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CC BY-NC-ND 4.0 · Ann Natl Acad Med Sci 2021; 57(01): 53-57
DOI: 10.1055/s-0040-1722536
Original Article

Management of Intussusceptions Secondary to Pathological Lead Points in Infants and Children

Rajendra K. Ghritlaharey
1   Department of Paediatric Surgery, Gandhi Medical College and Associated Kamla Nehru and Hamidia Hospitals, Bhopal, Madhya Pradesh, India
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Abstract

Objectives This study was undertaken to investigate and review the age, sex, clinical presentation, surgical procedures done, major postoperative complications, and the final outcome of infants and children operated for intussusceptions secondary to pathological lead points (PLPs).

Materials and Methods This is a single-institution, retrospective study and included infants and children below the age of 12 years who were operated for the secondary intussusceptions. This study was conducted at author’s Department of Paediatric Surgery during the last 20 years; from January 1, 2000 to December 31, 2019.

Results During the study period, 200 infants and children were operated for the intussusceptions, and 23 (11.5%) of them were operated for the intussusceptions secondary to PLPs. This review comprised 18 (78.26%) boys and 5 (21.73%) girls, and consisted of infants (n = 9, 39.13%) and children of 1 to 5 years of age (n = 7, 30.43%) and 6 to 12 years of age (n = 7, 30.43%). The age at presentation ranged from 3 months to 10 years, with the mean age of 41.47 ± 40.06 months. Clinically, all the children presented with features of acute intestinal obstruction. Ultrasonography (USG) examination of the abdomen revealed the diagnosis of intussusception in all of them but not able to document the PLPs as a cause for it. During the exploratory laparotomies, gangrenous bowel was detected in 15 (65.21%) cases. PLPs causing intussusceptions were Meckel’s diverticulum (n = 17, 73.91%), begin ileal growth (n = 4, 17.39%), benign ileal polyp (n = 1, 4.34%), and caecal lymphoma (n = 1, 4.34%). Surgical procedures were executed in the following order of frequency: (1) resection of segment of ileum including PLP, and ileoileal anastomosis (n = 13, 56.52%); (2) resection of segment of ileum including PLP, caecum and part of ascending colon, and ileoascending anastomosis (n = 5, 21.73%); (3) Meckel’s diverticulectomy (n = 3, 13.04%); and (4) resection of segment of ileum including PLP and terminal ileostomy (n = 2, 8.69%). This study documented two (8.69%) deaths in postoperative period.

Conclusion Meckel’s’ diverticulum was the commonest pathology for the secondary intussusceptions in infants and children and documented most frequently during infancy. Half of the secondary intussusceptions occurred within 24 months of age. Bowel resection was required in more than 85% of the cases during the surgical procedures.

Keywords

children - infants - intestinal obstruction - intussusception - Meckel’s diverticulum - pathological lead points - secondary intussusception


Publication History

Article published online:
08 February 2021

© 2021. National Academy of Medical Sciences (India). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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  • References

