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Background: Intussusception is one of the most common abdominal emergencies in children. While the majority of childhood intussusceptions are ilecolic and idiopathic, small bowel intussusceptions are rare and a pathological trigger is often blamed for the etiology. Ultrasonography is the most commonly used diagnostic tool in the diagnosis of intussusception. Objectives: To determine auxiliary diagnostic criteria for ultrasonography in the differentiation of small bowel intussusceptions based on ultrasonography, reduction and surgical findings of surgically confirmed small bowel intussusceptions and to contribute to the diagnosis and treatment algorithm of small bowel intussusceptions based on our clinical experience. Methods: The records of patients who underwent surgery for small bowel intussusception at the Faculty of Medicine, Department of Pediatric Surgery between January 2008 and December 2020 were retrospectively reviewed. Demographic characteristics, ultrasonographic findings, onset and duration of symptoms, treatment method, intraoperative findings and histopathological results of the patients were recorded. Results: Thirty-six pediatric patients with small bowel intussusception were operated. The average age of these patients was 59 ± 49.7 months and %78 was male. The location of the small bowel intussusception detected by ultrasound scan was the paraumbilical area and left quadrant in 19 (53%) patients and the right quadrant in 15 (42%) patients. In ultrasonography, the mean diameter of the invaginated segment was 3 (1.2-6.5) cm and the mean length was 6.7 (3-15) cm. Pathological lead points were detected in the etiology of nineteen (53%) patients. Thirteen (36%) patients underwent segmental resection and anastomosis due to necrosis. Conclusions: Small bowel intussusceptions are often localized in the paraumbilical and left upper quadrant. However, it should be kept in mind that it may be localized in the right lower quadrant like ileocolic invaginations. Enema reduction can be used as an adjunctive diagnostic method to exclude ileocolic invaginations rather than treatment in these patients. The diameter and length of the invaginated segment may be decisive in the surgical decision of the small bowel intussusception. Giriş: İnvaginasyon, çocuklarda sık görülen abdominal acillerden birisidir. Çocukluk çağı invaginasyonlarının büyük çoğunluğu ilekolik seviyede ve idiopatik iken, ince barsak invaginasyonları daha nadir olup etyolojide sıklıkla bir patolojik tetikleyici suçlanmaktadır. Ultrasonografi invaginasyon tanısında en sık kullanılan tanı aracıdır. Amaç: Cerrahi olarak kesinleşmiş ince barsak invaginasyonlarının ultrasonografi, redüksiyon ve cerrahi bulgularından yola çıkarak ince bağırsak invaginasyonlarında yardımcı tanı kriterleri belirlemek ve klinik deneyimlerimize dayanarak ince barsak invaginasyonlarının tanı ve tedavi algoritmasına katkıda bulunmak. Yöntemler: Tıp Fakültesi Çocuk Cerrahisi Kliniğinde Ocak 2008 - Aralık 2020 yılları arasında ince bağırsak invaginasyonları nedeniyle cerrahi olan hastaların kayıtları retrospektif olarak incelendi. Hastaların demografik özellikleri, ultsonografik bulguları, semptomların başlangıcı ve süresi, tedavi yöntemi, intraoperatif bulgulari ve patoloji sonuçları kaydedildi. Bulgular: İnce bağırsak invaginasyonu olan 36 hasta cerrahi olarak tedavi edildi. Bu hastaların ortalama yaşı 59 ± 49,7 ay ve %78'i erkek idi. Ultrasonografi ile saptanan invagininasyon segmentinin yeri 19 (%53) ‘unda paraumbilikal alan ve sol kadran, 15(%42) 'inde sağ kadran idi. Ultrasonografide invagine segmentin ortalama çapı 3 (1,2-6,5) cm ve ortalama uzunluğu 6,7 (3- 15) cm idi. Hastaların 19(%53)'unda etyolojide patolojik lead point tespit edildi. Onüç (%36) hastaya nekroz nedeniyle segmental rezeksiyon ve anastomoz uygulandı. Sonuçlar: İnce barsak invaginasyonları sıklıkla paraumblikal ve sol üst kadran lokalizasyonludur. Ancak ileokolik invaginasyonlar gibi sağ alt kadran lokalizasyonlu olabileceği de unutulmamalıdır. Enema redüksiyon, bu hastalarda tedaviden ziyade ileokolik invaginasyonların dışlanmasında yardımcı bir tanı yöntemi olarak kullanılabilir. SBI'nın cerrahi kararında, invajine segmentin çapı ve uzunluğu belirleyici olabilir.

The present study aimed to investigate the time-related predicting factors of the ultrasound-guided hydrostatic reduction (USGHR) failure in pediatric patients with ileocolic intussusception and delayed presentation.The present retrospective study included pediatric patients diagnosed with ileocolic intussusception who presented to our hospital with the related symptoms started 48 hours ago or greater duration during 2018-2020. The patients with spontaneous reduction were excluded from the study. Afterward, the participants with failed and successful USGHR were compared in terms of age, sex, symptom duration, and ultrasound findings using the χ 2 and logistic regression tests.A total of 103 children were included in the present study. The mean symptom duration was 4.13 ± 2.39 days, with a range of 2-14 days. Moreover, 47.6% of the patients had a successful reduction. In addition, there was a significant relationship between failed USGHR and the factors of symptom duration, free peritoneal fluid, entrapped fluid between intussuscepted loops, the size of the invaginated segment, and malperfusion of the intussuscepted bowel loops detected using the Doppler ultrasound ( P0.05). However, there was no significant relationship between failed USGHR and the factors of the primary location of intussusception and the presence of intussuscepted lymph nodes ( P0.05).The presence of entrapped fluid between the intussuscepted loops, free peritoneal fluid, and the length of the intussuscepted segments were all associated with USGHR failure in our study. Therefore, determining these predictors may help anticipate failure of reduction.

A 43-year-old woman with a right ovarian cyst presented with a 4-month history of recurrent epigastric pain and nausea once a day each month. Her symptoms spontaneously improved during each previous episode; however, the current episode was associated with the severe symptoms including epigastric

Primary adenocarcinoma of the fourth portion of the duodenum (D-IV) is reported infrequently than other parts of the duodenum. Its diagnosis is often late because of non-specific symptoms and signs. We encountered a 48-year-old male patient who was diagnosed as duodeno-duodenal intussusception, underwent segmental duodenal resection with duodenojejunal anastomosis and confirmed as adenocarcinoma of D-IV. He received adjuvant chemotherapy and is doing well at 1 year of follow-up. This report describes about the rare case of isolated adenocarcinoma of the D-IV presented as intussusception which is never reported before and successfully treated by segmental resection of the duodenum and jejunum.

A 40-year-old woman presented with acute-onset colicky abdominal pain. On physical examination, the patient was afebrile with a heart rate of 95 beats per minute. Abdomen was soft with tenderness in the periumbilical location. No rebound tenderness or guarding was noted. There was no palpable mass.

