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Long B, Easter J, Koyfman A. High risk and low incidence diseases: Pediatric intussusception. Am J Emerg Med 2025; 91:37-45. [PMID: 39987626 DOI: 10.1016/j.ajem.2025.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Revised: 02/02/2025] [Accepted: 02/15/2025] [Indexed: 02/25/2025] Open
Abstract
INTRODUCTION Pediatric intussusception is a serious condition that carries with it a high risk of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of pediatric intussusception, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Intussusception is one of the most common pediatric abdominal emergencies. This is associated with one part of the intestine telescoping into another, resulting in bowel edema. If the intussusception remains untreated, obstruction, ischemia, necrosis, and perforation may result. Most cases are idiopathic, with 10-25 % associated with a pathologic mass or lead point. The most common age group affected includes those between 3 months to 5 years. The triad of intermittent abdominal pain, currant jelly stool, and sausage-shaped mass is uncommon, though most patients will present with intermittent abdominal pain. Nonbilious emesis and bloody stools (gross blood or guaiac positive) are also common. Younger patients can present atypically, including altered mental status or lethargy. Thus, intussusception should be considered in pediatric patients with abdominal pain, emesis, and a sausage-shaped mass, as well as those with atypical presentations such as altered mental status or lethargy if there is no other etiology found on testing. The diagnostic modality of choice is ultrasound. Plain radiography may assist in evaluating for obstruction and perforation. Treatment includes prompt reduction of the intussusception. In patients who are stable and have no evidence of perforation, non-operative reduction with hydrostatic or pneumatic reduction should be attempted. Operative intervention is necessary in those who are unstable, peritonitic, or have a focal lead point. Discharge may be appropriate for patients following successful non-operative reduction if the patient is able to tolerate clear fluids, is asymptomatic, and can return for any recurrence of symptoms. CONCLUSION An understanding of pediatric intussusception and its many potential mimics can assist emergency clinicians in diagnosing and managing this high risk disease.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Joshua Easter
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
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Anzà D, Esposito M, Bertolazzi G, Fallucca A, Genovese C, Maniscalco G, Praticò AD, Scarpaci T, Vitale E, Restivo V. Determinants of Rotavirus Vaccine Acceptance in an Area of Southern Italy with Low Vaccination Coverage: A Case-Control Study by the Health Belief Model Questionnaire. Vaccines (Basel) 2025; 13:63. [PMID: 39852842 PMCID: PMC11769460 DOI: 10.3390/vaccines13010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Revised: 01/03/2025] [Accepted: 01/08/2025] [Indexed: 01/26/2025] Open
Abstract
BACKGROUND/OBJECTIVES Rotavirus (RV) is the primary cause of gastroenteritis in children worldwide, contributing significantly to morbidity and mortality, particularly among children under five years of age. The introduction of Rotavirus vaccines (RVV) has markedly reduced RV-related childhood deaths, especially in Europe, where substantial reductions in hospitalizations and disease prevalence have been observed. Despite these advances, RVV uptake in Italy remains below the desired targets, with notable regional disparities. In Sicily, vaccination rates have fluctuated, with current coverage failing to meet national goals. Safety concerns and insufficient parental awareness are major barriers to RVV acceptance. METHODS This case-control study was conducted in Southern Italy to identify factors influencing parental acceptance of RVV. Data were collected from parents using a structured questionnaire that assessed socio-demographic factors, vaccine knowledge, and attitudes based on the Health Belief Model (HBM). RESULTS Overall, 226 parents were enrolled. Higher perceived benefit of RVV was significantly associated with increased vaccine adherence (Odds Ratio = 13.65; 95% Confidence Interval = 6.88-27.09; p < 0.001). CONCLUSIONS These results highlight the need for targeted interventions to improve vaccine coverage and address regional and socio-economic barriers to RVV acceptance. Furthermore, tailored educational campaigns and univocal information from healthcare providers could play pivotal roles in achieving higher vaccine uptake.
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Affiliation(s)
- Davide Anzà
- Department of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy; (D.A.); (M.E.); (G.B.); (C.G.); (A.D.P.); (E.V.)
| | - Massimiliano Esposito
- Department of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy; (D.A.); (M.E.); (G.B.); (C.G.); (A.D.P.); (E.V.)
| | - Giorgio Bertolazzi
- Department of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy; (D.A.); (M.E.); (G.B.); (C.G.); (A.D.P.); (E.V.)
| | - Alessandra Fallucca
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (A.F.); (G.M.); (T.S.)
| | - Carlo Genovese
- Department of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy; (D.A.); (M.E.); (G.B.); (C.G.); (A.D.P.); (E.V.)
| | - Gabriele Maniscalco
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (A.F.); (G.M.); (T.S.)
| | - Andrea D. Praticò
- Department of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy; (D.A.); (M.E.); (G.B.); (C.G.); (A.D.P.); (E.V.)
| | - Tiziana Scarpaci
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (A.F.); (G.M.); (T.S.)
| | - Ermanno Vitale
- Department of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy; (D.A.); (M.E.); (G.B.); (C.G.); (A.D.P.); (E.V.)
| | - Vincenzo Restivo
- Department of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy; (D.A.); (M.E.); (G.B.); (C.G.); (A.D.P.); (E.V.)
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Fiagbedzi E, Arkorful J, Appiah E, Otumi N, Ofori I, Gorleku PN. A rare case of intusscusception in a 6-month-old baby. Radiol Case Rep 2024; 19:4451-4456. [PMID: 39165315 PMCID: PMC11334847 DOI: 10.1016/j.radcr.2024.06.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 06/17/2024] [Accepted: 06/30/2024] [Indexed: 08/22/2024] Open
Abstract
This case report discusses the clinical presentation, imaging findings, and successful management of a rare case of intussusception in a 6-month-old female infant referred to a regional hospital in Ghana. The patient presented with vomiting, lethargy, fever, and currant jelly stool. Differential diagnoses considered included Merkel diverticulum, volvulus, lymphadenopathy, and hypertrophic pyloric stenosis. Ultrasound imaging revealed a concentric lesion with characteristic signs of intussusception. Ileo-caeco coli intussusception was confirmed as the diagnosis. Surgical management was used for this patient. The postsurgery phase was without any complications. The patient recovered well and was discharged with a switch to oral medications. Infant intussusception is still a disease with a low morbidity rate.
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Affiliation(s)
- Emmanuel Fiagbedzi
- University of Ghana, Department of Medical Physics, Accra, Ghana
- University of Cape Coast, College of Health and Allied Sciences, Department of Medical Imaging Technology and Sonography, Cape Coast, Ghana
| | - Joseph Arkorful
- University of Cape Coast, College of Health and Allied Sciences, Department of Medical Imaging Technology and Sonography, Cape Coast, Ghana
| | - Emmanuel Appiah
- University of Cape Coast, College of Health and Allied Sciences, Department of Medical Imaging Technology and Sonography, Cape Coast, Ghana
| | - Nicholas Otumi
- University of Cape Coast, College of Health and Allied Sciences, Department of Medical Imaging Technology and Sonography, Cape Coast, Ghana
| | - Ishmael Ofori
- University of Cape Coast, College of Health and Allied Sciences, Department of Medical Imaging Technology and Sonography, Cape Coast, Ghana
| | - Philip Nii Gorleku
- University of Cape Coast, College of Health and Allied Sciences, Department of Medical Imaging Technology and Sonography, Cape Coast, Ghana
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Salahoudine I, Othmane A, Abdelhalim M, Khalid K, Youssef B. Predictive Factors for Bowel Resection in Childhood Intussusception. Afr J Paediatr Surg 2024; 21:254-256. [PMID: 39279618 PMCID: PMC11493225 DOI: 10.4103/ajps.ajps_42_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/10/2023] [Indexed: 09/18/2024] Open
Abstract
BACKGROUND Intestinal intussusception is the most common cause of intestinal obstruction in infants and children under 3 years of age. Any delay in diagnosis or management can lead to intestinal ischaemia and perforation. The aim of this study is to determine the sociodemographic and clinical risk factors associated with bowel resection in infants and children with intussusception. MATERIALS AND METHODS This is a retrospective analytical study of 118 patients operated at the Hassan II Hospital and University of Fez between 1 January 2008 and 1 January 2018. A comparison of risk factors between patients with and without bowel resection was performed using multivariate logistic regression. RESULTS One hundred and eighteen patients met the inclusion criteria. Of these, 44% had undergone bowel resection. Age >2 years (P = 0.006), duration of symptoms progression of more than 2 days (P = 0.002), bilious vomiting (P = 0.04) and palpation of an abdominal mass (P = 0.01) were significantly associated with bowel resection. Multivariate logistic regression showed that age <2 years (odds ratio [OR] =4.47 95% confidence interval [CI]: 1.12-17.78) and duration of symptom progression of more than 2 days (OR = 2.62 95% CI: 1.12-6.11) were independent risk factors for bowel resection. CONCLUSION Intussusception that occurs in child old than 2 years of age, or which has progressed for more than 2 days, is associated with an increased risk of intestinal resection.
