Ileoileal intussusception – surgical intervention needed?

Fallon SC, et al. Risk factors for surgery in pediatric intussusception in the era of pneumatic reduction. J Pediatr Surg. 2013 May;48(5):1032-6.

“In conclusion, our analysis of the treatment of a contemporary cohort of intussusception patients cared for at a large, tertiary-care children’s hospital showed that a longer history of pain, presentation as an infant, and a lead point, bowel wall thickness, and free or interloop fluid identified on ultrasound are independent risk factors for surgery. Practitioners who work in community settings or in hospitals without adequate pediatric surgical capabilities should consider early transfer to a higher level of care when available.”

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Saxena AK, et al. Small bowel intussusceptions: issues and controversies related to pneumatic reduction and surgical approach. Acta Paediatr. 2007 Nov;96(11):1651-4.

Pneumatic reduction is successful in ileoileal intussusceptions with signs of bowel viability. It should be attempted with caution in patients with jejunojejunal or ileoileal SBI with pathologic lead points or bowel ischaemia. Accurate interpretation of ultrasound along with judicious implementation of pneumatic reduction or surgical options can reduce morbidity. Early diagnosis is associated with better outcomes using non-surgical reduction techniques.

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Munden, MM, et al. Sonography of pediatric small-bowel Intussusception: differentiating surgical from nonsurgical cases. Am J Roentgen. 2007 Jan; 188(1): 275-279.

“Our findings suggest that surgery is indicated in the care of patients who have symptoms and small-bowel intussusception longer. Most (n = 13 [59%]) of these cases reduced spontaneously within minutes of being detected during the sonographic examination. In nine (41%) of the patients, intussusception lasted longer than the initial sonographic examination. The follow-up period after initial imaging varied from 39 minutes to no followup. All of these cases of intussusception were eventually determined to have resolved. This finding suggests that intussusception length
less than 3.5 cm is predictive of a benign course and that these patients need only clinical follow-up for confirmation of an asymptomatic condition.”

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Wiersma F, et al. Ileoileal intussusception in children: ultrasonographic differentiation from ileocolic intussusception. Pediatr Radiol. 2006 Nov;36(11):1177-81.

“In conclusion, unlike clinical symptoms, sonographic features, especially diameter and length, can differentiate ileoileal intussusception from ileocolic intussusception. The mean diameter of ileoileal intussusceptions was 1.5 cm and the mean length was 2.5 cm, compared with 3.7 cm and 8.2 cm, respectively, for ileocolic intussusception. Ileoileal intussusceptions resolve spontaneously and invasive treatment is unnecessary when no lead point is depicted by sonography. Clinical and sonographic follow-up are
recommended.”

Full-text for Children’s and Emory users.


More PubMed results on ileoileal intussusception.

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