Ileocolic intussusception is considered a pediatric emergency, with concerns for risk of significant morbidity in children with a prolonged intussusception state. Emergent therapy is standard of care, as prior studies have shown poor outcomes in patients with long delays ( 24 h) before intervention. Various factors can result in shorter delays, and there are limited studies evaluating outcomes in these patients. This study aimed to determine if there were differences in reduction success rates associated with short in-hospital time delays.This study is to determine enema success rate and morbidity in patients with documented time delays between intussusception diagnosis and therapeutic enema.A retrospective evaluation of pediatric patients with intussusception at a single children's hospital between 2007 and 2019 was performed. Patient's records were reviewed for time of symptom onset, radiologic diagnosis, and attempted enema. Ultrasounds and radiographs were reviewed for bowel obstruction, free peritoneal fluid, trapped fluid around the intussusceptum, and absent bowel wall perfusion. Patients were evaluated for efficacy of reduction attempt, requirement for surgical reduction, and complications including bowel resection and bowel perforation.There were 175 cases of ileocolic intussusception requiring enema reduction. Successful reduction occurred in 72.2% (13/18) of cases performed within 1 h of diagnosis; 74.3% (78/105) between 1 and3 h; 73.2% (30/41) between 3 and 6 h; and 81.2% (9/11) with greater than 6 h. Need for bowel resection was not associated with short delays between diagnosis and reduction attempts (p = .07).There was no difference in intussusception reduction efficacy or complication rate in patients with increasing time between imaging diagnosis of ileocolic intussusception and reduction attempt, including delay intervals up to 8 h.

Ileocolic intussusception is a common cause of pediatric bowel obstruction. Contrast enema is successful in treating the majority of patients, and if initially unsuccessful, approximately one-third may be reduced with repeat enemas. We sought to study protocol implementation for delayed repeat enema in pediatric patients not reduced completely by an initial contrast enema. Our aims were to assess repeat enema success rates and outcome differences in preprotocol and postprotocol patients with respect to (1) intussusception recurrence, (2) surgical intervention and complication rates, and (3) length of stay.We performed a retrospective review of treatment and clinical outcomes prior to and following protocol implementation for repeat enema for intussusception at two tertiary pediatric referral hospitals. The preprotocol period was defined from 2/2013 to 2/2016, and the postprotocol period was from 8/2016 to 11/2019.There were 112 patients in the preprotocol group, with 74 (66%) having successful reduction following the first enema. Of the 38 patients without successful reduction, 16 (42%) patients underwent repeat enema, and five were successful (31%). The postprotocol group included 122 patients, with 84 (69%) having successful first reduction. Of the 38 patients that failed, 25 patients (66%) underwent repeat enema, of which 13 (52%) were successful. Compared to preprotocol patients, postprotocol patients had significantly more enemas repeated and a trend toward fewer surgical interventions.Protocol implementation of repeat delayed enemas was significantly associated with an increased rate of repeat enemas at our institutions and reduced need for operative intervention during the index stay.

Multiple studies have shown an association between intussusception (IS) and receipt of monovalent or pentavalent rotavirus vaccine (RV) in the previous 21 days. Disease severity is an important consideration for risk-benefit evaluations of RV, but no studies have compared the severity of IS within 21 days of vaccination (vaccine-associated, VA) and later (not temporally-associated, VNA).We used active hospital-based surveillance in the Australian Paediatric Active Enhanced Disease Surveillance (PAEDS) network (July 2007 to February 2018) to identify infants ≤9 months of age meeting Brighton level 1 criteria for IS. We used five severity levels: (1) no surgery and length of stay (LOS) ≤1 day, (2) no surgery and LOS ≥2 days, (3) surgery, no bowel resection, (4) bowel resection, and (5) ICU admission.Of 323 eligible cases, 87 (26.9%) were VA and 236 (73.1%) VNA. VA-IS cases (median 21 weeks; 24.1% ≤14 weeks) were significantly younger than VNA-IS cases (median 28 weeks, 7.2% ≤14 weeks). Cases 0-≤14 weeks of age were significantly more likely than cases ≥25 weeks to require bowel resection (relative risk ratio 4.6, 95% CI, 1.48-14.3). This effect was not associated with RV. After adjustment for age and sex, VA-IS was not significantly overrepresented in severity levels 2-5; adjusted RRR of 1.37 (95% CI: 0.61-3.11) for bowel resection in cases 0-≤14 weeks of age.IS was uncommon but significantly more severe under 14 weeks of age. After adjustment for age and sex, IS severity was not related to RV.

Outcomes of ultrasound-guided saline enema include successful treatment, unsuccessful treatment, or recurrence. This study aimed to investigate the value of ultrasonic parameters of the ileocecal region during hydrostatic reduction to predict enema outcomes.Ultrasound images of patients diagnosed with ileocolic intussusception and treated with ultrasound-guided saline enema at two different institutions between January 2019 and April 2021 were retrospectively analyzed to assess ileocecal-valve diameter (ICVD), intussusceptum thickness (IT), and the ratio of IT to ICVD (I/I). Logistic regression analysis was used to explore correlations between ICVD, IT, I/I, and patient characteristics (sex, age, symptom duration, and enema outcome).Of 291 patients with ileocolic intussusception (207 boys; mean ICVD, 8.6 [SD: 0.1] mm; mean IT, 26 [SD: 0.2] mm; mean I/I, 3.0 [SD: 0.01]), 268 had first successful reduction; 23, first failed reduction; 7, final failed reduction; and 41, early recurrence. Significant risk factors for failed reduction included symptom duration24 hours (odds ratio [OR] = 10, P = .012), ICVD ≤ 8.5 mm (OR = 8, P = .01), and I/I 3.25 (OR = 16, P .001). Significant risk factors for early recurrence post-enema included age 1 year (OR = 10, P = .028), ICVD 8.5 mm (OR = 4, P = .003), and I/I ≤ 2.95 (OR = 6, P .001).ICVD and IT measured during ultrasound-guided hydrostatic reduction can predict enema outcomes. The mismatch between IT and ICVD is the primary cause of poor outcomes.

Aim: The aim of this work was to study the technical success and diagnostic capability of magnetic resonance defaecography (MRD) compared with video defaecography (VD). Method: Sixty four women with defaecation disorders underwent both MRD and x-ray VD over 1 year. The assessment by two radiologists in consensus was retrospective and blinded. The technical success of straining and evacuation was evaluated subjectively. The presence of enterocele, intussusception, rectocele and dyssynergic defaecation was analysed according to established criteria, with VD as the standard of reference. Results: It was found that 62/64 (96.9%) VD studies were technically fully diagnostic compared with 29/64 (45.3%) for MRD. The number of partially diagnostic studies was 1/64 (1.6%) for VD versus 21/64 (32.8%) for MRD, with 1/64 (1.6%) (VD) and 14/64 (21.9%) (MRD) being nondiagnostic. Thirty enteroceles were observed by VD compared with seven in MRD with moderate agreement (κ = 0.41). Altogether 53 intussusceptions were observed by VD compared with 27 by MRD with poor agreement (κ = −0.10 and κ = 0.02 in recto-rectal and recto-anal intussusception, respectively). Moderate agreement (κ = 0.47) was observed in diagnosing rectocele, with 47 cases by VD and 29 by MRD. Dyssynergic defaecation was observed in three patients by VD and in 11 patients by MRD, with slight agreement (κ = 0.14). Conclusions: The technical success and diagnostic capabilities of VD are better than those of MRD. VD remains the method of choice in the imaging of defaecation disorders.