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Affiliation(s)
- Idrissa Salahoudine
- Department of Pediatric Surgery, University Hospital of Hassan II, Fez, Morocco
| | - Alaoui Othmane
- Department of Pediatric Surgery, University Hospital of Hassan II, Fez, Morocco
- University of Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Mahmoudi Abdelhalim
- Department of Pediatric Surgery, University Hospital of Hassan II, Fez, Morocco
- University of Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Khattala Khalid
- Department of Pediatric Surgery, University Hospital of Hassan II, Fez, Morocco
- University of Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Bouabballah Youssef
- Department of Pediatric Surgery, University Hospital of Hassan II, Fez, Morocco
- University of Sidi Mohamed Ben Abdellah, Fez, Morocco
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Delgado-Miguel C, García A, Delgado B, Muñoz-Serrano AJ, Miguel-Ferrero M, Barrena S, López-Santamaría M, Martínez L. Intussusception Management in Children: A 15-Year Experience in a Referral Center. Indian J Pediatr 2023; 90:1198-1203. [PMID: 35821554 DOI: 10.1007/s12098-022-04248-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 02/26/2022] [Accepted: 04/05/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To report a 15-y, single-center experience in the management and outcomes of ileocolic intussusception (ICI) episodes. METHODS A retrospective study was performed in patients with ICI episodes, who were treated at a single quaternary referral center from 2005 to 2019. Data evaluated included patient demographics, clinical presentation, treatment modalities, hospital stay, complications, and outcomes. RESULTS A total of 546 ICI episodes (66.1% males) were included, with a median age at diagnosis of 15 mo. Enema reduction was performed in 478 patients (87.6%), with an overall success rate of 85.8%. Hydrostatic saline enema was the most effective method (89.3%) when compared to pneumatic (80.6%) or barium enema (79.8%), this difference being statistically significant (p = 0.031). No associated complications were observed during nonoperative reduction. Surgical treatment was performed in 101 patients, in whom 36 bowel resections were performed. Postoperative complications were reported in 6 patients (5.9%). Hospital stay was significantly longer in patients with operative management (median 5 d vs. 1 d; p < 0.001). CONCLUSIONS Nonoperative management has a high overall success rate and low complication and recurrence rates. Saline enema reduction presents the highest effectiveness, and should be considered the first-line treatment.
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Affiliation(s)
- Carlos Delgado-Miguel
- Department of Pediatric Surgery, La Paz Children's Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain.
| | - Antonella García
- School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Bonifacio Delgado
- Department of Mathematics, Complutense University of Madrid, Madrid, Spain
| | - Antonio J Muñoz-Serrano
- Department of Pediatric Surgery, La Paz Children's Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Miriam Miguel-Ferrero
- Department of Pediatric Surgery, La Paz Children's Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Saturnino Barrena
- Department of Pediatric Surgery, La Paz Children's Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Manuel López-Santamaría
- Department of Pediatric Surgery, La Paz Children's Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Leopoldo Martínez
- Department of Pediatric Surgery, La Paz Children's Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
- Institute for Biomedical Resarch La Paz (IdiPaz), Network for Maternal and Children Health (SAMID), La Paz Children's Hospital, Madrid, Spain
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Rukwong P, Wangviwat N, Phewplung T, Sintusek P. Cohort analysis of pediatric intussusception score to diagnose intussusception. World J Clin Cases 2023; 11:5014-5022. [PMID: 37583866 PMCID: PMC10424024 DOI: 10.12998/wjcc.v11.i21.5014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Intussusception is a primary cause of intestinal obstruction in young children. Delayed diagnosis is associated with increased morbidity. Ultrasonography (USG) is the gold standard for diagnosis, but it is operator dependent and often unavailable in limited resource areas. AIM To study the clinical characteristics of intussusception including management and evaluation of the diagnostic accuracy of abdominal radiography (AR) and the promising parameters found in the pediatric intussusception score (PIS). METHODS Children with suspected intussusception in our center from 2006 to 2018 were recruited. Clinical manifestations, investigations, and treatment outcomes were recorded. AR images were interpreted by a pediatric radiologist. Diagnosis of intussusception was composed of compatible USG and response with reduction. The diagnostic value of the proposed PIS was evaluated. RESULTS Ninety-seven children were diagnosed with intussusception (2.06 ± 2.67 years, 62.9% male), of whom 74% were < 2 years old and 37.1% were referrals. The common manifestations of intussusception were irritability or abdominal pain (86.7%) and vomiting (59.2%). Children aged 6 mo to 2 years, pallor, palpable abdominal mass, and positive AR were the parameters that could discriminate intussusception from other mimics (P < 0.05). Referral case was the only significant parameter for failure to reduce intussusception (P < 0.05). AR to diagnose intussusception had a sensitivity of 59.2%. The proposed PIS, a combination of clinical irritability or abdominal pain, children aged 6 mo to 2 years, and compatible AR, had a sensitivity of 85.7%. CONCLUSION AR alone provides poor screening for intussusception. The proposed PIS in combination with common manifestations and AR data was shown to increase the diagnostic sensitivity, leading to timely clinical management.
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Affiliation(s)
- Punwadee Rukwong
- Department of Pediatrics, Phrapokklao Hospital, Chantaburi 22000, Meuang, Thailand
| | - Nathawit Wangviwat
- Division of Laboratory Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Teerasak Phewplung
- Department of Radiology, Chulalongkorn University, Bangkok 10330, Thailand
| | - Palittiya Sintusek
- Thai Pediatric Gastroenterology, Hepatology and Immunology Research Unit, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand
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Suleiman JM, Msuya D, Tarmohamed M, Lodhia J. Prolapsed ileocolic intussusception in an infant: An uncommon presentation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.102028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Caro-Domínguez P, Hernández-Herrera C, Le Cacheux-Morales C, Sánchez-Tatay V, Merchante-García E, Vizcaíno R, Fernández-Pineda I. Ileocolic intussusception: Ultrasound-guided hydrostatic reduction with sedation and analgesia. RADIOLOGIA 2021; 63:406-414. [PMID: 34625196 DOI: 10.1016/j.rxeng.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The first-choice treatment for ileocolic intussusception is imaging-guided reduction with water, air, or barium. The objectives of the current study were to evaluate the efficacy and safety of ultrasound-guided reduction of intussusception using water in patients under sedation and analgesia. We compare this approach with our previous experience in reduction using barium under fluoroscopic guidance without sedation and analgesia and investigate what factors predispose to surgical correction. MATERIAL AND METHODS We retrospectively reviewed cases of children with ileocolic intussusception treated in a third-level pediatric hospital during a 52-month period: during the first 24 months, reduction was done using barium and fluoroscopy without sedoanalgesia, and during the following 28 months, reduction was done using water and ultrasound with sedoanalgesia. A pediatric radiologist and a pediatrician reviewed the clinical history, surgical records, and imaging studies. RESULTS In the 52-month period, 59 children (41 boys and 18 girls; mean age, 16.0 months) were diagnosed with ileocolic intussusception at our hospital. A total of 33 reductions (28 patients and 5 recurrences) were done using barium under fluoroscopic guidance, achieving a 61% success rate. A total of 38 reductions (31 patients and 7 recurrences) were done using water under ultrasound guidance with patients sedated, achieving a success rate of 76%. No significant adverse effects were observed in patients undergoing ultrasound-guided hydrostatic reduction under sedation, and the success rate in this group was higher (p = 0.20). The factors that predisposed to surgical reduction were greater length of the intussusception (p = 0.03), location in areas other than the right colon (p = 0.002), and a greater length of time between symptom onset and imaging tests (p = 0.08). CONCLUSION Ultrasound-guided hydrostatic reduction of ileocolic intussusception under sedoanalgesia is efficacious and safe.
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Affiliation(s)
- P Caro-Domínguez
- Unidad de Radiología Pediátrica, Departamento de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - C Hernández-Herrera
- Unidad de Radiología Pediátrica, Departamento de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - C Le Cacheux-Morales
- Unidad de Radiología Pediátrica, Departamento de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - V Sánchez-Tatay
- Servicio de Urgencias Pediátricas, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - E Merchante-García
- Unidad de Radiología Pediátrica, Departamento de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - R Vizcaíno
- Departamento de Cirugía Pediátrica, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - I Fernández-Pineda
- Departamento de Cirugía Pediátrica, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Abstract
PURPOSE We assessed management and outcomes for intussusception at nine academic hospitals in South Africa. METHODS Patients ≤ 3 years presenting with intussusception between September 2013 and December 2017 were prospectively enrolled at all sites. Additionally, patients presenting between July 2012 and August 2013 were retrospectively enrolled at one site. Demographics, clinical information, diagnostic modality, reduction methods, surgical intervention and outcomes were reviewed. RESULTS Four hundred seventy-six patients were enrolled, [54% males, median age 6.5 months (IQR 2.6-32.6)]. Vomiting (92%), bloody stool (91%), abdominal mass (57%), fever (32%) and a rectal mass (29%) represented advanced disease: median symptom duration was 3 days (IQR 1-4). Initial reduction attempts included pneumatic reduction (66%) and upfront surgery (32%). The overall non-surgical reduction rate was 28% and enema perforation rate was 4%. Surgery occurred in 334 (70%), 68 (20%) patients had perforated bowel, bowel resection was required in 61%. Complications included recurrence (2%) and nosocomial sepsis (4%). Length of stay (LOS) was significantly longer in patients who developed complications. Six patients died-a mortality rate of 1%. There was a significant difference in reduction rates, upfront surgery, bowel resection, LOS and mortality between centres with shorter symptom duration compared longer symptom duration. CONCLUSION Delayed presentation was common and associated with low success for enema reduction, higher operative rates, higher rates of bowel resection and increased LOS. Improved primary health-care worker education and streamlining referral pathways might facilitate timely management.
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Caro-Domínguez P, Hernández-Hernández C, Le Cacheux C, Sánchez-Tatay V, Merchante E, Vizcaíno R, Fernández I. Invaginación ileocólica: reducción hidrostática ecoguiada con sedoanalgesia. RADIOLOGIA 2021. [DOI: 10.1016/j.rx.2020.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tang XB, Hu DY, Mu XQ, Bai YZ. Association of air temperature with pediatric intussusception in northeastern China: A 10-year retrospective study. Am J Emerg Med 2020; 42:211-216. [PMID: 33191045 DOI: 10.1016/j.ajem.2020.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/22/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine whether an association existed between intussusception and air temperature. METHODS A retrospective study was performed between March 2006 and February 2016 to determine the relationship between pediatric primary intussusception (PPI) and air temperature. Information from hospital records of 5922 cases of PPI and Mean daily temperatures of Shenyang were obtained. Pearson correlation analysis was used to examine the association between monthly PPI cases and monthly mean temperature. Factorial analysis-of-variance was used to examine differences in the numbers of seasonal PPI cases during different seasons. RESULTS Monthly PPI cases fluctuated throughout the year, with a peak in June, and a trough in February. Pearson correlation analysis showed that monthly PPI cases was associated with the monthly mean temperature (p < 0.01). Factorial analysis-of-variance showed there was significant difference in the numbers of seasonal PPI cases during different seasons. Multiple comparison showed a significant difference in seasonal PPI cases between spring and summer, spring and winter, summer and autumn, summer and winter, autumn and winter (p < 0.01). CONCLUSIONS Monthly PPI cases were positively associated with monthly mean temperature in Shenyang. The incidence of intussusception shows a seasonal trend, with a peak in summer (May to July).
