Demographic, Clinical and Radiological Characteristics of Pediatric Cases Diagnosed As Transient Intussusception As A Result of Spontaneous Reduction

Öz

Objectives: Transient intussusception (TI) is a condition in which part of the small intestine is identified to enter the anterior part of the intestine telescopically, but this condition spontaneously reduces during follow-up. The observation of this situation has increased with the widespread use of ultrasonography among diagnostic tools. In this study, the aim was to present cases of intussusception that resulted in spontaneous reduction in our clinic. Materials and Methods: The records of cases diagnosed with intussusception between 01.01.2014 and 01.09.2022 were scanned. The files of the patients who were diagnosed with TI as a result of observation were investigated. Age, gender, clinical findings, duration of admission, ultrasonography findings, treatment options and results were analyzed retrospectively. Results: A total of 71 cases diagnosed with intussusception included 50 males and 21 females, with a mean age of 22.3 months. Intussusception was ileo-colic in 36 patients, ileo-ileal in 32 patients, and jejuno-jejunal in three patients. Clinical observation with physical examination and ultrasonography (US) was performed in 33 (21%) patients with SBI who did not have signs of peritoneal irritation and had short segment involvement. Surgical reduction was performed in four patients because intussusception persisted after observation. Control US performed on the remaining 29 patients showed that intussusception disappeared. The age range of 29 patients diagnosed with TI ranged from 10 to 122 months (mean 46.2 months). Of the cases, 19 (65.5%) were male and 10 (34.4%) were female. The length of the invaginated segment ranged from 1-2.2 cm (mean 1.8 cm). Conclusion: Spontaneous reduction of SBI, which does not have acute abdominal findings and progresses with short segment involvement on US, may occur during clinical observation. For this reason, close follow-up of suitable cases that may develop spontaneous reduction is important to avoid unnecessary surgical interventions and consequences.

Anahtar Kelimeler

• Child
• Intussusception
• Transient
• Spontan reduction

Spontan Redüksiyon Sonucu Geçici İnvajinasyon Tanısı Alan Pediatrik Olguların Demografik, Klinik ve Radyolojik Özellikleri

Öz

Amaç: Geçici invajinasyon, ince bağırsağın bir kısmının teleskopik olarak bağırsağın ön kısmına girdiğinin tespit edildiği ancak takip sırasında bu durumun kendiliğinden düzeldiği bir durumdur. Tanı araçları arasında ultrasonografinin yaygınlaşması ile birlikte bu durumun görünürlülüğü artmıştır. Bu çalışmada kliniğimizde spontan azalma ile sonuçlanan invajinasyon olgularının sunulması amaçlandı. Gereç ve Yöntemler: Ocak 2014 ile Eylül 2022 tarihleri arasında invajinasyon tanısı alan bütün olguların kayıtları tarandı. Gözlem sonucunda geçici invajinasyon tanısı konulan hastaların dosyaları incelendi. Yaş, cinsiyet, klinik bulgular, başvuru süresi, ultrasonografi bulguları, tedavi seçenekleri ve sonuçları retrospektif olarak incelendi. Bulgular: İnvajinasyon tanısı alan 50’si erkek, 21’i kız çocuğu olmak üzere toplam 71 olgunun yaş ortalaması 22.3 aydı. İnvajinasyon 36 hastada ileokolik, 32 hastada ileo-ileal ve 3 hastada jejuno-jejunaldi. Peritoneal irritasyon bulgusu olmayan ve kısa segment tutulumu olan 33 (%21) ince barsak invajinasyonlu hastaya fizik muayene ve ultrasonografi ile klinik gözlem yapıldı. Dört hastada gözlem sonrası invajinasyonun devam etmesi nedeniyle cerrahi redüksiyon uygulandı. Geri kalan 29 hastaya 12 saat sonra yapılan kontrol ultrasonunda invajinasyon görüntüsünün kaybolduğu görüldü. Geçici invajinasyon tanısı alan 29 hastanın yaş aralığı 10 ile 122 ay (ortalama 46.2 ay) arasında değişiyordu. Olguların 19’u (%65.5) erkek, 10’u (%34.4) kadındı. İnvaginasyonlu segmentin uzunluğu 1-2.2 cm (ortalama 1.8 cm) arasında değişiyordu. Sonuç: Akut batın bulguları olmayan ve ultrasonda kısa segment tutulumu ile seyreden ince barsak invajinasyonlarında klinik gözlem sonucu spontan redüksiyon meydana gelebilir. Bu nedenle spontan redüksiyon gelişebilecek uygun vakaların yakın takibi, gereksiz cerrahi müdahalelerin ve sonuçlarının önlenmesi açısından önemlidir.