Transanal protrusion of intussusception (TAPI; also known as prolapsed intussusception) is a rare complication. Here, we present a successful colonoscopic reduction of ileocolic intussusception presented with transanal prolapse. An 8‑month male child, weighing 8 kg, was referred to our hospital presenting with a mass in his anal canal, diarrhea and rectal bleeding for two days. The sonographic evaluation revealed an ileocolic intussusception in the rectosigmoid area. The patient was treated using colonoscopic reduction. To our knowledge, this is the first study reporting colonoscopic reduction for transanal prolapsed intussusceptions. Our study suggests gastroenterologists to consider colonoscopy as a therapeutic method for prolapsed intussusceptions and encourages them to attempt reducing the invagination using this method before laparotomy, especially in cases presenting within 48 h of onset of symptoms and no peritonitis symptoms.Die transanale Protrusion einer Invagination (TAPI) ist eine seltene Komplikation, die auch als prolabierte Invagination bezeichnet wird. Im Beitrag wird die erfolgreiche koloskopische Reposition einer ileokolischen Invagination mit transanalem Prolaps beschrieben. Ein 8 Monate altes, 8 kg schweres männliches Kind wurde mit einer Raumforderung im Analkanal, Diarrhö und seit 2 Tagen bestehenden rektalen Blutungen in unser Krankenhaus eingewiesen. In der Ultraschalluntersuchung zeigte sich eine ileokolische Invagination im Bereich des Rektosigmoids. Der Patient wurde koloskopisch behandelt. Unseres Wissens ist dies die erste Arbeit, die über eine koloskopische Reposition einer transanal prolabierten Invagination berichtet. Unsere Arbeit schlägt Gastroenterologen vor, die Koloskopie als therapeutisches Verfahren bei prolabierten Invaginationen in Betracht zu ziehen, und ermutigt zu einem koloskopischen Repositionsversuch vor einer Laparotomie, vor allem bei Patienten, die innerhalb von 48 h nach Symptombeginn vorgestellt werden und die keine Peritonitissymptomatik erkennen lassen.

The patient’s destiny often depends on the pediatrician infectious disease specialist’s ability to appraise the abdominal pain. In this article we analyzed the incidence of development of the intussusception in children with dyspepsia, also we represented the clinical features of this surgical disease., От умения врача педиатра-инфекциониста правильно интерпретировать абдоминальную боль нередко зависит судьба пациента. В статье анализируется частота развития инвагинации у детей, возникшей на фоне диспептических проявлений, отображены клинические особенности данной хирургической патологии., Від уміння лікаря педіатра-інфекціоніста інтерпретувати абдомінальний біль часто залежить доля пацієнта. У статті аналізується частота розвитку інвагінації у дітей, що виникла на тлі диспептичних явищ, відображені клінічні особ­ливості цієї хірургічної патології.

Intussusception, although quite common in children with the classic triad of cramping abdominal pain, bloody diarrhea, and palpable masses, is a rare cause of acute abdomen with myriad presentations in adults. It is defined as the telescoping of a proximal segment of the gastrointestinal (GI) tract, called the intussusceptum, into the lumen of the adjacent distal segment of the GI tract, called intussuscipiens. Due to its different manifestations and time course, adult colonic intussusception often poses a diagnostic challenge for emergency doctors. The treatment of colonic intussusception in adults typically involves surgery, often with bowel resection and anastomosis followed by a defunctioning loop ileostomy. We report a case of left-sided colocolic intussusception secondary to a tubular adenoma as the lead point, which was successfully treated by resection and primary anastomosis. The pathological diagnosis of the lesion was reported as adenocarcinoma and resected bowel margins were found free of the tumor.

We implemented a quality improvement (QI) initiative to safely reduce post-reduction monitoring for pediatric patients with ileocolic intussusception. We hypothesized that there would be decreased length of stay (LOS) and hospital costs, with no change in intussusception recurrence rates.A retrospective cohort study was conducted of pediatric ileocolic intussusception patients who underwent successful enema reduction at a tertiary-care pediatric hospital from January 2015 through June 2020. In September 2017, an intussusception management protocol was implemented, which allowed discharge within four hours of reduction. Pre- and post-QI outcomes were compared for index encounters and any additional encounter beginning within 24 h of discharge. An economic evaluation was performed with hospital costs inflation-adjusted to 2020 United States Dollars ($). Cost differences between groups were assessed using multivariable regression, adjusting for Medicaid and transfer status, P 0.05 significant.Of 90 patients, 37(41%) were pre-QI and 53(59%) were post-QI. Patients were similar by age, sex, race, insurance status, and transfer status. Pre-QI patients had a median LOS of 23.4 h (IQR: 16.1-34.6) versus 9.3 h (IQR 7.4-14.2) for post-QI patients, P 0.001. Mean total costs per patient in the pre-QI group were $3,231 (95% CI, $2,442-$4,020) versus $1,861 (95% CI, $1,481-$2,240) in the post-QI group. The mean absolute cost difference was $1,370 less per patient in the post-QI group (95% CI, [-$2,251]-[-$490]). Five patients had an additional encounter within 24 h of discharge [pre-QI: 1 (3%) versus post-QI: 4 (8%), p = 0.7] with four having intussusception recurrence [pre-QI: 1 (3%) versus post-QI: 3 (6%), p = 0.6].Implementation of a quality improvement initiative for the treatment of pediatric intussusception reduced hospital length of stay and costs without negatively affecting post-discharge encounters or recurrence rates. Similar protocols can easily be adopted at other institutions.Level III.Retrospective comparative treatment study.

Incidental findings are common in the evaluation of surgical patients. Understanding the appropriate assessment and management of these frequent occurrences is important for the provision of comprehensive quality care. This review details the epidemiology, considerations, and recommendations for management of common incidental manifestations in surgical patients, including Meckel diverticulum, adrenal incidentaloma, thyroid nodule, solitary pulmonary nodule, small bowel intussusception, gallstones, and incidental appendectomy.

The case was a 17-year-old young woman with a one-year history of recurrent abdominal pain and discomfort. B-scan ultrasonography identified intussusception and contrast-enhanced computed tomography of the pelvis revealed volvulus. A laparoscopic procedure was planned to identify the reason for the intussusception and obstruction. Intraoperatively, the intussusception was found to be caused by a cauliflower-shaped polypoid tumor measuring approximately 4 × 3 cm. Postoperative pathological examination identified the tumor to be a traditional serrated adenoma of the small intestine, which is rare and has atypical clinical manifestations. If unexplained abdominal pain or gastrointestinal bleeding occurs and an abdominal mass cannot be accurately located, laparoscopic or open surgery should be performed immediately. Early surgery is the most effective and reliable way of securing a prompt diagnosis and a favorable prognosis.

We aimed to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on the incidence of intussusception.Literature search of the PubMed and EMBASE databases was conducted for articles published in English until August 5, 2022.Overall, 127 articles were retrieved, and five studies from South Korea (n=4) and the United States of America (n=1) containing clinical data from single-center medical records to nationwide databases were ultimately included in the systematic review. All the included studies reported that the incidence of intussusception decreased significantly during the pandemic period compared with the pre-pandemic period. The communicable disease incidence tended to decrease even as the incidence of non-communicable diseases did not significantly change. There was no significant difference in the time to diagnosis between the pre-pandemic and pandemic periods; however, the time to radiologic reduction was significantly longer or not depending on the study.The COVID-19 pandemic significantly reduced the incidence of intussusception in children, supporting the hypothesis that infection plays a major role in the etiology of intussusception. Future studies in the late pandemic or post-pandemic era, which would represent the level of implementation of non-pharmaceutical interventions and social distancing as well as additional data from various countries will be needed.