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Affiliation(s)
- Xiao Bing Tang
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Dong Yan Hu
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xian Qing Mu
- Department of Pediatric Surgery, Shenyang Children's Hospital, Shenyang, Liaoning, China
| | - Yu Zuo Bai
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
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Abstract
OBJECTIVE. Intussusception is the most common cause of intestinal obstruction in young children. Radiology has a key role in its diagnosis and treatment. This systematic review summarizes the currently available evidence for best practices in radiologic management of pediatric intussusception. CONCLUSION. High diagnostic accuracy and lack of ionizing radiation make ultrasound (US) the preferred imaging modality for diagnosing intussusception. For intussusception reduction, fluoroscopy-guided pneumatic enema and US-guided hydrostatic enema are equally dependable and safe techniques. The areas that warrant further research in this field include the efficacy and safety of the US-guided pneumatic enema, potential benefits of sedation and general anesthesia for the reduction procedure, and the optimal management of intussusceptions potentially involving pathologic lead points.
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Lee EH, Yang HR. Nationwide Population-Based Epidemiologic Study on Childhood Intussusception in South Korea: Emphasis on Treatment and Outcomes. Pediatr Gastroenterol Hepatol Nutr 2020; 23:329-345. [PMID: 32704494 PMCID: PMC7354872 DOI: 10.5223/pghn.2020.23.4.329] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/08/2020] [Accepted: 03/06/2020] [Indexed: 01/07/2023] Open
Abstract
PURPOSE This was a nationwide population-based study conducted to investigate the epidemiology, treatment, disease outcomes, and associated factors of childhood intussusception in South Korea. METHODS Data from the Korean National Health Insurance Service database on all patients <18 years old diagnosed with intussusception from 2007 to 2017 were analyzed. RESULTS A total of 34,688 cases were identified among 30,444 patients. The overall incidence was 28.3/100,000 person-years with a male predominance. Most cases (83.1%) occurred in children <3 years old, with an annual incidence of 195.2, 200.1, and 118.6 cases per 100,000 children in their first, second, and third year of life, respectively. The median age at the first occurrence was 18.7 months, and it was higher in boys than in girls. The post-discharge recurrence rate was 10.6% (3,226/30,444) and the in-hospital recurrence rate was 6.1% (1,842/30,444). The total recurrence rate (post-discharge recurrence and/or in-hospital recurrence) was 15.0% (4,580/30,444). Enema reduction was successful in 90.0% of cases. Enema reduction was more successful in girls than in boys. A total of 3,296 (10.8%) patients underwent 3,481 surgeries, including 735 (21.1%) laparoscopic surgeries. Post-discharge recurrence and surgery were significantly affected by age, sex, and hospital type. Mortality was noted in nine cases (0.03%). CONCLUSION Our study provides accurate epidemiologic data on the treatment and outcomes of intussusception through complete enumeration during an 11-year-period.
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Affiliation(s)
- Eun Hye Lee
- Department of Pediatrics, Nowon Eulji Medical Center, Seoul, Korea.,Department of Pediatrics, Eulji University School of Medicine, Daejeon, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Esteghamati A, Joulani M, Sayyahfar S, Salahi S, Babaie M, Shamshiri AR, Fahimzad A. Incidence of intussusception in children less than five years of age: a pre-rotavirus vaccine survey from Iran, 2010-2015. Med J Islam Repub Iran 2020; 34:40. [PMID: 32617279 PMCID: PMC7320972 DOI: 10.34171/mjiri.34.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Indexed: 11/05/2022] Open
Abstract
Background: The aim of this study was to determine the baseline statistics of intussusception in the under-five- year age group in Iran to facilitate the monitoring of potential side effects after administration of rotavirus vaccine. Methods: This hospital-based historical cohort study reviewed children under 60 months of age with the final diagnosis of intussusception, ICD-10 code K56.1, using census in all hospitals of Tehran, Iran from March 2010-2015. Demographic (sex, age, hospital stay duration), clinical manifestations (such as currant jelly stool, abdominal pain, vomiting, and fever),diagnostic and treatment methods (contrast enema, ultrasonography, laparotomy, and laparoscopy), and outcome data of patients aged less than 5 years with the diagnosis of intussusception were collected and analyzed using SPSS Version 16.0 (SPSS Inc., Chicago, IL, USA) Results: In this study, 759 patients were diagnosed with intussusception; 309 (40.7%) cases were less than 12 months old. The annual incidence of intussusception was 66.54 cases per 100.000 in children less than one-year-old and 31.61 cases per 100.000 in children less than five years old. The most common symptoms and signs were abdominal pain/irritability (94.2%) and tenderness (24.2%), respectively. The diagnostic method was ultrasound in 75.9% of cases. The most frequent anatomic location was the ileocolic region (87.87%) and the most common treatment method was barium enema. Conclusion: This research has provided a baseline statistic for childhood intussusception in Tehran prior to the administration of the rotavirus vaccine to provide a better comparison with post-introduction data.
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Affiliation(s)
- Abdoulreza Esteghamati
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadamin Joulani
- Student Research Committee (SRC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shirin Sayyahfar
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Sarvenaz Salahi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahla Babaie
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Shamshiri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Fahimzad
- Pediatric Infections Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Oberle D, Hoffelner M, Pavel J, Mentzer D, Barth I, Drechsel-Bäuerle U, Keller-Stanislawski B. Retrospective multicenter matched case-control study on the risk factors for intussusception in infants less than 1 year of age with a special focus on rotavirus vaccines - the German Intussusception Study. Hum Vaccin Immunother 2020; 16:2481-2494. [PMID: 32271647 PMCID: PMC7644239 DOI: 10.1080/21645515.2020.1726679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Studies associate rotavirus vaccination with intussusception. In Germany, a retrospective multicenter matched case-control study was performed to identify risk factors for intussusception with a special focus on rotavirus vaccines. Children with place of birth and residence in Germany who had been treated for intussusception from 2010 to 2014 and who had been less than 1 year old at the time of intussusception were recruited. Case report forms were independently validated by two pediatricians according to the criteria of intussusception defined by the Brighton Collaboration (BC). Cases with the highest diagnostic certainty (level 1) were matched with population-based controls by age, gender, federal state, and place of residence. Information on vaccine exposures originated from vaccination certificates. One hundred and sixteen cases were matched with 272 controls. A significantly increased adjusted odds ratio (aOR) for intussusception (5.74, 95% CI: 1.51-21.79) was detected in individuals immunized with rotavirus vaccine dose 1 prior to symptom onset as compared to non-exposed individuals. Age at the start of the rotavirus immunization series did not modify the risk of intussusception. The odds for intussusception were not increased postdose 2 and 3 as well as any dose. One further risk factor for intussusception, family history of intussusception (aOR 3.26, 95% CI 1.09 - 9.77) was identified. Breastfeeding was found to have a protective effect (aOR 0.54, 95% CI 0.33 - 0.88). Rotavirus vaccine dose 1 was associated with a 5.7-fold increased risk to develop intussusception regardless of age at immunization whereas the overall risk for intussusception in the first year of life was not increased.
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Affiliation(s)
- Doris Oberle
- Department Safety of Drugs and Medical Devices, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines , Langen, Germany
| | - Marcus Hoffelner
- Department Safety of Drugs and Medical Devices, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines , Langen, Germany
| | - Jutta Pavel
- Department Safety of Drugs and Medical Devices, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines , Langen, Germany
| | - Dirk Mentzer
- Department Safety of Drugs and Medical Devices, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines , Langen, Germany
| | - Immanuel Barth
- Department Safety of Drugs and Medical Devices, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines , Langen, Germany
| | - Ursula Drechsel-Bäuerle
- Department Safety of Drugs and Medical Devices, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines , Langen, Germany
| | - Brigitte Keller-Stanislawski
- Department Safety of Drugs and Medical Devices, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines , Langen, Germany
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Hwang S, Kim J, Jung JY, Ham EM, Park JW, Kwon H, Kim DK, Kwak YH. The epidemiology of childhood intussusception in South Korea: An observational study. PLoS One 2019; 14:e0219286. [PMID: 31860649 PMCID: PMC6924652 DOI: 10.1371/journal.pone.0219286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 06/20/2019] [Indexed: 11/19/2022] Open
Abstract
Intussusception is one of the most common causes of intestinal obstruction in young children. We report a retrospective, observational study of the epidemiology of intussusception in South Korea using the National Health Insurance Service-National Sample Cohort (NHIS-NSC). A cohort of newborns born between 2002 and 2008 was selected. The primary objective was to assess the incidence of intussusception in the pediatric population of Korea. The secondary objectives were to describe the basic epidemiological characteristics of intussusception and to identify risk factors. A total of 362 children were identified. The highest incidence of intussusception (2.6 per 1,000) was observed in children aged 1-2 years. A total of 58.8% of the children were male, and there was no significant difference in incidence according to the birth year (P = 0.804). Most of the children diagnosed with intussusception underwent air reduction, while only 0.6% had surgery. In all, 82.3% of the children were admitted to the hospital, 0.8% of them had to be admitted to the ICU, and the 6-month mortality was only 0.3%. In this retrospective, observational study, the incidence of intussusception was highest among children between 1 and 2 years of age. Most of the children underwent air reduction.
