Management of Intussusception: Follow-up or Reduction?

Yıl 2023, Cilt: 18 Sayı: 3, 37 - 40, 20.11.2023

Ömer Katı , Şükrü Güngör , Yaşar Kandur , Ahmet Gökhan Güler

https://doi.org/10.17517/ksutfd.1151371

Öz

Objective: In this study, we describe the management and outcome of children with intussusception and analyze the sonographic findings that can be used to differentiate transient, self-limited small bowel intussusception from the cases with an indication for surgery.
Material and Methods: We retrospectively reviewed the medical records of pediatric patients with the diagnosis of invagination who had been followed up in the pediatric surgery service between 2012-2017.
Results: The median age was 39.5±35.9 (range 2-171) months. Among these patients, 57 (64%) had been followed up without surgery, and the remaining patients (n= 32, 36%) had undergone surgery. The median age of patients who had not undergone surgery was significantly greater than that of the patients who had undergone surgery (52.2±38.4 vs. 16.75±12.6; p<0.001). Twenty (35.1%) patients in the non-surgical group had developed abdominal pain after discharge, whereas none of the patients in the surgical group had developed abdominal pain postoperatively. An analysis of the differences between the groups with respect to the length of the invaginated segment revealed that length of that segment were significantly greater in the surgically managed cases (p=<0.001). A ROC curve based on the length of the invaginated intestinal segment revealed that, 41.5 mm was the best cutoff point for invaginated intestinal length, which resulted in a sensitivity of 68.8% and a specificity of 96.5%.
Conclusion: In our study, unlike other studies, the surgical threshold of the invagination length was revised as 4.15 cm. Thus, patients below this value may not have an immediate indication for surgery.

Anahtar Kelimeler

Intussusception, follow-up, ultrasonography, length

İnvajinasyonda Tedavi Yaklaşımı: Takip mi, Cerrahi mi?

Öz

Amaç: Bu çalışmada, invajinasyon tanısı alan çocuk hastalarda ultrasonografik bulguların cerrahi yaklaşım ile sadece izlem yönetimi kararında etkinliğini analiz etmeyi amaçladık.
Gereç ve Yöntemler: 2012-2017 yılları arasında çocuk cerrahisi servisinde izlenen invajinasyon tanılı çocuk hastaların tıbbi kayıtları geriye dönük olarak incelendi.
Bulgular: Ortanca yaş 39.5 ± 35.9 (dağılım 2-171) aydı. Elli yedi (% 64) hasta takip edilmiş, geri kalan hastalar (n = 32, % 36) ameliyat edilmişti. Ameliyat geçirmemiş hastaların ortanca yaşı ameliyat geçirenlere göre anlamlı olarak daha yüksekti (52.2 ± 38.4'e karşı 16.75 ± 12.6; p <0.001). Ameliyatsız grupta 20 (%35.1) hastada taburcu olduktan sonra karın ağrısı gelişirken, ameliyat grubundaki hastaların hiçbirinde ameliyat sonrası karın ağrısı gelişmedi. İnvajine segmentin uzunluğu ameliyat edilen grupta anlamlı olarak daha fazla idi (p=<0.001). İnvajinasyonlu bağırsak segmentinin uzunluğuna dayanan bir ROC eğrisi analizi, % 68.8'lik bir duyarlılık ve % 96.5'lik özgüllük ile 41.5 mm’ nin cerrahi sınır uzunluğu olduğunu ortaya koydu.
Sonuç: Çalışmamızda önceki çalışmalardan farklı olarak invajinasyon uzunluğunun cerrahi eşiği 4,15 cm olarak revize edildi. Bu nedenle, bu değerin altındaki hastalarda ameliyat için acil bir endikasyon olmayabilir.

Anahtar Kelimeler

İnvajinasyon, takip, ultrasonografi, uzunluk.

Kaynakça

• Jiang J, Jiang B, Parashar U, Nguyen T, Bines J, Patel MM. Childhood intussusception: a literature review. PLoS One . 2013;22;8(7):e68482.
• Justice FA, Auldist AW, Bines JE. Intussusception: trends in clinical presentation and management J Gastroenterol Hepatol . 2006;21(5):842-6.
• Zhang Y, Bai YZ, Li SX, Liu SJ, Ren WD, Zheng LQ. Sonographic findings predictive of the need for surgical management in pediatric patients with small bowel intussusceptions. Langenbecks Arch Surg 2011;396(7):1035–40.
• Munden MM, Bruzzi JF, Coley BD, Munden RF. Sonography of pediatric small-bowel intussusception: differentiating surgical from nonsurgical cases. AJR Am J Roentgenol 2007;188(1):275–9.
• Ko SF, Lee TY, Ng SH, et al. Small bowel intussusception in symptomatic pediatric patients: experiences with 19 surgically proven cases. World J Surg. 2002;26(4): 438-43.
• Koh EP, Chua JH, Chui CH, Jacobsen AS. A report of 6 children with small bowel intussusception that required surgical intervention. J Pediatr Surg. 2006;41(4):817-20.
• Doi O, Aoyama K, Hutson JM. Twenty-one cases of small bowel intussusception: the pathophysiology of idiopathic intussusception and the concept of benign small bowel intussusception. Pediatr Surg Int. 2004;20(2):140-3.
• Siaplaouras J, Moritz JD, Gortner L, Alzen G. Small bowel intussusception in childhood. Klin Padiatr. 2003;215(2):53-6.
• Arslan S, Turan C, Doganay S, et al. The effectiveness of pneumoreduction for intussusception. Ann Ital Chir. 2014;85(5):459-63
• Strouse PJ, DiPietro MA, Saez F. Transient small-bowel intussusception in children on CT. Pediatr Radiol. 2003;33(5):316-20.
• Cohen MD, Baker M, Grosfeld JL, Siddiqui A. Post-operative intussusception in children with neuroblastoma. Br J Radiol. 1982;55(651):197-200.
• Ko SF, Tiao MM, Hsieh CS, et al. Pediatric small bowel intussusception disease: feasibility of screening for surgery with early computed tomographic evaluation. Surgery.2010;147(4):521-8.
• Ein SH. Recurrent intussusception in children. J Pediatr Surg 1975;10(5):751-5.
• Turner D, Rickwood AM, Brereton RJ. Intussusception in older children. Arch Dis Child. 1980;55:544-6
• Xiaolong X, Yang W, Qi W, Yiyang Z, Bo X. Risk factors for failure of hydrostatic reduction of intussusception in pediatric patients: A retrospective study. Medicine (Baltimore). 2019;98(1):e13826
• Ekinci RMK, Balci S, Melek E et al. Clinical manifestations and outcomes of 420 children with Henoch Schönlein Purpura from a single referral center from Turkey: A three-year experience. Mod Rheumatol. 2020;30(6):1039-46.
• Güney LH, Fakıoğlu, E, Acer T, Ötgün I, Arslan EE, Akıllı MS, et al.Is every intussusception treatment an emergency intervention or surgery? Ulus Travma Acil Cerrahi Derg, March 2016;22:139-144.
• Vandewalle RJ , Bagwell AK, Shields JR et al. Radiographic and Clinical Factors in Pediatric Patients With Surgical Small-bowel Intussusception. J Surg Res. 2019;233:167-172
• Lvoff N, Breiman RS, Coakley FV, Lu Y, Warren RS. Distinguishing features of self-limiting adult small-bowel intussusception identified at CT. Radiology 2003;227:68–72.