BACKGROUND Colonic intussusception is a very rare disease in adults, and if present, is usually manifested by another pathology, such as malignancy. This report describes the diagnosis and treatment of the underlying cause of intussusception, which was spontaneously reduced. CASE REPORT A 39-year-old woman with no significant past medical history presented to St. Joseph's University Medical Center on July 2022 with gradually worsening abdominal pains for 1 year and hematochezia for 3 months. Physical examination was positive for left lower quadrant abdominal tenderness to palpation. A computed tomography scan of the abdomen and pelvis without contrast showed a long segment of intussusception involving the sigmoid colon and rectum, without any noticeable lesions. A repeat computed tomography scan with rectal contrast showed a 2.1×1.1-cm mesenteric mass in the sigmoid colon at the region of the intussusception. The patient was taken for a laparoscopic sigmoid resection with primary anastomosis, showing a 5-cm mass in the sigmoid colon, and surgical pathology confirming neoplastic etiology of intussusception. The patient recovered well after surgery, and was referred for oncological intervention soon afterward. CONCLUSIONS This report displays the importance of the type of imaging modalities with and without contrast to diagnosis and determine underlying causes of intussusception and further guide treatment options.

The first-line treatment for intussusception is radiologic reduction with either air-contrast enema (AE) or liquid-contrast enema (LE). The purpose of this study was to explore relationships between self-reported institutional AE or LE intussusception reduction preferences and rates of operative intervention and bowel resection.Pediatric Health Information System (PHIS) hospitals were contacted to assess institutional enema practices for intussusception. A retrospective study using 2009-2018 PHIS data was conducted for patients aged 0-5 y to evaluate outcomes. Chi-squared tests were used to test for differences in the distribution of surgical patients by hospital management approach.Of the 45 hospitals, 20 (44%) exclusively used AE, 4 (9%) exclusively used LE, and 21 (46%) used a mixed practice. Of 24,688 patients identified from PHIS, 13,231 (54%) were at exclusive AE/LE hospitals and 11,457 (46%) were at mixed practice hospitals. Patients at AE/LE hospitals underwent operative procedures at lower rates than at mixed practice hospitals (14.8% versus 16.5%, P0.001) and were more likely to undergo bowel resection (31.1% versus 27.1%, P= 0.02).Practice variation exists in hospital-level approaches to radiologic reduction of intussusception and mixed practices may impact outcomes.

Background The causes of idiopathic ileocolic intussusception are unknown, with infection as the most likely culprit. Recently, social distancing measures were implemented during the coronavirus disease 2019 (COVID-19) pandemic to decrease transmissible infectious diseases, creating an opportune setting to study the role of infection on the pathogenesis of intussusception on a population level. Objective To investigate the impact of social distancing on intussusception. Materials and methods We retrospectively reviewed air contrast enemas and pylorus ultrasounds performed between March 2010 and March 2021 to identify cases of ileocolic intussusception and hypertrophic pyloric stenosis (HPS), using the latter as a negative control. The study time frame was divided into two periods: pre-pandemic (March 2010–February 2020) and pandemic (April 2020–March 2021). The number of cases that occurred in these two time periods were compared using the Poisson regression model. Results Of the 407 cases of idiopathic ileocolic intussusception identified, 396 occurred in the pre-pandemic time period (mean = 39.6 per 12-month period) and 11 occurred in the 12-month pandemic time period. The mean monthly number of intussusceptions showed a decline of 72% (95% confidence interval [CI] 49–85%) between the pre-pandemic and pandemic time periods (3.3 vs. 0.9 monthly cases; P

Objectives The primary objective of this study was to analyze and review the demographics of children operated upon for intussusception. Secondary objectives were to review the clinical characteristics, surgical procedures performed, postoperative complications, and outcome. Materials and Methods It is a single-institution, retrospective study and consists of children below the age of 12 years. This study was conducted at the author’s department of pediatric surgery for the past 21 years, from January 1, 2000 to December 31, 2020. Results During the study period, 212 children were operated upon for intussusceptions and included 146 (68.86%) boys and 66 (31.13%) girls. This review consisted of infants 158 (74.52%), and children of 1 to 5 years of age (30; 14.15%), and 6 to 12 years of age (24; 11.32%). Clinically, 177 (83.49%) children presented with the features of acute intestinal obstruction, and the remaining 35 (16.5%) presented with features of perforation peritonitis. Primary (idiopathic) intussusception was documented in 188 (88.67%) of the cases. Gangrenous bowel was evident in 98 (46.22%) children. Sixty-two percent of the cases required bowel resection. Surgical procedures were executed in children for intussusception in the following order of frequency: (1) operative reduction with or without serosal tear/bowel perforation repair, n = 81 (38.2%); (2) resection of diseased ileum and ileoileal anastomosis, n = 52 (24.52%); (3) resection of diseased ileum ± part of colon and an ileostomy, n = 36 (16.98%); and (4) resection of diseased ileum, cecum, part of colon, and ileocolic (ileo-ascending or ileo-transverse) anastomosis, n = 43 (20.28%). Postoperatively, 9 (4.24%) children required reexploration for the management of their complications. Twenty-one (9.9%) children died during the postoperative period. Conclusion Intussusception remains the most common cause of acute intestinal obstruction in infants and young children. Delay in the referral, diagnosis, and seeking treatment were significantly associated with bowel gangrene, required bowel resection during the surgical therapy, and also culminated in significantly higher mortalities.

Purpose we attempted to summarize the clinical characteristics of recurrent intussusception through a large sample size retrospective study. Methods 5778 patients who were diagnosed with intussusception and treated in our hospital between January 2014 and December 2018 were reviewed. Results the overall recurrence rate was 20.0%, with the recurrence frequency ranged from 1 to 17 episodes and the recurrence interval ranged from 0 to 5 years. 80.0% (926/1158) patients had only 1 to 2 episodes of recurrence. Most of the patients (88.3%) relapsed within 1 year after successful reduction, among which 616 patients (53.2%) relapsed within 3 days. The recurrence rate of intussusception was the lowest when the age was less than 1 year, increased and kept high level in patients aged from 1 to 5 years old, then decreased after 5 years. The pathologic lead point (PLP) proportion of recurrence group was higher than that of non-recurrence group (2.2% VS 1.2%, P = 0.005). Conclusions the overall recurrence rate was 20.0%. Most of the patients had only 1 to 2 episodes of recurrence and relapsed within 1 year after successful reduction. Age and PLP were risk factors for intussusception recurrence.

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.

To develop a model to identify risk factors and predict recurrent cases of intussusception in children.Consecutive cases and recurrent cases of intussusception in children from January 2016 to April 2022 were screened. The cohort was divided randomly at a 4:1 ratio to a training dataset and a validation dataset. Three parallel models were developed using extreme gradient boosting (XGBoost), logistic regression (LR), and support vector machine (SVM). Model performance was assessed by the area under the receiver operating characteristic curves (AUC).A total of 2469 cases of intussusception were included, where 225 were recurrent cases. The XGBoost (AUC = 0.718) models showed the best performance in the validation dataset, followed by the LR model (AUC = 0.652), while the SVM model (AUC = 0.613) performed worst among the three models. Based on the Shapley Additive exPlanation values, the most important variables in the XGBoost models were air enema pressure, mass size, age, duration of symptoms, and absence of vomiting.Machine learning models, especially XGBoost, could be used to predict recurrent cases of intussusception in children. The most important contributing factors to the models are air enema pressure, mass size, age, duration of symptoms and absence of vomiting.