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Affiliation(s)
- Soyun Hwang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnan-si, Gyeonggi-do, Republic of Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- * E-mail:
| | - Eun Mi Ham
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnan-si, Gyeonggi-do, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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18
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Fotso Kamdem A, Vidal C, Pazart L, Leroux F, Pugin A, Savet C, Sainte-Claire Deville G, Guillemot D, Massol J. A case-control study of risk factors for intussusception among infants in eastern France after the introduction of the rotavirus vaccine. Vaccine 2019; 37:4587-4593. [PMID: 30851968 DOI: 10.1016/j.vaccine.2019.02.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 01/31/2019] [Accepted: 02/14/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of the present study was to investigate the risk factors for intussusception (IS) among infants, including vaccination against rotavirus. METHODS Case-control study with systematic inclusion of all infants aged <1 year with suspected IS admitted to emergency departments in the eastern region of France between 1 April 2008 and 31 March 2012. All cases classed level 1 according to the Brighton classification were matched to 4 hospital controls. Two exposure windows were examined; exposure to the first dose of rotavirus vaccine in the 7 and in the 14 days prior to the occurrence of IS. RESULTS A total of 115 cases were matched with 457 controls. The average vaccination coverage rate over the 4 years of study was 8.6%. Rotavirus vaccine was not found to be significantly associated with the occurrence of IS in the 7 days (odds ratio (OR) not calculated; p = 0.99) and in the 14 days after administration of one dose vaccine (OR 1.33, 95% confidence interval (CI) 0.14-12.82). Infant formula alone or combined with breastfeeding was associated with an excess risk of IS (OR 2.74, 95% CI 1.10-6.79). A history of gastroenteritis within 2 weeks prior to hospitalisation was also associated with an increased risk (OR 2.24, 95% CI 1.07-4.67). CONCLUSION Our study indicates that infant formula alone or combined with breastfeeding is a risk factor for IS. A small, non-significant increase in the risk of IS was observed after rotavirus vaccination, although the low vaccine coverage rate likely precluded detection of a significant increase in risk.
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Affiliation(s)
- Arnaud Fotso Kamdem
- Department of Pediatric Surgery, Besançon University Hospital, F-25000 Besançon, France.
| | - Chrystelle Vidal
- INSERM-CIC-1431, Besançon University Hospital, F-25000 Besançon, France.
| | - Lionel Pazart
- INSERM-CIC-1431, Besançon University Hospital, F-25000 Besançon, France.
| | - Franck Leroux
- INSERM-CIC-1431, Besançon University Hospital, F-25000 Besançon, France.
| | - Aurore Pugin
- INSERM-CIC-1431, Besançon University Hospital, F-25000 Besançon, France.
| | - Caroline Savet
- Phisquare Institute, Transplantation Foundation, F-75015 Paris, France.
| | | | - Didier Guillemot
- INSERM UMR 1181 « Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases » (B2PHI), F-75015 Paris, France; Institut Pasteur, UMR 1181, B2PHI, F-75015 Paris, France; University of Versailles St Quentin, UMR 1181, B2PHI, F-78180 Montigny-le-Bretonneux, France; AP-HP, Raymond Poincare Hospital, F-92380 Garches, France.
| | - Jacques Massol
- Phisquare Institute, Transplantation Foundation, F-75015 Paris, France.
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Restivo V, Costantino C, Giorgianni G, Cuccia M, Tramuto F, Corsello G, Casuccio A, Vitale F. Case–control study on intestinal intussusception: implications for anti-rotavirus vaccination. Expert Rev Vaccines 2018; 17:1135-1141. [DOI: 10.1080/14760584.2018.1546122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Vincenzo Restivo
- Department of Science for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Claudio Costantino
- Department of Science for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Gabriele Giorgianni
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Mario Cuccia
- Infection Diseases Epidemiology and Prevention Section, Catania Local Health Unit, Catania, Italy
| | - Fabio Tramuto
- Department of Science for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Giovanni Corsello
- Department of Science for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Alessandra Casuccio
- Department of Science for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Francesco Vitale
- Department of Science for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
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Ultrasound Guided Reduction of Intussusception with Saline and Evaluating the Factors Affecting the Success of the Procedure. IRANIAN JOURNAL OF PEDIATRICS 2018. [DOI: 10.5812/ijp.62442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Liu N, Yen C, Huang T, Cui P, Tate JE, Jiang B, Parashar UD, Duan ZJ. Incidence and epidemiology of intussusception among children under 2 years of age in Chenzhou and Kaifeng, China, 2009-2013. Vaccine 2018; 36:7862-7867. [PMID: 29439864 DOI: 10.1016/j.vaccine.2018.02.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 12/25/2017] [Accepted: 02/05/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION In China, rotavirus is the leading cause of diarrhea hospitalizations among children aged <5 years. A locally manufactured rotavirus vaccine is available for private market use, but little is known about its coverage. Given the impending availability of newer rotavirus vaccines, we evaluated intussusception rates among children aged <2 years to better understand intussusception epidemiology for future vaccine safety monitoring. METHODS We conducted a retrospective review at 4 hospitals in Chenzhou City of Hunan Province and Kaifeng City of Henan Province. We identified intussusception cases admitted during 2009-2013 by reviewing medical records with the ICD-10 discharge code for intussusception and extracting demographic and clinical information from the electronic clinical record systems. RESULTS During 2009-2013, 1715 intussusception hospitalizations among 1,487,215 children aged <2 years occurred in both cities. The average annual intussusception hospitalization incidence was 112.9 per 100,000 children aged <2 years (181.8 per 100,000 children <1 year; 56 per 100,000 children 1 to <2 years). Intussusception incidence was low among infants aged <3 months and peaked at age 6-8 months. No clear seasonality was observed. Ultrasound was used to diagnose 95.9% of cases. Enema reduction was performed in 80% cases; 25% of cases in Chenzhou and 16% in Kaifeng required surgical intervention. No deaths were reported. The median time between symptom onset and admission was 1 day. CONCLUSIONS This study provides information on intussusception incidence and epidemiology in two cities of China during 2009-2013. Monitoring intussusception rates in this population will be important in the post-rotavirus vaccine era.
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Affiliation(s)
- Na Liu
- Department of Viral Diarrhea, Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Catherine Yen
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tao Huang
- Department of Viral Diarrhea, Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Pengwei Cui
- Department of Viral Diarrhea, Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jacqueline E Tate
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Baoming Jiang
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Umesh D Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zhao-Jun Duan
- Department of Viral Diarrhea, Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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22
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Gadroen K, Kemmeren JM, Bruijning-Verhagen PC, Straus SM, Weibel D, de Melker HE, Sturkenboom MC. Baseline incidence of intussusception in early childhood before rotavirus vaccine introduction, the Netherlands, January 2008 to December 2012. ACTA ACUST UNITED AC 2017; 22:30556. [PMID: 28662763 PMCID: PMC5490455 DOI: 10.2807/1560-7917.es.2017.22.25.30556] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 11/17/2016] [Indexed: 11/20/2022]
Abstract
Intussusception is a rare, potentially life-threatening condition in early childhood. It gained attention due to an unexpected association with the first rotavirus vaccine, RotaShield, which was subsequently withdrawn from the market. Across Europe, broad variations in intussusception incidence rates have been reported. This study provides a first estimate of intussusception incidence in young children in the Netherlands from 1 January 2008 to 31 December 2012, which could be used for future rotavirus safety monitoring. Our estimates are based on two different sources: electronic medical records from the primary healthcare database (IPCI), as well as administrative data from the Dutch hospital register (LBZ). The results from our study indicate a low rate of intussusception. Overall incidence rate in children < 36 months of age was 21.2 per 100,000 person-years (95% confidence interval (CI): 12.5–34.3) based on primary healthcare data and 22.6 per 100,000 person-years (95% CI: 20.9–24.4) based on hospital administrative data. The estimates suggest the upper and lower bound of the expected number of cases.
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Affiliation(s)
- Kartini Gadroen
- Department of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands.,Medicines Evaluation Board (CBG-MEB), Utrecht, the Netherlands
| | - Jeanet M Kemmeren
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Patricia Cj Bruijning-Verhagen
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sabine Mjm Straus
- Department of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands.,Medicines Evaluation Board (CBG-MEB), Utrecht, the Netherlands
| | - Daniel Weibel
- Department of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands
| | - Hester E de Melker
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Kaplan SL, Magill D, Felice MA, Edgar JC, Anupindi SA, Zhu X. Intussusception reduction: Effect of air vs. liquid enema on radiation dose. Pediatr Radiol 2017; 47:1471-1476. [PMID: 28578475 DOI: 10.1007/s00247-017-3902-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/10/2017] [Accepted: 05/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Both air and radiopaque liquid contrast are used to reduce ileocolic intussusception under fluoroscopy. Some suggest air lowers radiation dose due to shorter procedure times. However, air enema likely lowers radiation dose regardless of fluoroscopy time due to less density over the automatic exposure control cells. OBJECTIVES We test the hypothesis that air enema reduction of ileocolic intussusception results in lower radiation dose than liquid contrast enema independent of fluoroscopy time. We describe a role for automatic exposure control in this dose difference. MATERIALS AND METHODS We retrospectively evaluated air and liquid intussusception reductions performed on a single digital fluoroscopic unit during a 26-month period. We compared patient age, weight, gender, exam time of day and year, performing radiologist(s), radiographic image acquisitions, grid and magnification use, fluoroscopy time and dose area product. We compared categorical and continuous variables statistically using chi-square and Mann-Whitney U tests, respectively. RESULTS The mean dose area product was 2.7-fold lower for air enema, 1.3 ± 0.9 dGy·cm2, than for liquid, 3.5 ± 2.5 dGy·cm2 (P<0.005). The mean fluoroscopy time was similar between techniques. The mean dose area product/min was 2.3-fold lower for air, 0.6 ± 0.2 dGy·cm2/min, than for liquid, 1.4 ± 0.5 dGy·cm2/min (P<0.001). No group differences were identified in other measured dose parameters. CONCLUSION Fluoroscopic intussusception reduction using air enema uses less than half the radiation dose of liquid contrast enema. Dose savings are independent of fluoroscopy time and are likely due to automatic exposure control interaction.
