J Korean Surg Soc.
2000 Nov;59(5):667-673.
A Clinical Analysis of Intussusception in Infants and Children
- Affiliations
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- 1Department of Surgery, Mokpo Catholic Hospital, Mokpo, Korea.
Abstract
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PURPOSE: Intussusception is a very common pediatric problem and needs early management. This study
evaluated the risk factors of intussusception in infants and children for early diagnosis and treatment.
METHODS
216 cases of pediatric intussusception occurring between 1993 and 1999 in Mokpo Catholic
Hospital were investigated retrospectively. 164 patients treated with barium reduction comprised the
barium reduction (BR) group and 52 patients treated with manual reduction or bowel resection was
operation (OP) group. RESULTS: The age incidence under 1 year old was 108 patients (65.9%) in BR
group, 45 patients (86.5%) in OP group. Male to female ratio was 1.8:1 in BR and 1.7:1 in OP,
respectively. In the seasonal distribution spring was more common in both group (34.1%, 34.6%). 60.4%
in BR group, 76.9% in OP group were revealed leukocytosis above 10.000/mm3 in serum. Previous
combined diseases were upper respiratory infection (31.7%, 42.3%), acute gastroenteritis (1.2%, 1.9%)
and multiple familial polyposis (0.5% in BR group). The frequent symptoms and signs were bloody stool
(86.0%,92.3%), abdominal pain and irritability (86.6%, 82.7%), vomiting (76.9%, 67.3%), and abdominal
mass (56.7%, 76.9%). Tachycardia was 12.2% in BR and 44.2% in OP. In plain abdominal radiography,
intestinal obstructive pattern was present in 5.5% of BR group and 53.8% of OP group. Success rate
of barium reduction within 24 hours after symptom appearance was 82.3%. Within 24-48 hours was
61.1%, above 48 hours was 25%. There was a statistically significant difference between BR group and
OP group of patients under 1 year old, with tachycardia, symptoms for longer than 48 hours and
obstructive pattern on plain abdominal radiography (p<0.05). Of surgical cases, 84.6% were idiopathic.
The common anatomical type was ileo-colic type (53.9%). The methods of operation were manual
reduction (94.2%) and bowel resection (5.8%). Postoperative complications occurred in 4 cases; 3 cases
of wound infection and 1 case of pulmonary complication. Recurrence rate was 12.8% in BR group.
CONCLUSION
Risk factors of high incidence such as under 1 year old, severe obstructive pattern on the
plain abdominal radiograph, symptoms for longer than 48 hours, and tachycardia, were related with a
low success rate of barium reduction. Therefore, a gentle barium enema is recommended in high risk
patients for diagnosis and prompt surgical intervention.