Background: Intussusception is a condition found primarily in the pediatric population. In the adult population, however, intussusception is usually due to a pathological process, with a higher risk of bowel obstruction, vascular compromise, inflammatory changes, ischemia, and necrosis. Radiographic and sonographic evidence can aid in the diagnosis. Surgical intervention involving resection of affected bowel is the standard of care in adult cases of intussusception. Case Reports: We present the case of a 21-year-old female who presented to the Emergency Department with diffuse cramping abdominal pain and distention. Workup revealed ileocecal intussusception, with a prior appendectomy scar serving as the lead point discovered during exploratory laparotomy. We also present the case of a 66-year-old male, who presented with one week of intermittent lower abdominal pain associated with several episodes of nausea and vomiting. Workup revealed ileocolic intussusception secondary to adenocarcinoma of the right colon, confirmed upon exploratory laparotomy with subsequent right hemicolectomy. Conclusion: In the adult population, intussusception is usually caused by a lead point, with subsequent telescoping of one part of the bowel into an adjacent segment. While intussusception can occur in any part of the bowel, it usually occurs between a freely moving segment and either a retroperitoneal or an adhesion-fixed segment. The etiology may be associated with pathological processes such as carcinoma or iatrogenic causes, such as scars or adhesions from prior surgeries. The cases presented here demonstrate important etiologies of abdominal pain in adult patients. Along with gynecological etiologies of lower quadrant abdominal pain in female patients, it is important for the emergency physician to expand the differential diagnosis to include other causes, such as intussusceptions, especially given the symptoms that could be associated with bowel obstruction.

The authors present diagnosis and treatment of two children with postoperative intussusception. A 6-month baby with retroperitoneal teratoma developed clinical signs of intestinal obstruction in 2 days after surgery. The child underwent redo laparotomy, and ileocecal intussusception was found. In the second case, a 6-month baby with choledochal cyst underwent laparotomy, cyst excision and Roux-en-Y-hepaticojejunostomy. Six days later, clinical deterioration with signs of bowel obstruction appeared. Redo laparotomy was performed for early adhesive ileus, and ileoileal intussusception was observed. In both cases, postoperative intussusception was diagnosed during relaparatomy that confirms the complexity of diagnosis.Представлен анализ результатов диагностики и лечения двух детей с редким заболеванием органов брюшной полости — послеоперационной инвагинацией кишечника. Первое клиническое наблюдение ребенка, 6 мес, после операции по поводу тератомы забрюшинного пространства. На 2-е сутки появилась клиника непроходимости кишечника. С диагнозом «ранняя спаечная кишечная непроходимость» выполнена релапаратомия. На операции выявлена слепо-ободочная инвагинация кишечника, произведена дезинвагинация. Во втором наблюдении у ребенка, 6 мес, с диагнозом «киста холедоха» выполнен гепатикоеюноанастомоз на изолированной петле по Ру. На 6-е сутки состояние ухудшилось, появилось вздутие живота, не отходили газы, стула не было. По желудочному зонду появилось отделяемое зеленого цвета, произведена релапаратомия по поводу ранней спаечной кишечной непроходимости. Интраоперационно диагностирована тонко-тонкокишечная инвагинация. Произведена дезинвагинация. В обоих наблюдениях диагноз послеоперационной инвагинации кишечника установлен во время релапаратомии, что подтверждает сложность диагностики.

Background Primary intussusception in children is a common acute abdominal disease. The cause of this disease is still not fully understood. Many articles have reported that children with intussusception are often accompanied by hyperplasia of mesenteric lymph nodes and submucosal lymphoid tissue of the terminal ileum. Therefore, hyperplasia of intestinal-associated lymphoid tissue (mesenteric lymph nodes and submucosal lymphoid tissue of the intestinal tract) may be one of the main causes of intussusception. However, the characteristics and differences of intestinal-associated lymphoid tissues in healthy children and children with intussusception at different ages have not been reported. In addition, the relationship between mesenteric lymph nodes and intestinal submucosal lymphatic tissue also needs to be further understood. Methods 73 patients with intussusception during the recovery phase who were treated in our hospital from October 2019 to October 2021 were collected as the observation group, while 101 children with healthy physical examination or diseases unrelated to intestinal lymphoid hyperplasia were collected as the control group. They were divided into different age groups of 1–6 months, 7–12 months, 13–18 months, 19–24 months, 25–36 months, 3–4 years, 5–6 years, and 7–8 years old. Ultrasonography was used to explore and scan mesenteric lymph nodes in fixed areas of the right lower abdomen and around the umbilicus. The size (cm3) and number (n) of detectable lymph nodes in each region were recorded and calculated, and the total mesenteric lymph node volume (cm3) of the right lower abdomen (RLTMLNV) and periumbilical region (PTMLNV) was calculated, respectively. The total mesenteric lymph node volume of each region in different ages of the two groups was analyzed. Results (1) There were significant differences between the control group and the observation group in the right lower abdominal total mesenteric lymph nodes volume (RLTMLNV) and the periumbilical total mesenteric lymph nodes volume (PTMLNV) (P = 0.001). The mesenteric lymph nodes in the observation group showed severe hyperplasia. (2) Children with intussusceptions are usually accompanied by severe mesenteric lymphoid hyperplasia. The mean volume value of RLTMLNV was greater than that of PTMLNV. Especially within 2 years of age, the mean value of RLTMLNV was significantly higher than that of PTMLNV with statistical significance (P Conclusions Our research shows: (1) The occurrence of primary intussusception in children is related to the hyperplasia of intestinal-associated lymphoid tissue. (2) Children with intussusceptions were usually accompanied by severe mesenteric lymphoid hyperplasia. The mesenteric lymphoid hyperplasia was more evident in the right lower abdominal ileocecal area than in the periumbilical area before 2 years of age. RLTMLNV has better predictability of intussusception than PTMLNV. The occurrence of intussusceptions was more closely related to the hyperplasia of intestinal-associated lymphoid tissue in the right lower abdomen. (3) Normal children showed a low degree of mesenteric lymphoid hyperplasia before 2 years old, moderate hyperplasia after 2 years old, and mesenteric lymphoid hyperplasia in the right lower abdominal ileocecal area was basically the same as the periumbilical area. The lymphatic tissue of the right lower abdomen and periumbilical mesentery in children with intussusceptions showed severe hyperplasia, and there were no significant differences among different age groups.

Intestinal intussusception is a pathology in which an intestinal segment and its mesentery are telescoped into an adjacent intestinal segment as a result of peristalsis, and in many cases cause intestinal obstruction. Its etiology can be variable, including intestinal diverticula, adhesion bands, vascular malformations, neoplasms, among others. The vast majority occur in pediatric patients, however, up to 5% of these are documented in adult patients and their main etiology in this age group are neoplasms. We present a case of intestinal intussusception secondary to Burkitt's lymphoma that received management at fourth level hospital in Bogotá, Colombia.La intususcepción intestinal es una patología en la que un segmento intestinal y su mesenterio se invaginan al segmento intestinal contiguo. Su etiología puede ser benigna, maligna o idiopática, dentro de las que se incluyen divertículos intestinales, bandas adherenciales, malformaciones vasculares y neoplasias, entre otras. La mayoría se presentan en pacientes pediátricos, pero hasta un 5% se documentan en pacientes adultos y su principal etiología en este grupo etario son las neoplasias. Presentamos un caso de intususcepción intestinal secundaria a linfoma de Burkitt que recibió manejo en un hospital de cuarto nivel en Bogotá, Colombia.