  • 1 Columbani PM, Scholz S. Intussusception. In: Coran AG, Adzick NS, Krummel TM, Laberge, et al, eds. In: Pediatric Surgery. 7th ed. Philadelphia, PA: Elsevier Inc. 2012: 1093-1110
  • 2 Takeuchi M, Osamura T, Yasunaga H, Horiguchi H, Hashimoto H, Matsuda S. Intussusception among Japanese children: an epidemiologic study using an administrative database. BMC Pediatr 2012; 12: 36
    CrossrefPubMedGoogle Scholar
  • 3 Ekenze SO, Mgbor SO. Childhood intussusception: the implications of delayed presentation. Afr J Paediatr Surg 2011; 8 (01) 15-18
    CrossrefPubMedGoogle Scholar
  • 4 Pandey A, Singh S, Wakhlu A, Rawat J. Delayed presentation of intussusception in children-a surgical audit. Ann Pediatr Surg 2011; 7: 130-132
    CrossrefGoogle Scholar
  • 5 Carapinha C, Truter M, Bentley A, Welthagen A, Loveland J. Factors determining clinical outcomes in intussusception in the developing world: experience from Johannesburg, South Africa. S Afr Med J 2016; 106 (02) 177-180
    CrossrefPubMedGoogle Scholar
  • 6 Banapour P, Sydorak RM, Shaul D. Surgical approach to intussusception in older children: influence of lead points. J Pediatr Surg 2015; 50 (04) 647-650
    CrossrefPubMedGoogle Scholar
  • 7 Maazoun K, Mekki M, Sahnoun L. et al. [Intussusception owing to pathologic lead points in children: report of 27 cases] (in French). Arch Pediatr 2007; 14 (01) 4-9
    CrossrefPubMedGoogle Scholar
  • 8 Wong CW, Jin S, Chen J, Tam PK, Wong KK. Predictors for bowel resection and the presence of a pathological lead point for operated childhood intussusception: A multi-center study. J Pediatr Surg 2016; 51 (12) 1998-2000
    CrossrefPubMedGoogle Scholar
  • 9 Hwang S, Kim J, Jung JY. et al. The epidemiology of childhood intussusception in South Korea: an observational study. PLoS One 2019; 14 (12) e0219286
    CrossrefPubMedGoogle Scholar
  • 10 Fiegel H, Gfroerer S, Rolle U. Systematic review shows that pathological lead points are important and frequent in intussusception and are not limited to infants. Acta Paediatr 2016; 105 (11) 1275-1279
    CrossrefPubMedGoogle Scholar
  • 11 Lianos G, Xeropotamos N, Bali C, Baltoggiannis G, Ignatiadou E. Adult bowel intussusception: presentation, location, etiology, diagnosis and treatment. G Chir 2013; 34 (9,10) 280-283
    PubMedGoogle Scholar
  • 12 Lindor RA, Bellolio MF, Sadosty AT. Earnest F IV, Cabrera D. Adult intussusception: presentation, management, and outcomes of 148 patients. J Emerg Med 2012; 43 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 13 Gupta V, Doley RP, Subramanya Bharathy KG. et al. Adult intussusception in Northern India. Int J Surg 2011; 9 (04) 297-301
    CrossrefPubMedGoogle Scholar
  • 14 Flaum V, Schneider A, Gomes Ferreira C. et al. Twenty years’ experience for reduction of ileocolic intussusceptions by saline enema under sonography control. J Pediatr Surg 2016; 51 (01) 179-182
    CrossrefPubMedGoogle Scholar
  • 15 Trigylidas TE, Hegenbarth MA, Patel L, Kennedy C, O’Rourke K, Kelly JC. Pediatric emergency medicine point-of-care ultrasound for the diagnosis of intussusception. J Emerg Med 2019; 57 (03) 367-374
    CrossrefPubMedGoogle Scholar
  • 16 Zhang Y, Dong Q, Li SX. et al. Clinical and ultrasonographic features of secondary intussusception in children. Eur Radiol 2016; 26 (12) 4329-4338
    CrossrefPubMedGoogle Scholar
  • 17 Snyder CL. Meckel’s diverticulum. In: Coran AG, Adzick NS, Krummel TM, et al, eds. In: Pediatric Surgery 7th ed. Philadelphia, PA: Elsevier Inc 2012: 1085-1092
  • 18 Simon NM, Joseph J, Philip RR, Sukumaran TU, Philip R. Intussusception: Single center experience of 10 years. Indian Pediatr 2019; 56 (01) 29-32
    CrossrefPubMedGoogle Scholar
  • 19 Fahiem-Ul-Hassan M, Mufti GN, Bhat NA. et al. Management of intussusception in the era of ultrasound-guided hydrostatic reduction: a 3-year experience from a tertiary care center. J Indian Assoc Pediatr Surg 2020; 25 (02) 71-75
    CrossrefPubMedGoogle Scholar
  • 20 Thanh Xuan N, Huu Son N, Huu Thien H. Treatment outcome of acute intussusception in children under two years of age: A prospective cohort study. Cureus 2020; 12 (04) e7729
    PubMedGoogle Scholar
  • 21 Das MK, Arora NK, Gupta B. et al. Intussusception in children aged under two years in India: Retrospective surveillance at nineteen tertiary care hospitals. Vaccine 2020; 38 (43) 6849-6857
    CrossrefPubMedGoogle Scholar
  • 22 Lin XK, Huang XZ, Bao XZ, Zheng N, Xia QZ, Chen CD. Clinical characteristics of Meckel diverticulum in children: a retrospective review of a 15-year single-center experience. Medicine (Baltimore) 2017; 96 (32) e7760
    Google Scholar
  • 23 Lin XK, Xia QZ, Huang XZ, Han YJ, He GR, Zheng N. Clinical characteristics of intussusception secondary to pathologic lead points in children: a single-center experience with 65 cases. Pediatr Surg Int 2017; 33 (07) 793-797
    CrossrefPubMedGoogle Scholar
  • 24 Zhao L, Feng S, Wu P, Lai XH, Lv C, Chen G. Clinical characteristics and surgical outcome in children with intussusceptions secondary to pathologic lead points: retrospective study in a single institution. Pediatr Surg Int 2019; 35 (07) 807-811
    CrossrefPubMedGoogle Scholar
  • 25 Clark AD, Hasso-Agopsowicz M, Kraus MW. et al. Update on the global epidemiology of intussusception: a systematic review of incidence rates, age distributions and case-fatality ratios among children aged <5 years, before the introduction of rotavirus vaccination. Int J Epidemiol 2019; 48 (04) 1316-1326
    CrossrefPubMedGoogle Scholar