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Affiliation(s)
- Summer L Kaplan
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA. .,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Dennise Magill
- Environmental Health and Radiation Safety, University of Pennsylvania, Philadelphia, PA, USA
| | - Marc A Felice
- Environmental Health and Radiation Safety, University of Pennsylvania, Philadelphia, PA, USA
| | - J Christopher Edgar
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sudha A Anupindi
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xiaowei Zhu
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Intussusception: past, present and future. Pediatr Radiol 2017; 47:1101-1108. [PMID: 28779197 DOI: 10.1007/s00247-017-3878-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/19/2017] [Accepted: 04/20/2017] [Indexed: 12/14/2022]
Abstract
Intussusception is a common etiology of acute abdominal pain in children. Over the last 70 years, there have been significant changes in how we diagnose and treat intussusception, with a more recent focus on the role of ultrasound. In this article we discuss historical and current approaches to intussusception, with an emphasis on ultrasound as a diagnostic and therapeutic modality.
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Variables determining the success of ultrasound-guided hydrostatic reduction of intussusception in infants. ANNALS OF PEDIATRIC SURGERY 2017. [DOI: 10.1097/01.xps.0000508444.67598.8c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Hawken S, Ducharme R, Rosella LC, Benchimol EI, Langley JM, Wilson K, Crowcroft NS, Halperin SA, Desai S, Naus M, Sanford CJ, Mahmud SM, Deeks SL. Assessing the risk of intussusception and rotavirus vaccine safety in Canada. Hum Vaccin Immunother 2017; 13:703-710. [PMID: 27835525 PMCID: PMC5360150 DOI: 10.1080/21645515.2016.1240846] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/27/2016] [Accepted: 09/20/2016] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Intussusception has been identified as a rare adverse event following rotavirus immunization. We sought to determine the incidence of intussusception among infants in Canada both before and after introduction of rotavirus immunization programs. METHODS We used Canadian Institute for Health Information (CIHI) Discharge Abstract Database (DAD) to identify infants under 1 y of age who were admitted to a Canadian hospital, which the exception of Quebec, which does not submit data to CIHI, with a diagnosis of intussusception (ICD-10 code K56.1, and ICD-9 code 560) between January 1st, 2003 and December 31, 2013. We compared rates of intussusception hospitalization before and after rotavirus vaccine program introduction. Rates were adjusted for calendar year, age (in months), sex and region using Poisson regression models. Denominator data for infants under 1 year, stratified by age in months, were obtained from Statistics Canada. RESULTS Annual intussusception hospitalization rates ranged from 20-30 per 100,000 infants over the study period, with no evidence of a trend over time. Intussusception hospitalization rates were highest in infants 4 to <8 months and lowest in those under 2 months or between 10 and <12 months. Males had higher rates than females both overall and within each age group. The rate of intussusception hospitalization after rotavirus vaccine program introduction was 22.4 (95% CI: 18.3, 27.4) compared to 23.4 (95% CI: 21.5, 25.4) per 100,000 before program introduction. CONCLUSIONS We have described baseline intussusception hospitalization rates for infants in Canada and have found no evidence of a change in rate after implementation of routine rotavirus immunization programs.
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Affiliation(s)
- Steven Hawken
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
| | - Robin Ducharme
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Laura C. Rosella
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Eric I. Benchimol
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario, Division of Gastroenterology, Ottawa, Ontario, Canada
| | - Joanne M. Langley
- Departments of Pediatrics & Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Centre for Vaccinology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Kumanan Wilson
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
| | - Natasha S. Crowcroft
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Scott A. Halperin
- Canadian Centre for Vaccinology, IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shalina Desai
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Monika Naus
- British Columbia Centre for Disease Control, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Salah M. Mahmud
- Vaccine and Drug Evaluation Centre, Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Shelley L. Deeks
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Incidence of acute intussusception among infants in eastern France: results of the EPIstudy trial. Eur J Pediatr 2017; 176:301-309. [PMID: 28058530 DOI: 10.1007/s00431-016-2838-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
UNLABELLED The incidence of intussusception in infants varies around the world. The epidemiology of intussusception in France has never been prospectively studied. We performed a prospective observational study with systematic inclusion of all infants aged <1 year with suspected intussusception admitted to the emergency departments of the hospitals in the eastern region of France (98,000 live births per year), from 4/1/2008 to 3/31/2012. Cases were classified using the Brighton Collaboration classification. In total, 185 infants with suspected intussusception were included of which 169 were idiopathic intussusception. Among these 169 cases, 115 (68%) were classed as Brighton level 1 (confirmed cases). Overall incidence of intussusception over the 4 years of the study was 29.8 (95% CI 24.6-35.7) cases per 100,000 live births for level 1 and 37.5 (95% CI 31.7-44.2) cases per 100,000 live births for all cases (levels 1-4). Annual incidence rates of level 1 intussusception were as follows: 44 (95% CI 31.9-59.3), 30.9 (20.9-44.2), 21.7 (13.4-33.2) and 22.1 (13.7-33.8) per 100,000 live births in the 1st, 2nd, 3rd and 4th study years, respectively. CONCLUSION The incidence rate of intussusception in the eastern part of France is comparable to that of other European countries. There was a significant trend towards a decrease in the incidence of intussusception. What is known • Intussusception is the most frequent causes of intestinal obstruction in infants and young children. Overall incidence of intussusception in infants aged <1 year varies widely around the world. No specific epidemiological studies have not been conducted in France on intussusception. What is new: • This prospective and multicenter study provides important information about the epidemiology of intussusception in infants in France over a period of 4 years.
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Restivo V, Costantino C, Tramuto F, Vitale F. Hospitalization rates for intussusception in children aged 0-59 months from 2009 to 2014 in Italy. Hum Vaccin Immunother 2017; 13:445-449. [PMID: 28075671 DOI: 10.1080/21645515.2017.1264784] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The real cause of intussusception is not fully understood and a variety of conditions have been associated with it (Meckel diverticulum, polyps, duplication cysts, parasites, Henoch-Schönlein purpura, cystic fibrosis, hemolytic-uremic syndrome and infectious gastroenteritis). Furthermore few European countries, following WHO recommendation to monitor baseline incidence of intussusception before implementation of immunization program for rotavirus, used intussusception rate as a baseline value to compare the same figures in the period before and after introduction of vaccination. In this study, data of intussusception hospitalizations occurred among Italian children aged 0 through 59 months from 2009 to 2014 were analyzed. A total amount of 3,088 children were included, accounting for a hospitalization rate of 20.2 per 100,000. Overall, the hospitalization rate for intussusception had a slight increase in trend from 2009 to 2014 (18%). In particular children 0-11 months had a hospitalization rate higher than 12-59 months with an aggregate value of 36 Vs. 16 per 100,000 respectively. Among all children hospitalized for intussusception a total of 239 (7.7%) had also a previous or concomitant hospitalization for gastroenteritis. This study demonstrates that Italian hospitalizations for intussusception are increasing by time and the role played by different risk factors, including acute gastroenteritis, have to be investigated in the future. These data could be useful to monitor intussusception hospitalization in the perspective of anti-rotavirus vaccination introduction in Italy.
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Affiliation(s)
- Vincenzo Restivo
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro," University of Palermo , Palermo , Italy
| | - Claudio Costantino
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro," University of Palermo , Palermo , Italy
| | - Fabio Tramuto
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro," University of Palermo , Palermo , Italy
| | - Francesco Vitale
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro," University of Palermo , Palermo , Italy
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Trotta F, Da Cas R, Bella A, Santuccio C, Salmaso S. Intussusception hospitalizations incidence in the pediatric population in Italy: a nationwide cross-sectional study. Ital J Pediatr 2016; 42:89. [PMID: 27677340 PMCID: PMC5039877 DOI: 10.1186/s13052-016-0298-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/21/2016] [Indexed: 11/30/2022] Open
Abstract
Background Study to investigate the intussusception incidence background in the pediatric population and its temporal trend in Italy. Methods A cross-sectional study was conducted on the pediatric population aged 0 to 15 years, in the period 1 January 2002 to 31 December 2012. Intussusception cases were identified using the national hospital discharge database. The annual intussusception incidence, the incidence rate ratios (IRRs) and the related 95 % confidence Intervals (CI) were calculated. Results The overall intussusception incidence rate was 21 per 100,000 children aged ≤15 years, and was higher among boys than girls. The highest intussusception incidence rate occurred in infants <1 year of age (39 per 100,000 infants). Among infants, incidence varied with the geographical area, with higher rates in the central Italy (50 per 100,000 infants). The annual incidence rates in infants were stable since 2004 and up to 2012, ranging from 40.1 and 33.0 per 100,000 infants. Similar stable patterns were observed when conducting the analysis on children over 1 year of age. Conclusions This study provided the intussusception incidence background in Italy in different pediatric ages, including infants, over an 11-year period. This information is essential in post-marketing safety surveillance, to continuously monitor the benefit/risk profile of rotavirus vaccinations. Electronic supplementary material The online version of this article (doi:10.1186/s13052-016-0298-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francesco Trotta
- Pharmacovigilance Office, Italian Medicines Agency (AIFA), Via del Tritone 181, Rome, 00187, Italy. .,National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Viale Regina Elena 299, Rome, 00161, Italy.
| | - Roberto Da Cas
- National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Viale Regina Elena 299, Rome, 00161, Italy
| | - Antonino Bella
- National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Viale Regina Elena 299, Rome, 00161, Italy
| | - Carmela Santuccio
- Pharmacovigilance Office, Italian Medicines Agency (AIFA), Via del Tritone 181, Rome, 00187, Italy
| | - Stefania Salmaso
- National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Viale Regina Elena 299, Rome, 00161, Italy
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Vitale F, Costantino C, Restivo V, Casuccio N, Corsello G, Palermo M, Tozzo I. Precise reply and clarifications on behalf of Sicilian Public Health Authorities to the case report published by La Rosa and collegues. Hum Vaccin Immunother 2016; 12:2969-2971. [PMID: 27560654 PMCID: PMC5137532 DOI: 10.1080/21645515.2016.1200777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
As a results of the case report “Post-rotavirus vaccine intussusception in identical twins: a case report” recently published on Human Vaccines & Immunotherapy by La Rosa et al., the principal Sicilian Public Health Authorities decided to specify several points and underline some important details omitted by the authors. In particular, aims to underline the remarkable benefit for Sicilian Regional Health service after the introduction of the rotavirus vaccination. Universal mass vaccination against rotavirus is properly managed by the Regional Health Authorities and is contributing to a consistent increase of public health in the Sicilian pediatric population; any modification of such a program should be based on robust scientific evidences. Finally, a single case report should not be considered as a basis to recommend a change in the clinical practice but instead a possible point of start for discussion and research.