Rare incidence cases are part of the routine work of pediatric surgeons. Cecal anomalies in children are an example of such cases. Objectives: To describe the presentation, workup, management and outcome of rare cecal anomalies in children and to analyze the skills needed for their successful treatment.A retrospective chart review was conducted of all cases of cecal anomalies managed by the pediatric surgical service at a tertiary hospital from June 2017 to January 2020. Data regarding demographics, clinical presentation, radiological studies, surgical treatment, pathology, complications, and outcome were collected.Five cases of cecal anomalies were encountered over a period of 32 months, including a cecal volvulus, cecal duplication, cecal intussusception, and two cecal masses (one ulcerated lipoma and one polyp). All patients, except the patient with cecal duplication, presented acutely and were managed surgically. Long-term follow-up of 17-24 months was unremarkable in all cases.A wide knowledge base, careful judgment, and creativity enable pediatric surgeons to successfully treat rare conditions such as rare cecal anomalies. These skills should be part of the education of pediatric surgery trainees.

Introducción: la invaginación intestinal es causa frecuente de síndrome oclusivo en etapa de lactante, y la reducción hidrostática guiada por ecografía es una opción de tratamiento conservador. Objetivo: determinar la eficacia de la reducción hidrostática guiada por la ecografía en el tratamiento de la invaginación intestinal en el Hospital Pediátrico Docente “General Pedro Agustín Pérez”, de Guantánamo, durante el período enero de 2017 a enero de 2022. Método: se realizó un estudio descriptivo y retrospectivo en el servicio de Cirugía Pediátrica de dicha institución. El universo se constituyó por el total de pacientes tratados con esa terapéutica (n=59), en los cuales se estudió: edad, sexo, manifestaciones clínicas, número de intentos de reducción, tiempo de evolución de la invaginación y la reductibilidad, complicaciones durante o después del proceder y necesidad de tratamiento quirúrgico y la causa del mismo. La información se obtuvo mediante la revisión del registro estadístico del Comité de Intervenciones Quirúrgicas del centro y las historias clínicas. Resultados: predominó el sexo masculino (62,7 %), la edad entre 3 a 6 meses de edad (59,3 %) y los síntomas vómitos e irritabilidad (59,3 %). Se logró la reducción hidrostática en el 91,5 % de los casos, de ellos, en el primer intento el 83,0 %. El 100,0 % de los pacientes tuvo menos de 24 horas de evolución y se logró la desinvaginación en el 81,4 %. Conclusiones: los resultados de este estudio muestran que este tratamiento es conservador, seguro y efectivo, no expone al paciente a radiaciones ionizantes y reduce los riesgos de una intervención quirúrgica, realizado por un equipo de profesionales conformado por cirujano, radiólogo y anestesiólogo, solucionando el problema de salud en un breve período de tiempo.

Surgical treatment of ileo-colic intussusception (ICI) has been reported as the second cause of emergency laparotomy in children. The performance of incidental appendectomy after surgical reduction is currently controversial. The aim is to analyse the outcomes of performing incidental appendectomy after surgical ICI reduction with or without associated bowel resection.A retrospective study was performed in patients with ICI episodes, who underwent surgical treatment in our institution between 2005-2019. Patients were divided in two groups according to the performance of associated appendectomy (AA group) or not (NA group). Subsequently, a stratified analysis was performed according to the need for bowel resection in both groups. Demographic variables, intraoperative findings, surgical time, hospital stay, postoperative complications and recurrences were analysed.A total of 101 patients (77 AA group; 24 NA group) were included, without differences in demographics or intraoperative findings. A total of 36 bowel resections were performed (24 group AA; 10 group NA), with no differences in surgical time (55.7 min in group AA vs. 61.2 min in group NA; p = 0.587) or hospital stay (median 5 days in both groups). There were also no differences in postoperative complications or recurrences between the two groups. Stratified analysis showed that bowel resection increases operative time, hospital stay and postoperative complications, regardless of whether associated appendectomy was performed or not.Incidental appendectomy during surgical treatment of ICI in children is a safe procedure that does not increase operative time, hospital stay, postoperative complications or recurrence.El tratamiento quirúrgico de la intususcepción ileocólica (IIC) es la segunda causa más frecuente de laparotomía de urgencia en niños. La realización de una apendicectomía incidental tras la reducción quirúrgica sigue siendo motivo de controversia. El objetivo de este trabajo es analizar los resultados obtenidos al llevar a cabo una apendicectomía incidental tras la reducción quirúrgica de una IIC con o sin resección intestinal asociada.Se realizó un estudio retrospectivo en pacientes con episodios de IIC sometidos a tratamiento quirúrgico en nuestro centro entre 2005 y 2019. Los pacientes se dividieron en dos grupos según se llevara a cabo apendicectomía asociada (grupo AA) o no (grupo NA). Posteriormente, se elaboró un análisis estratificado según la necesidad de practicar resección intestinal en ambos grupos. Se analizaron las variables demográficas, los hallazgos intraoperatorios, el tiempo quirúrgico, la estancia hospitalaria, las complicaciones posoperatorias y las recidivas.Se incluyeron un total de 101 pacientes (77 en el grupo AA, y 24 en el grupo NA), sin diferencias en las características demográficas ni en los hallazgos intraoperatorios. Se practicaron un total de 36 resecciones intestinales (24 en el grupo AA; 10 en el grupo NA), sin diferencias en el tiempo quirúrgico (55,7 min en el grupo AA frente a 61,2 min en el grupo NA; p = 0,587) ni en la estancia hospitalaria (mediana de 5 días en ambos grupos). Tampoco se registraron diferencias en términos de complicaciones posoperatorias o recidivas entre los dos grupos. El análisis estratificado mostró que la resección intestinal incrementa el tiempo quirúrgico, la estancia hospitalaria y las complicaciones posoperatorias, con independencia de si se lleva a cabo apendicectomía asociada o no.La apendicectomía incidental durante el tratamiento quirúrgico de la IIC en niños es un procedimiento seguro que no aumenta el tiempo quirúrgico, la estancia hospitalaria, las complicaciones posoperatorias ni las posibilidades de recidiva.

An 87-year-old man had a self-extracted percutaneous endoscopic gastrojejunostomy tube (PEG-J tube) and underwent PEG-J replacement. He vomited 2 days after the replacement, and bowel bleeding occurred 5 days after the replacement. Therefore, he presented to our hospital. A simple abdominal computed tomography scan showed a target sign in the jejunum on the anus side rather than on the PEG-J tube tip portion, resembling intussusception. We confirmed mucosa necrosis in the intussusception by small-diameter endoscopy and attempted internal treatment. However, resistance was so strong that the internal treatment was difficult;therefore, he underwent a jejunal resection. Although diarrhea and dumping syndrome are common PEG-J complications, there have been few reports of intussusception caused by PEG-J. We report a case of adult-onset intussusception, which was thought to be caused by long-term PEG-J implantation.

Perforated appendicitis continues to be a significant cause of morbidity for children. In most centers, ultrasound has replaced computed tomography as the initial imaging modality for this condition. Controversies surrounding optimal medical and surgical management of appendicitis are discussed. Management of intussusception begins with clinical assessment and ultrasound, followed by image-guided air or saline reduction enema. When surgery is required, laparoscopy is typically utilized unless bowel resection is required. The differential diagnosis for pediatric gastrointestinal bleeding is broad but often made with age, history, and physical examination. Endoscopy or laparoscopy is sometimes needed to confirm a diagnosis or for treatment.

