2021 Volume 57 Issue 7 Pages 1049-1056
Purpose: The incidence of intussusception is low in older children for various reasons. Owing to the lack of a consensus concerning clinical management, the treatment approach differs among clinicians. To optimize the management of intussusception, we retrospectively analyzed cases in older children admitted to our hospital over 10 years.
Methods: From 2007 to 2017, 10 children >5 years old were diagnosed with intussusception and admitted to our hospital. We retrospectively reviewed their clinical records.
Results: The patients were six boys and four girls between 5 and 14 years old. The main symptoms were abdominal pain (10/10), vomiting (6/10), and hematochezia (2/10). Eight patients were successfully managed by enema, but four of them developed recurrence. Five patients, including three recurrent cases, underwent surgery. The pathological lead point (PLP) was found in three patients. On laparotomy, intestinal wall thickening was found in these three patients, leading to ileocecal resection or an intestinal biopsy. Pathologically, they all showed lymphoid hyperplasia or inflammatory changes. The type of intussusception was ileocolic in nine and enteroenteric in one. To explore the PLP, nine patients underwent computed tomography (CT), magnetic resonance imaging (MRI), Meckel’s scintigraphy, and colonoscopy depending on their condition.
Conclusions: Patients presenting with recurrent intussusception were likely to undergo surgery because identifying the PLP by imaging is difficult. To avoid unnecessary surgery, it is important to repeat enema reduction, even for recurrent cases, while searching for PLP through various modalities, including colonoscopy.