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Affiliation(s)
- Francesco Vitale
- a Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" - University of Palermo , Palermo , Italy.,b Member of the Vaccination Board of the Sicilian Health Department , Palermo , Italy.,c Past President of the Sicilian Section of the Italian Society of Hygiene, Preventive Medicine and Public Health (S.It.I.) , Palermo , Italy
| | - Claudio Costantino
- a Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" - University of Palermo , Palermo , Italy
| | - Vincenzo Restivo
- a Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" - University of Palermo , Palermo , Italy
| | - Nicolò Casuccio
- b Member of the Vaccination Board of the Sicilian Health Department , Palermo , Italy.,d President of the Sicilian Section of the Italian Society of Hygiene, Preventive Medicine and Public Health (S.It.I.) , Palermo , Italy
| | - Giovanni Corsello
- a Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" - University of Palermo , Palermo , Italy.,b Member of the Vaccination Board of the Sicilian Health Department , Palermo , Italy.,e President of the Italian Society for Pediatrics (S.I.P.) , Palermo , Italy
| | - Mario Palermo
- b Member of the Vaccination Board of the Sicilian Health Department , Palermo , Italy.,f Director of the Public Hygiene service of the Sicilian Health Department , Palermo , Italy
| | - Ignazio Tozzo
- g Director of the Department of Sanitary Activities and Epidemiological Observatory of the Sicilian Health Department , Palermo , Italy
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Meta-analysis of Air Versus Liquid Enema for Intussusception Reduction in Children. AJR Am J Roentgenol 2016; 205:W542-9. [PMID: 26496576 DOI: 10.2214/ajr.14.14060] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the effectiveness and safety of air versus liquid enema reduction in the treatment of intussusception in children. MATERIALS AND METHODS Literature searches of the PubMed, Embase, and Cochrane Library databases were conducted from January 1, 1966, through May 31, 2013. Articles on the use of air or liquid enema in children with a confirmed diagnosis of intussusception and reporting either a success rate for enema reduction of intussusception or a perforation rate were selected. Enema reduction success rate, perforation rate, and recurrence rate were the main outcomes and were calculated by random effects modeling. RESULTS One hundred two articles (101 reporting success rate, 71 reporting perforation rate) were included that presented results for 32,451 children (age range, 1 day-22 years; boys, 66%; girls, 34%). In 44 studies (16,187 children), the combined estimate for success rate of air enema was 82.7% (95% CI, 79.9-85.6%; inconsistency index [I(2)] = 97%), and in 52 studies (13,081 children) of liquid enema, it was 69.6% (95% CI, 65.0-74.1%; I(2) = 98%). In 38 studies (15,752 children), the combined estimate of perforation rate for air enema was 0.39% (95% CI, 0.23- 0.55%; I(2) = 40%), and in 30 studies (9429 children) of liquid enema, it was 0.43% (95% CI, 0.24- 0.62%; I(2) = 9%). Among 10,494 children (26 studies) undergoing air enema reduction, the rate of first intussusception recurrence was 6% (95% CI, 4.5-7.5%; I(2) = 89%), similar to the 7.3% (95% CI, 5.8-8.8%; I(2) = 71%) found for 4004 children (24 studies) undergoing liquid enema reduction. CONCLUSION Air enema was superior to liquid enema for intussusception reduction. The success rate was higher without a difference in perforation rate. Limitations included heterogeneity and publication bias.
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Pediatric Intussusception and Interventional Radiology in a Developing Country: Experience and Challenges of Ultrasound Saline Reduction Complementary to Primary Surgery. Int Surg 2015. [DOI: 10.9738/intsurg-d-14-00190.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nonoperative reduction is considered a safe and effective treatment procedure for pediatric intussusception. However, the procedures are yet to be adopted in some developing countries. This study evaluates our experience with ultrasound saline reduction of pediatric intussusception in southeast Nigeria. Retrospective analysis of 58 children managed for intussusception from June 2009 to May 2013 at the University of Nigeria teaching hospital, Enugu. The median age at presentation was 7 months (IQR = 5 to 9 months), and the average duration of symptoms before diagnosis was 3.9 days (range, 1 to 14 days). Thirteen (22.4%) had saline hydrostatic reduction initially (11 succeeded, 2 failed), and a total of 47 cases had operative treatment (including the 2 with failed saline reduction). Operative procedures were right hemicolectomy in 24 cases, manual reduction 18, ileal resection 3, and colonic resection 2. Eighteen (38.3%) cases developed postoperative complications, and there were 2 postoperative deaths from unremitting septicemia. Comparison of the cases that had saline reduction with cases that underwent operative treatment showed a difference in the average time to diagnosis, need for preintervention transfusion, onset of oral intake, and average duration of admission. Challenges in the saline reduction procedure were delayed presentation, insufficient facilities and trained personnel. Ultrasound saline reduction procedure for pediatric intussusception is feasible in our setting. Despite the delay in presentation in most of our cases, this procedure may still be applied initially to patients who do not have clinical or radiologic contraindications.
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Costantino C, Restivo V, Cuccia M, Furnari R, Amodio E, Vitale F. Analysis of hospitalizations due to intussusception in Sicily in the pre-rotavirus vaccination era (2003-2012). Ital J Pediatr 2015; 41:52. [PMID: 26232152 PMCID: PMC4522101 DOI: 10.1186/s13052-015-0160-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/22/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Intussusception is the most common cause of bowel obstruction in infants with an incidence ranging from 9-328 cases per 100,000 infants aged 0-11 months. Causes underlining this clinical manifestation are still unknown. Possible relationship with a withdrawn tetravalent rotavirus vaccine was not confirmed by post-licensure studies and actually no increased risk of intussusception was found between infants vaccinated with both the recently licensed rotavirus vaccines. Aim of this study is to analyze the intussusception hospitalizations in Sicily from 2003 to 2012 before the introduction of rotavirus universal vaccination and its possible relation with rotavirus gastroenteritis trend. METHODS Were collected data from hospital discharge records occurred from 1(st) January 2003 to 31(st) December 2012 in Sicily. Intussusception cases were defined as all hospitalizations with an ICD-9-CM code of 560.0 on any discharge diagnoses. As a proxy for the severity of cases were considered ICD-9-CM procedure codes accounting for surgical or radiologic reduction. RESULTS A total of 340 intussusception cases were hospitalized in Sicily from 2003 to 2012 in children aged 0-59 months. 46.8 % occurred in the age class 0-11 months. Hospitalization rate for intussusception was 11.4 cases per 100,000 per year (32.6 cases per 100,000 among 0-11 months children; 7.3 cases per 100,000 among 12-59 months children), with a M:F sex ratio of 1.8. During hospitalization only 25 % of intussusceptions had a spontaneous resolution, 56.5 % of cases required a surgical intervention. From 2003 to 2012 intussusception cases were equally distributed during the year without any seasonality, while gastroenteritis hospitalizations due to rotavirus infection have a typically late winter and spring distribution. CONCLUSIONS In Sicily from 2003 to 2012 hospitalizations due to intestinal invagination were higher among children aged 0-11 months with observed rates similar to other European countries. Regional baseline data analysis of intussusception among 0-59 children is recognized as an evidence-based public health strategy by international health authorities. Indeed, this strategy is necessary to compare any post-licensure age or sex-related change in intussusception trend after universal rotavirus vaccination introduction.
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Affiliation(s)
- Claudio Costantino
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" -, University of Palermo, Via del Vespro n 133, ZIP code 90127, Palermo, Italy.
| | - Vincenzo Restivo
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" -, University of Palermo, Via del Vespro n 133, ZIP code 90127, Palermo, Italy.
| | - Mario Cuccia
- Infection diseases epidemiology and prevention section -, Catania Local Health Unit, Catania, Italy.
| | - Roberto Furnari
- Medical Doctor, Hygiene and Preventive Medicine specialist -, Catania, Italy.
| | - Emanuele Amodio
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" -, University of Palermo, Via del Vespro n 133, ZIP code 90127, Palermo, Italy.
| | - Francesco Vitale
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" -, University of Palermo, Via del Vespro n 133, ZIP code 90127, Palermo, Italy.
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Oberle D, Jenke AC, von Kries R, Mentzer D, Keller-Stanislawski B. Rotavirus vaccination: a risk factor for intussusception? Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 57:234-41. [PMID: 24469287 DOI: 10.1007/s00103-013-1893-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recently published pharmacoepidemiological studies associate the currently authorized Rotavirus (RV) vaccines with intussusception (IS). We aimed at investigating whether, in Germany, there are excess IS cases in RV vaccinees compared with the background incidence before market authorization in 2006. Suspected cases of IS following receipt of RV vaccines reported to the Paul-Ehrlich-Institut (PEI) from 2006 to 2010 were reviewed and validated against the criteria of the Brighton Collaboration's definition for IS. An observed-versus-expected analysis was conducted using standardized morbidity ratio (SMR) methods based on age-specific incidence rates for IS ranging from 19.2 to 98.5 per 100,000 person-years. A total of 27 cases of suspected IS in RV vaccinees were reported to the PEI. No excess of IS cases could be detected 1-7 days after receipt of either RV vaccine after any dose in the first year of life; however, in infants aged 3-5 months, a significantly increased SMR for IS was found in a risk window of 1-7 days after the first dose of either RV vaccine [SMRs: Rotarix® 4.6 (95% CI 1.5-10.7); RotaTeq® 5.8 (95% CI 1.2-17.1)]. A significantly increased risk of IS in a risk window of 1-7 days after RV vaccination was not found when the first dose was administered earlier. Therefore, it is recommended to start the vaccination course at 6-12 weeks of age.