Purpose This study aimed to investigate the influence of erect position on anorectal manometry in patients with rectoanal intussusception (RAI). Methods This was a single center prospective observational study. Eighty female patients with fecal incontinence (FI) who underwent defecography between 1st January 2016 and 30th April 2022 were included. The effect of posture on commonly measured parameters during manometry was assessed in the left-lateral and erect positions. The severity of FI was assessed using FI Severity Index (FISI). Results Defecography showed that 30 patients had circumferential RAI (CRAI), and 50 had non-CRAI. There were no significant differences in age, parity, FI type, and FISI scores between the groups. However, FISI scores were significantly lower in 51 patients with passive FI than 12 patients with mixed FI type [21 (8–38) vs. 32 (8–43), P = 0.007]. Endo-anal ultrasound showed no significant difference in the incidence of sphincter defects between the groups. Maximum squeeze pressure was significantly lower in the erect position than in the left-lateral position in the CRAI patients [119 cm H2O (59‒454 cm H2O) vs. 145 cm H2O (65‒604 cm H2O), P = 0.006] however, this finding was not observed in the non-CRAI group and the subgroup of anterior RAI patients. In either group, maximum resting pressure, defecation desire volume, and maximum tolerated volume were significantly higher, while anal canal length was significantly shorter in the erect position than in the left-lateral position, respectively. Conclusion Voluntary contraction in female FI patients with CRAI was suppressed in the erect position.

Intussusception from a testicular germ cell tumour is extremely rare. Metastatic gastrointestinal implants outgrow their blood supply leading to central necrosis. This results in erosions and ulcerations, which can be visualised as submucosal polypoid masses. These masses can then serve as a lead point for intussusception. We report a case of a 25-year-old patient with small bowel obstruction due to an intussuscepted choriocarcinoma in the absence of any other apparent retroperitoneal disease. Urologists must exclude gastrointestinal tract (GIT) involvement in testicular cancers, and similarly, surgeons need to exclude testicular tumours in young men with unexplained GIT haemorrhage, bowel obstruction or intussusception.

Intussusception is one of the most common abdominal emergencies in early children. Intussusception recurs in 8-20% of children after successful nonoperative reduction. The aim of this study was to explore the ultrasound findings to predict risk of recurrence in pediatric intussusception after air enema reduction.A total of 336 intussusception children were followed up for 1 year after received successful air enema reduction. They were divided into the recurrent group and the non-recurrent group. The differences of clinical characteristics, ultrasonic features, and laboratory tests were analyzed by univariate analyses and the Cox proportional hazard model.Sixty-five children with recurrent intussusception were identified. There were statistically significances in the diameter of the mass, in the presence or absence of enlarged lymph nodes out of the sleeve, and in the sleeve between recurrent and non-recurrent groups (P .05). Other ultrasonic features, clinical characteristics, and blood parameters had no differences (P .05). Multivariate Cox proportional hazard model showed that the diameter of the mass and abdominal lymph nodes may be the risk factors of intussusception recurrence (HR = 1.395, 95% CI: 1.045~1.863 and HR = 2.078, 95% CI: 1.118~3.865, P .05). The cut-off value of mass diameter was 2.55 cm, above which recurrence is more likely.Intussusception recurrence was prone with greater mass diameter (2.55 cm) and enlarged abdominal lymph nodes. Although these ultrasound findings for recurrence do not necessarily reduce the rate of recurrence, it can predict the recurrent possibility, and help the emergency physicians to be more vigilant in these children and better counsel parents upon discharge.

A juvenile boxer dog was diagnosed with gastroesophageal intussusception that occurred after the induction of emesis with apomorphine. A ventral midline coeliotomy and diaphragmotomy were performed and the intussusception was manually reduced. Despite initial satisfactory recovery, the dog was diagnosed with cardiac tamponade 1 week post-operatively. Escherichia coli was cultured from pericardial and pleural effusion samples. During subtotal pericardiectomy surgery the pericardium was found to be markedly thickened with adhesions to the epicardium, thoracic wall and diaphragm. Substantial haemorrhage and refractory hypotension necessitated the administration of a blood transfusion during surgery. The dog entered cardiac arrest in the immediate post-operative period and cardiopulmonary resuscitation was unfortunately unsuccessful. Gastroesophageal intussusception should be considered a possible severe adverse effect of administering apomorhine to induce emesis in dogs. Additionally, septic pericardial and pleural effusions may occur post-reduction of gastroesophageal intussusception.

Can laboratory tests that are routinely used in adult patients also be used in pediatric patients? Does the current literature support the routine use of troponin, brain natriuretic peptide, D-dimer, and lactate in children? Adult problems such as acute coronary syndrome and pulmonary embolism are rare in pediatrics, and there is a paucity of literature on how blood tests commonly used to help diagnose these conditions in adults play a role in the diagnosis and management of children. This article presents the literature about 4 common blood tests and examines the clinical applications of each.

PURPOSE To compare postoperative complications of laparoscopic surgery (LS) with open surgery (OS) in surgical intussusception patients. METHODS From March 2015 to February 2018, infants between 6 to 24 months old had the clinical and sono-graphical signs of intussusception enrolled in this double-blind, randomized clinical trial. We divided surgical intussusception patients into two groups. In the LS group, we evaluated patients by direct laparoscopic observation, on-table hydrostatic enema, and mechanical reduction of intussusception. In the OS group, we performed the conventional technique. These patients were followed for 2 years after procedures for comparison of postoperative complications between the two groups. RESULTS We had 52 patients who needed surgical exploration (26 in each group). There were four (15%) and seven (27%) patients with self-reduced intussusception in LS and OS groups, respectively. The conversion rate was 31% (eight cases). Five cases (19%) in the LS group and four cases (15%) in the OS group needed bowel resections. Operating time was longer in the LS group (P ≤ 0.006), and the postoperative complication rate was higher in the OS group (P ≤ 0.021). DISCUSSION Laparoscopy is a screening tool to determine the need for OS in surgical intussusception patients. Laparoscopy reduces the incidence of OS and its complications.

A systematic review was conducted in Mexico to consolidate and evaluate evidence after 15 years of rotavirus vaccination, according to the National Immunization Program. Five databases were screened to identify published articles (January 2000–February 2020) with evidence on all clinical and epidemiological endpoints (e.g. immunogenicity, safety, efficacy, impact/effectiveness) of rotavirus vaccination in Mexico. Twenty-two articles were identified (observational studies including health-economic models: 17; randomized controlled trials: 5). Fourteen studies evaluated a human attenuated vaccine (HRV), four studies evaluated both vaccines, and only two evaluated a bovine-human reassortant vaccine, with local efficacy data only for HRV. Local evidence shows vaccines are safe, immunogenic, efficacious, and provide an acceptable risk-benefit profile. The benefits of both vaccines in alleviating the burden of all-cause diarrhea mortality and morbidity are documented in several local post-licensure studies. Findings signify overall benefits of rotavirus vaccination and support the continued use of rotavirus vaccine in Mexico.