Anahtar Kelimeler

• Çocuk
• İnvajinasyon
• Geçici
• Spontan redüksiyon

Kaynakça

1. 1. Pepper VK, Stanfill AB, Pearl RH. Diagnosis and management of pediatric appendicitis, intussusception, and Meckel diverticulum. Surg Clin North Am 2012; 92:505–26.
2. 2. Bines J, Ivanoff B. Acute Intussusception in infants and children: Incidence, clinical presentation and management: a global perspective. Geneva: World Health Organization 2002.
3. 3. Chouikha A, Fodha I, Maazoun K, Ben Brahim M, Hidouri S, Nouri A, et al. Rotavirus infection and intussusception in Tunisian children: implications for use of attenuated rotaviruses vaccines. J Pediatr Surg 2009; 44: 2133-8.
4. 4. Khalifa AB, Jebali A, Kedher M, Trabelsi A. Infectious etiology of acute idiopathic intussusception in children. Ann Biol Clin 2013; 71: 389-93.
5. 5. Marsicovetere P, Ivatury SJ, White B, Holubar SD. Intestinal Intussusception: Etiology, Diagnosis, and Treatment. Clin Colon Rectal Surg 2017; 30: 30-9.
6. 6. Mandeville K, Chien M, Willyerd FA, Mandell G, Hostetler MA, Bulloch B. Intussusception: clinical presentations and imaging characteristics. Pediatr Emerg Care 2012; 28: 842–4.
7. 7. Rajagopal R, Mishra N, Yadav N, Jhanwar V, Thakur A, Mannan N, et al. Transient versus surgically managed small bowel intussusception in children: Role of ultrasound. Afr J Paediatr Surg 2015; 12: 140-2.
8. 8. Hryhorczuk AL, Strouse PJ. Validation of US as a first-line diagnostic test for assessment of pediatric ileocolic intussusception. Pediatr Radiol 2009; 39: 1075-9.

9. 9. Zhang Y, Bai YZ, Li SX, Shou JL, Ren WD, Zheng LQ, et al. Sonographic findings predictive of the need for surgical management in pediatric patients with small bowel intussusceptions. Langenbecks Arch Surg 2011; 396: 1035–40.
10. 10. Khasawneh R, El-Hei M, Al-Omari M, Al-Qaralleh M, Al-Manasra AR, Alqudah AA, et al. The radiological characteristics of childhood intussusception including unusual features and rare pathological lead points. Heliyon 2021; 7: e07231.
11. 11. Betz BW, Hagedorn JE, Guikema JS, Barnes CL. Therapeutic enema for pediatric ileocolic intussusception: using a balloon catheter improves efficacy. Emerg Radiol 2013; 20: 385–91.
12. 12. Kim JH. US features of transient small bowel intussusception in pediatric patients. Korean J Radiol 2004; 5: 178-84
13. 13. Fallat ME. Intussusception. In Ashcraft KW et al (eds): Pediatric Surgery. W.B. Saunders Company, Philedelphia, pp 2000;518-526.
14. 14. Blanch AJ, Perel SB, Acworth JP. Paediatric intussusception: epidemiology and outcome. Emerg Med Australias 2007;19: 45-50.
15. 15. Shapkina AN, Shapkin VV, Nelubov IV, Pryanishena LT. Intussusception in children: 11-year experience in Vladivostok. Pediatr Surg Int 2006; 22: 901-4
16. 16. Bruce J, Borzi PA. Intussusception in childhood. Surgery 1992; 10: 213-216.
17. 17. Kornecki A, Daneman A, Navarro O, Conolly B, Manson D, Alton DJ. Spontaneous reduction of intussusception: clinical spectrum, management and outcome. Pediatr Radiol 2000; 30: 58–63.
18. 18. Fallon SC, Lopez ME, Zhang W, Brandt ML, Wesson DE, Lee TC, et al. Risk factors for surgery in pediatric intussusception in the era of pneumatic reduction. J Pediatr Surg 2013; 48: 1032–6.
19. 19. Tran LA, Yoshida LM, Nakagomi T, Gauchan P, Ariyoshi K, Anh DD, et al. A High Incidence of Intussusception Revealed by a Retrospective Hospital-Based Study in Nha Trang, Vietnam between 2009 and 2011. Trop Med Health 2013; 41: 121–7.
20. 20. Zissin R, Gayer G, Konen O, Shapiro-Feinberg M. Transient colocolic intussusception. Clin Imaging 2000; 24: 8-9.
21. 21. 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; 20:140–3.
22. 22. Jehangir S, John J, Rajkumar S, Mani B, Srinivasan R, Kang G. Intussusception in southern India: Comparison of retrospective analysis and active surveillance. Vaccine 2014;32 suppl:A99-103.
23. 23. Wang Q, Luo M, Xie X, Wu Y, Xiang B. Can intussusceptions of small bowel and colon be transient? A prospective study. Eur J Pediatr 2019; 178: 1537-44.