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Affiliation(s)
- D Oberle
- Referat Pharmakovigilanz S1, Federal Institute for Vaccines and Biomedicines (Paul-Ehrlich-Institut), Paul-Ehrlich-Str. 51-59, 63225, Langen, Germany,
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Sonography-guided hydrostatic reduction of ileocolic intussusception in children: analysis of failure and success in consecutive patients presenting timely to the hospital. Eur J Pediatr 2015; 174:307-16. [PMID: 25132464 DOI: 10.1007/s00431-014-2394-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/29/2014] [Accepted: 07/30/2014] [Indexed: 11/27/2022]
Abstract
UNLABELLED In children with ileocolic intussusception sonography is increasingly being used for diagnosis, whereas fluoroscopy is frequently used for guiding non-invasive reduction. This study assessed the success rate of radiation-free sonography-guided hydrostatic reduction in children with ileocolic intussusception, using novel well-defined success rate indices. All children were evaluated who presented from 2005 to 2013 to the local university hospital with ileocolic intussusception. The patients were treated with sonography-guided hydrostatic reduction unless primary surgery was clinically indicated. The according success rate was determined by indices of Bekdash et al. They represent the ratio of persistently successful non-surgical reductions versus four different denominators, depending on including/excluding cases with primary surgery and including/excluding cases requiring bowel resection/intervention. Fifty-six consecutive patients were included (age, 3 months to 7.8 years). About 80% of the patients presented until 24 h and 20% until 48 h after the onset of symptoms. Seven patients underwent primary surgery, with bowel resection required in three cases. Hydrostatic reduction was attempted in 49 patients, being permanently successful in 41 cases (selective reduction rate 41/49 = 83.7%; crude reduction rate 41/56 = 73.2%). The remaining eight patients underwent secondary surgery, with just two patients not requiring surgical bowel resection/intervention (corrected selective reduction rate 41/43 = 95.3%). The composite reduction rate was 87.2% (successful/feasible reductions, 41/47). CONCLUSION Radiation-free sonography-guided hydrostatic reduction has a good success rate in children with ileocolic intussusception. It may be particularly valuable in centers that are already experienced with using sonography for the diagnosis.
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Fluoroscopy-guided hydrostatic reduction of intussusception in infancy: role of pharmacological premedication. Radiol Med 2015; 120:549-56. [PMID: 25572541 DOI: 10.1007/s11547-014-0486-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/04/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE Intussusception is one of the most common causes of paediatric emergency. Fluoroscopy-guided hydrostatic reduction is a common nonoperative management strategy for the treatment of intussusception. The role of pharmacological premedication in increasing the success rate of hydrostatic reduction is still controversial. The purpose of this study was to verify the presence of a possible correlation between pharmacological premedication and the percentage of hydrostatic reduction of intussusception in paediatric patients. MATERIALS AND METHODS This study considered children with a diagnosis of idiopathic intussusception treated at our hospital between January 2007 and June 2013. One group of patients underwent hydrostatic reduction by barium enema without any preliminary therapy. A second group of patients received pharmacological premedication with both a sedative and an anti-oedematous agent before the procedure. RESULTS A total of 398 patients were treated with barium enema for therapeutic purposes. In the group of patients who received no premedication (n = 254), 165 (65 %) children achieved hydrostatic reduction of the intussusception. Among the patients who received pharmacological premedication prior to barium enema (n = 144), 122 (85 %) children achieved resolution of the intussusception. CONCLUSIONS Our study shows that the use of pharmacological premedication is effective for the reduction of the intussusception, as its limit patient stress, fluoroscopic time and radiation dose.
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An institutional analysis and systematic review with meta-analysis of pneumatic versus hydrostatic reduction for pediatric intussusception. Surgery 2013; 154:328-34. [PMID: 23889959 DOI: 10.1016/j.surg.2013.04.036] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 04/19/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Intussusception remains a frequent cause of bowel obstruction in children and typically is treated by reduction via enema. Controversy persists regarding the optimal reduction technique to maximize success while minimizing morbidity. METHODS We reviewed our institutional data comparing outcomes of enema reduction that use contrast medium versus air. A systematic review also was undertaken of comparative studies evaluating pneumatic (oxygen or air) versus hydrostatic (any contrast medium) reduction. Critical appraisal was performed with the Methodological Index for Non Randomized Studies scale for observational studies, Jadad score for randomized trials. Meta-analysis was performed with REVMAN 5.1. RESULTS Institutional data revealed a failed reduction rate of 20.4% (20/98) with air and 29.6% (8/27) with contrast reduction. Nineteen studies were included in the systematic review. The cumulative failure rate favored pneumatic reduction (odds ratio [OR] 0.45; 95% confidence interval [95% CI] 0.34-0.60); sensitivity analysis of prospective studies demonstrated similar results (OR 0.39; 95% CI 0.24-0.63). The number needed to treat to eliminate one failed reduction was nine pneumatic reductions. No difference was noted in reported perforations (OR 0.98; 95% CI 0.48-2.03). CONCLUSION Pneumatic reduction is more likely to successfully reduce intussusception in children without evidence of increased morbidity. In the context of available expertise, pneumatic reduction should be the method of choice for the treatment of intussusception barring an indication for immediate operative intervention.
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Validation of diagnostic codes for intussusception and quantification of childhood intussusception incidence in Ontario, Canada: a population-based study. J Pediatr 2013; 163:1073-9.e3. [PMID: 23809052 DOI: 10.1016/j.jpeds.2013.05.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/10/2013] [Accepted: 05/14/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To validate an algorithm to identify cases of intussusception using the health administrative data of Ontario, Canada, and to apply the algorithm to estimate provincial incidence of intussusception, preceding the introduction of the universal rotavirus vaccination program. STUDY DESIGN We determined the accuracy of various combinations of diagnostic, procedural, and billing codes using the chart-abstracted diagnoses of patients of the Children's Hospital of Eastern Ontario as the reference standard. We selected an algorithm that maximized positive predictive value while maintaining a high sensitivity and used it to ascertain annual incidence of intussusception for fiscal years 1995-2010. We explored temporal trends in incidence using Poisson regression. RESULTS The selected algorithm included only the International Classification of Diseases (ICD)-9 or ICD-10 code for intussusception in the hospitalization database and was sensitive (89.3%) and highly specific (>99.9%). The positive predictive value of the ICD code was 72.4%, and the negative predictive value was >99.9%. We observed the highest mean incidence (34 per 100000) in male children <1 year of age. Temporal trends in incidence varied by age group. There was a significant mean decrease in incidence of 4% per year in infants (<1 year) until 2004 and rates stabilized thereafter. CONCLUSIONS We have demonstrated that intussusception can be accurately identified within health administrative data using validated algorithms. We have described changes in temporal trends in intussusception incidence in Ontario and established a baseline to allow ongoing monitoring as part of vaccine safety surveillance.
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de Vries A, Ashtiani N, Ahmadi N, Bakx R, de Vaate AWB, Bökenkamp A. Intussusception presenting with malignant hypertension and lethargy. CASE REPORTS IN NEPHROLOGY AND UROLOGY 2013; 3:105-9. [PMID: 23914204 PMCID: PMC3731624 DOI: 10.1159/000353849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The most common cause of malignant hypertension in children is renal or renovascular pathology. The combination with lethargy suggests a diagnosis of hypertensive crisis with hypertensive encephalopathy. Here, we present a case of severe hypertension with lethargy as the sole presenting symptoms of ileocecal intussusception. Both normalized following surgical repositioning. We conclude that malignant hypertension and lethargy can be presenting symptoms of intussusception.
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Affiliation(s)
- Andra de Vries
- Department of Pediatric Intensive Care, University Medical Center Groningen, Groningen, The Netherlands
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Jiang J, Jiang B, Parashar U, Nguyen T, Bines J, Patel MM. Childhood intussusception: a literature review. PLoS One 2013; 8:e68482. [PMID: 23894308 PMCID: PMC3718796 DOI: 10.1371/journal.pone.0068482] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 05/31/2013] [Indexed: 02/07/2023] Open
Abstract
Background Postlicensure data has identified a causal link between rotavirus vaccines and intussusception in some settings. As rotavirus vaccines are introduced globally, monitoring intussusception will be crucial for ensuring safety of the vaccine programs. Methods To obtain updated information on background rates and clinical management of intussusception, we reviewed studies of intussusception in children <18 years of age published since 2002. We assessed the incidence of intussusception by month of life among children <1 year of age, seasonality, method of diagnosis, treatment, and case-fatality. Findings We identified 82 studies from North America, Asia, Europe, Oceania, Africa, Eastern Mediterranean, and Central & South America that reported a total of 44,454 intussusception events. The mean incidence of intussusception was 74 per 100,000 (range: 9–328) among children <1 year of age, with peak incidence among infants 5–7 months of age. No seasonal patterns were observed. A radiographic modality was used to diagnose intussusception in over 95% of the cases in all regions except Africa where clinical findings or surgery were used in 65% of the cases. Surgical rates were substantially higher in Africa (77%) and Central and South America (86%) compared to other regions (13–29%). Case-fatality also was higher in Africa (9%) compared to other regions (<1%). The primary limitation of this review relates to the heterogeneity in intussusception surveillance across different regions. Conclusion This review of the intussusception literature from the past decade provides pertinent information that should facilitate implementation of intussusception surveillance for monitoring the postlicensure safety of rotavirus vaccines.
