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Operative indications in recurrent ileocolic intussusception.
Fisher, Jeremy G; Sparks, Eric A; Turner, Christopher G B; Klein, Justin D; Pennington, Elliot; Khan, Faraz A; Zurakowski, David; Durkin, Emily T; Fauza, Dario O; Modi, Biren P.
Afiliación
  • Fisher JG; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
  • Sparks EA; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
  • Turner CG; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
  • Klein JD; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
  • Pennington E; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
  • Khan FA; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
  • Zurakowski D; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
  • Durkin ET; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
  • Fauza DO; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
  • Modi BP; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA. Electronic address: biren.modi@childrens.harvard.edu.
J Pediatr Surg ; 50(1): 126-30, 2015 Jan.
Article en En | MEDLINE | ID: mdl-25598108
BACKGROUND: Air-contrast enema (ACE) is standard treatment for primary ileocolic intussusception. Management of recurrences is less clear. This study aimed to delineate appropriate therapy by quantifying the relationship between recurrence and need for bowel resection, pathologic lead points (PLP), and complication rates. METHODS: After IRB approval, a single institution review of patients with ileocolic intussusception from 1997 to 2013 was performed, noting recurrences, outcomes, and complications. Fisher's exact and t-tests were used. RESULTS: Of 716 intussusceptions, 666 were ileocecal. Forty-four underwent bowel resection, with 29 PLPs and 9 ischemia/perforation. Recurrence after ACE occurred in 96 (14%). Recurrence did not predict PLP (P=0.25). Recurrence (≥3) was associated with higher resection rate (P=0.03), but not ischemia/perforation (P=0.75). ACE-related complications occurred in 4 (0.5%) patients. Successful initial ACE had 98% negative predictive value for resection and PLP (e.g., after successful ACE, 2% had resections, 2% PLP). After failed initial ACE, 36% received resection, and 23% had PLP (P<0.001). CONCLUSIONS: Recurrence is associated with a greater risk of resection but not PLP or ACE-complication. Failed ACE is associated with increased risk for harboring PLP and receiving resection. ACE should be the standard treatment in recurrent intussusception, regardless of number of recurrences.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enema / Enfermedades del Íleon / Intususcepción Tipo de estudio: Prognostic_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Pediatr Surg Año: 2015 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Imprimir
XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enema / Enfermedades del Íleon / Intususcepción Tipo de estudio: Prognostic_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Pediatr Surg Año: 2015 Tipo del documento: Article Pais de publicación: Estados Unidos