Korean J Pediatr Gastroenterol Nutr.  2010 Sep;13(2):128-133. 10.5223/kjpgn.2010.13.2.128.

Small Bowel Intussusception in Children: Spontaneous Resolution vs. Surgical Intervention

• Park MR
• Lim MS
• Seo JK
• Ko JS
• Chang JY
• Yang HR
• Lim YJ
• Kim WS

• KMID: 1459428
• DOI: http://doi.org/10.5223/kjpgn.2010.13.2.128

Abstract

PURPOSE
Intussusception is one of the most common causes of an acute abdomen in infancy. The majority of pediatric cases of intussusception are of the ileocolic type and usually idiopathic. Small bowel intussusception is rarely diagnosed in children, and few cases have been reported. The purpose of this study was to determine the clinical features and causes of small bowel intussusception in children.
METHODS
We retrospectively reviewed the clinical and radiologic findings of 21 children with small bowel intussusception who were admitted to Seoul National University Children's Hospital between March 2005 and January 2010.
RESULTS
The clinical presentation of small bowel intussusception included abdominal pain or irritability (85%), vomiting (23%), fever (14%), bloody stools (14%), and abdominal masses (4%). Six patients required surgical management. Ultrasonography showed that the mean diameter of the lesions and mean thickness of the outer rims were 1.6+/-0.7 and 1.7+/-1.8 mm, respectively. Eleven lesions were located in the left abdominal or paraumbilical regions. Children who underwent surgical management were older than children with transient small bowel intussusception (mean age, 51 vs. 109 months). The mean diameter of the lesions and mean thickness of the outer rims were greater in the surgically-managed group. The location of intussusception was not significantly different between the two groups.
CONCLUSION
Small bowel intussusception was spontaneously reduced in a large number of pediatric patients. However, sonographic demonstration of larger size, older age, and pathologic lead point warrant surgical intervention.

Keyword

Small bowel intussusception; Children; Surgical; Spontaneous reduction

MeSH Terms

Abdomen, Acute
Abdominal Pain
Child
Fever
Humans
Intussusception
Retrospective Studies
Vomiting

Figure

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  Fig. 1. Typical benign small bowel intussusceptions (jeju-nojejunal) in a 4 year old boy with abdominal pain. Transeverse (A) and longitudinal (B) US scan showed doughnut (A) and sandwich signs (B).

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  Fig. 2. US (A) and CT scan (B) of a 5-year-old boy with recurrent abdominal pain and melena who underwent surgical reduction of small bowel intussusceptions at multiple sites (arrow). Based on biopsy, he was diagnosed with Burkitt lymphoma.

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