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Affiliation(s)
- James Jiang
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Samad L, Cortina-Borja M, Bashir HE, Sutcliffe AG, Marven S, Cameron JC, Lynn R, Taylor B. Intussusception incidence among infants in the UK and Republic of Ireland: a pre-rotavirus vaccine prospective surveillance study. Vaccine 2013; 31:4098-102. [PMID: 23871447 PMCID: PMC3988919 DOI: 10.1016/j.vaccine.2013.06.084] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 04/22/2013] [Accepted: 06/25/2013] [Indexed: 12/16/2022]
Abstract
The pre-rotavirus vaccine incidence of intussusception among UK and Irish infants was 24.8 and 24.2/100,000 live births. The highest incidence (50.3/100,000 live births) occurred in the fifth month of life (for England). A seasonal trend in intussusception was observed with the incidence significantly increased during winter and spring. Baseline rates will inform rotavirus vaccine-safety policy by enabling comparison with post-introduction incidence. Introduction Intussusception, an abdominal emergency in young children, has been linked to a previous vaccine used to prevent rotavirus gastroenteritis. Although this vaccine was withdrawn, recent studies have suggested a potential, very small increased risk of intussusception following the administration of newly developed rotavirus vaccines. We aimed to determine the baseline incidence of intussusception among infants in the UK and Republic of Ireland – prior to the imminent introduction of the rotavirus vaccine into the UK schedule this year. Methods Prospective, active surveillance via the established British Paediatric Surveillance Unit (BPSU) was carried out from March 2008 to March 2009. Clinicians across 101 National Health Service (and equivalent) hospitals, including 27 paediatric surgical centres, reported cases admitted for intussusception in the UK and Republic of Ireland. The standard Brighton Collaboration case definition was used with only definite cases included for incidence estimation. Results The study response rate was 94.5% (379 questionnaires received out of 401 case notifications). A total of 250 definite cases of intussusception were identified. The annual incidence among infants in the UK and Republic of Ireland was 24.8 (95% CI: 21.7–28.2) and 24.2 (95% CI: 15.0–37.0) per 100,000 live births. In the UK, the highest incidence occurred in Northern Ireland (40.6, 95% CI: 21.0–70.8), followed by Scotland (28.7, 95% CI: 17.5–44.3), England (24.2, 95% CI: 20.9–27.9), then Wales (16.9, 95% CI: 6.8–34.8). In England, regional incidence was highest in London and lowest in the West Midlands. By age, the highest incidence (50.3/100,000 live births, 95% CI: 33.4–72.7) occurred in the fifth month of life (for England). A seasonal trend in the presentation of intussusception was observed with the incidence significantly (p = 0.001) increased during winter and spring. Conclusion The baseline rates obtained in this study will inform rotavirus vaccine-safety policy by enabling comparison with post-introduction incidence.
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Affiliation(s)
- Lamiya Samad
- General and Adolescent Paediatric Unit, University College London, Institute of Child Health, England, United Kingdom.
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Ludvigsson JF, Nordenskjöld A, Murray JA, Olén O. A large nationwide population-based case-control study of the association between intussusception and later celiac disease. BMC Gastroenterol 2013; 13:89. [PMID: 23679928 PMCID: PMC3661363 DOI: 10.1186/1471-230x-13-89] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 05/13/2013] [Indexed: 02/07/2023] Open
Abstract
Background Case reports and case series studies suggest a positive association between intussusception and celiac disease (CD). Methods We contacted Sweden’s 28 pathology departments and obtained data on 29,096 patients with biopsy-verified CD (equal to Marsh stage 3) through biopsy reports. Patients with CD were matched for age, sex, calendar period and county of residence with up to five reference individuals from the general population (n = 144,522). Cases of intussusception were identified from nationwide inpatient, hospital-based outpatient and day-surgery data from the Swedish Patient Register. Odds ratios (ORs) for future CD in patients with intussusception were estimated using conditional logistic regression. Results 34 (0.12%) individuals with CD had a diagnosis of intussusception vs. 143 (0.10%) reference individuals, suggesting that intussusception was not a risk factor for later CD (OR = 1.17; 95% confidence interval (CI) = 0.82–1.67). The OR for CD in patients with at least two records of intussusception was 0.40 (95% CI = 0.06–2.99). In contrast, a post-hoc analysis showed that CD was associated with a statistically significantly increased risk of intussusception after CD diagnosis (hazard ratio = 1.95; 95% CI = 1.01–3.77); however, this analysis was based on only 12 cases with both CD and intussusception. Conclusion We found no association between intussusception and future CD; and a mostly modest increased risk of intussusception after a diagnosis of CD.
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Affiliation(s)
- Jonas F Ludvigsson
- Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Karolinska, Sweden.
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Fallon SC, Lopez ME, Zhang W, Brandt ML, Wesson DE, Lee TC, Rodriguez JR. Risk factors for surgery in pediatric intussusception in the era of pneumatic reduction. J Pediatr Surg 2013; 48:1032-6. [PMID: 23701778 DOI: 10.1016/j.jpedsurg.2013.02.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 02/03/2013] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Surgical treatment is still necessary for intussusception management in a subgroup of patients, despite advances in enema reduction techniques. Early identification of these patients should improve outcomes. METHODS The medical records of patients treated for intussusception at our institution from 2006 to 2011 were reviewed. Univariate and multivariate analyses, including stepwise logistic regression, were performed. RESULTS Overall, 379 patients were treated for intussusception, and 101 (26%) patients required operative management, with 34 undergoing intestinal resection. The post-operative complication rate was 8%. On multivariate analysis, failure of initial reduction (OR 9.9,p=0.001 95% CI, 4.6-21.2), a lead point (OR 18.5,p=0.001 95% CI, 6.6-51.8) or free/interloop fluid (OR 3.3,p=0.001 95% CI, 1.6-6.7) or bowel wall thickening on ultrasound (OR 3.3,p=0.001 95% CI, 1.1-10.1), age <1 year at reduction (OR 2.7,p=0.004, 95% CI, 1.4-5.9), and abdominal symptoms>2 days (OR 2.9,p=0.003, 95% CI, 1.4-5.9) were significantly associated with a requirement for surgery. Similarly, a lead point (OR 14.5, p=0.005 95% CI, 2.3-90.9) or free/interloop fluid on ultrasound (OR 19.8, p=0.001 95% CI, 3.4-117) and fever (OR 7.2, p=0.023 95% CI, 1.1-46) were significantly associated with the need for intestinal resection. CONCLUSION Abdominal symptoms>2 days, age<1 year, multiple ultrasound findings, and failure of initial enema reduction are significant predictors of operative treatment for intussusception. Patients with these findings should be considered for early surgical consultation or transfer to a hospital with pediatric surgical capabilities.
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Affiliation(s)
- Sara C Fallon
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
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Bena-Boupda N, Weitzel D, Keller KM. Rezidivierende Bauchschmerzen durch Dünndarminvaginationen. Monatsschr Kinderheilkd 2012. [DOI: 10.1007/s00112-012-2658-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
PURPOSE OF REVIEW Evaluation of the child with acute abdominal pain is challenging because of the wide range of potential diagnoses. Presenting symptoms, clinical examination, and laboratory findings can guide selection of diagnostic imaging. RECENT FINDINGS Intussusception and intestinal malrotation are potentially serious causes of intestinal obstruction, which are best evaluated by ultrasound and upper gastrointestinal series, respectively. Ultrasound has diagnostic importance in the evaluation of multiple diseases, including appendicitis, by potentially decreasing the need for inpatient observation, cholecystitis and complications of gall stones such as pancreatitis, and ovarian diseases. Pelvic inflammatory disease should be considered in evaluation of a teenage girl with lower abdominal pain. Less common causes of acute abdominal pain include ingested foreign bodies, infected congenital anomalies, and perforated peptic ulcer disease. SUMMARY Presenting symptoms and physical examination findings can narrow the number of potential diagnoses in pediatric acute abdominal pain and thereby guide diagnostic imaging selection. Abdominal/pelvic ultrasound, rather than computed tomography scan, is the preferred modality for initial evaluation of many potential causes of pediatric abdominal pain.
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Samad L, Marven S, El Bashir H, Sutcliffe AG, Cameron JC, Lynn R, Taylor B. Prospective surveillance study of the management of intussusception in UK and Irish infants. Br J Surg 2011; 99:411-5. [PMID: 22180094 DOI: 10.1002/bjs.7821] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Intussusception is the most common cause of acute intestinal obstruction in infants. This study examined the clinical presentation, management and outcomes of intussusception in this age group. METHODS Prospective surveillance of intussusception in infants was carried out between March 2008 and March 2009 in the UK and Ireland. Monthly cards were sent to paediatric clinicians who were requested to notify cases of intussusception. RESULTS The study identified 261 confirmed cases. The commonest presenting symptom/sign was non-bilious vomiting, in 210 (80·5 per cent) of the infants. Abdominal ultrasonography was done in 247 infants (94·6 per cent) and was diagnostic in 242 (98·0 per cent), compared with plain abdominal X-ray, which was diagnostic in 33 (23·6 per cent) of 140 infants. Enema reduction was carried out in 240 (92·0 per cent) of the 261 infants; the majority (237, 98·8 per cent) had pneumatic reduction with a success rate of 61·2 per cent (145 of 237). Surgery was required in 111 infants (42·5 per cent); 92 operations were as a result of unsuccessful enema reduction, and the remaining 19 infants (17·1 per cent) had primary surgery. Forty-four infants (39·6 per cent of operations) needed a bowel resection. The majority of children (238, 91·2 per cent) recovered uneventfully; 21 (8·0 per cent) had sequelae, one child died (0·4 per cent), and the outcome was unknown for one infant. CONCLUSION This study described current treatment patterns for intussusception in infancy; these represent a benchmark for improved standards of care for this condition.
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Affiliation(s)
- L Samad
- UCL Institute of Child Health, London, UK.
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