Intussusception is the most common cause of intestinal obstruction between 6 months and 36 months of age. There is no defined etiology in at least 75-90% of patients. Recurrent intussusception occurs in 5-16% of all intussusceptions and the treatment strategy is controversial in this patient group. The treatment of continued recurrent intussusception is a challenging problem when no lead point is revealed despite recurrence.We aimed to review our 10 years of experience in recurrent intussusception and describe a new operative technique for recurrent intussusception cases without any lead points.We, retrospectively, reviewed the data of patients with recurrent intussusception in our referral pediatric surgery clinic between 2007 and 2017. Ultrasound-guided hydrostatic reduction (UGHR) was performed on all patients. Surgery was performed on those patients who had findings of acute abdomen and complete intestinal obstruction or two failed attempts of UGHR for diagnostic purposes if a pathologic lead point was suspected based on patient findings and age. Laparoscopy or laparotomy was performed according to surgeon preference and experience. A total of 87 UGHRs were performed. Thirty-three patients were admitted to our clinic due to recurrent intussusception. The mean age was 12.75±14.14 (6-84) months, and 19 were male and 14 were female. Abdominal pain, agitation, and vomiting were common symptoms. UGHR was performed on all 33 patients on at least two different occasions. The time between the first and second UGHR treatments was 42.6±186.19 (0-899) days. The success rate of the second UGHR was 27 out of 33 patients (81.8%). Surgery was performed on six patients. Laparoscopy-assisted ileal folding and fixation to the cecal wall was performed on one patient with recurrent intussusceptions. Appendectomy was performed first, and then, ileal folding with cecal fixation was performed using 4/0 polyglactin sutures. The sutures were placed between the serosal layers of the adjacent terminal ileal loops and the cecal wall.Surgeons should try to find permanent solutions for patients with multiple recurrent intussusceptions that are resistant to treatment. Surgical excision of the lead point will help prevent recurrent intussusception. Satisfactory results can also be obtained by UGHR even in patients with recurrences. Laparoscopy is helpful in diagnosis, detection of lead points, and treatment of irreducible intussusception. This new operative technique can be satisfactory for recurrent intussusceptions without any lead points.

The aim of this study was to determine the accuracy and interrater reliability of (1) point-of-care ultrasound (POCUS) image interpretation for identification of intussusception and (2) reliability of secondary signs associated with intussusception among experts compared with novice POCUS reviewers.We conducted a planned secondary analysis of a prospective, convenience sample of children aged 3 months to 6 years who were evaluated with POCUS for intussusception across 17 international pediatric emergency departments between October 2018 and December 2020. A random sample of 100 POCUS examinations was reviewed by novice and expert POCUS reviewers. The primary outcome was identification of the presence or absence of intussusception. Secondary outcomes included intussusception size and the presence of trapped free fluid or echogenic foci. Accuracy was summarized using sensitivity and specificity, which were estimated via generalized mixed effects logistic regression. Interrater reliability was summarized via Light's κ statistics with bootstrapped standard errors (SEs). Accuracy and reliability of expert and novice POCUS reviewers were compared.Eighteen expert and 16 novice POCUS reviewers completed the reviews. The average expert sensitivity was 94.5% (95% confidence interval [CI], 88.6-97.5), and the specificity was 94.3% (95% CI, 90.3-96.7), significantly higher than the average novice sensitivity of 84.7% (95% CI, 74.3-91.4) and specificity of 80.4% (95% CI, 72.4, 86.7). κ was significantly greater for expert (0.679, SE 0.039) compared with novice POCUS reviewers (0.424, SE 0.044; difference 0.256, SE 0.033). For our secondary outcome measure of intussusception size, κ was significantly greater for experts (0.661, SE 0.038) compared with novices (0.397, SE 0.041; difference 0.264, SE 0.029). Interrater reliability was weak for expert and minimal for novice reviewers regarding the detection of trapped free fluid and echogenic foci.Expert POCUS reviewers demonstrate high accuracy and moderate interrater reliability when identifying intussusception via image interpretation and perform better than novice reviewers.

Intussusception is the invagination of a segment of bowel (intussusceptum) into the lumen of an adjacent segment (intussuscipiens). Adult intussusception is rare and typically asymptomatic, although bowel obstruction can be a predominant symptom, making it difficult to diagnose. Splenosis is an uncommon and benign disease, arising from the self-implantation of splenic tissue elsewhere in the body after splenectomy or splenic trauma. Colocolic intussusception secondary to splenosis is rare. We report a case of colon intussusception with a mass in the intussusception detected by ultrasound. Abdominal ultrasound identified the intussusception location but failed to distinguish its pathological properties. Colonoscopy revealed the exudation of necrotic and fibrous tissue. Surgery was performed because of suspicions of a malignant tumor.

Intussusception is a medical emergency caused by proximal insertion of the intestinal segment to its lumen, which results in ischemia, necrosis, and sepsisassociated mortality in pediatric patients. Intussusception is managed mainly by surgical reduction; hydrostatic reduction is a noninvasive alternative with lower risk of complications. The study was aimed to analyze the risk factors for the failure of hydrostatic reduction in children with intussusception at the Hasan Sadikin General Hospital.The medical records of children diagnosed with intussusception and treated with hydrostatic reduction during January 2010 and September 2019 were included. Variables of the study included age, sex, onset of symptoms, and outcome. Logistic regression analyses were performed to determine the significance and strength of correlation on the included characteristics with outcomes of hydrostatic reduction in the population. The p0.05 was deemed significant.There were a total of 56 children with intussusception who were treated with hydrostatic therapy during the study period. The failure rate of hydrostatic therapy was 83.9%. Age, sex, onset of symptoms, and location of intussusception were not significantly associated with the failure of hydrostatic reduction (p0.05). Dehydration was the only symptom significantly associated with the failure of hydrostatic reduction (OR 16.80; p = 0.001).Dehydration is significantly associated with the failure of hydrostatic reduction in children with intussusception.

Intussusception is a common cause of intestinal obstruction in children, especially in those of age5 years. The typical signs and symptoms of this condition is colicky abdominal pain, bloody mucous stool, and palpated abdominal mass, with a classic target sign finding on abdominal ultrasound. In older children, the symptoms may vary, which necessitates investigation of the cause of intussusception, as it is often caused by a pathologic lead point. We report here the case of a 14-year-old girl with total bowel obstruction, hematochezia, a very dilated reverse C-shaped bowel loop, and intestinal pneumatosis on abdominal X-ray. During laparotomy, we detected jejunojejunal intussusception caused by jejunal polyp. After bowel resection and anastomosis, the patient recovered well and had no other events during follow-up.

In November 2011, rotavirus (RV) vaccine was launched in Japan as a voluntary vaccination to prevent RV-associated gastroenterocolitis. We examined the characteristics of intussusception following RV vaccination in our two centers.We investigated intussusception patients16 years old from January 2006 to September 2020. Patients were categorized according to the period (before [Group A] or after the introduction of arbitrary RV vaccination [Group B]). The patient characteristics and treatment of intussusception were retrospectively investigated.During the study period, 560 patients (group A, n = 233; group B, n = 327) were identified. The distribution of patients who were 0-6 months old was not significantly different between the groups (group A, n = 12, 5.2%; group B, n = 18, 5.5%). Among these 18 patients in Group B, 7 were vaccinated against RV, and 10 were not. One patient was excluded due to incomplete data. On comparing patients with and without RV vaccination, the mean age at the onset of intussusception was 3.3 ± 0.4 versus 4.0 ± 0.3 months (P = 0.19), the mean interval from the onset to treatment was 7.5 ± 2.4 versus 16.0 ± 2.2 h (P = 0.03), the time of the contrast enema for treatment was 9.1 ± 3.3 versus 7.7 ± 2.8 min (P = 0.76), and the final pressure of the contrast enema was 92.5 ± 4.4 versus 92.2 ± 4.4 cmHArbitrary RV vaccination did not influence the age distribution of intussusception, and the interval from the onset to treatment was significantly shorter in the patients with RV vaccination than in those without it. Recognizing the presence of intussusception following RV vaccination enables accurate treatment.