences.

View details for DOI 10.1016/j.jpedsurg.2014.10.012

View details for Web of Science ID 000348043500026

View details for PubMedID 25598108