Identifying Predictive Factors for the Recurrence of Pediatric Intussusception

다국어 초록 (Multilingual Abstract)

Purpose: The aim of the study was to identify factors related to the recurrence of intussusception in pediatric patients. Methods: The medical charts of patients diagnosed with intussusception and treated at Dongsan Medical Center, between March 2015 to June 2017, were retrospectively reviewed. Univariate and multivariate analyses were performed. Results: Among 137 patients, 23 patients (16.8%) had a recurrent intussusception and 8 of these patients (6%) had more than 2 episodes of recurrence. The age at diagnosis was significantly different between the non-recurrence and recurrence group ( p =0.026), with age >1 year at the time of diagnosis associated with a greater rate of recurrence ( p =0.002). The time interval from symptom onset to the initial reduction (<48 vs. ≥48 hours) was significantly longer in the recurrence group ( p =0.034) and patients in the recurrence group had higher levels of C-reactive protein (CRP) ( p =0.024). Bloody stools and a history of infection were significantly more frequent in the non-recurrence group ( p =0.001 and p <0.001, respectively). On stepwise regression analysis, age >1 year at the time of presentation (odds ratio [OR], 4.79; 95% confidence interval [CI], 1.56–14.06; p =0.016) and no history of infection (OR, 0.18; 95% CI, 0.06–0.58; p =0.004) were retained as predictors of recurrence. Conclusion: Patients with intussusception who are older than 1 year at diagnosis, have an elevated CRP level, a delay of ≥48 hours between symptom onset and the initial reduction, an absence of bloody stools, and no history of infection should be closely monitoring for symptoms and signs of a possible recurrence.

참고문헌 (Reference)

1 박미란, "소아에서 소장형 장중첩증; 자연 정복과 수술적 치료의 비교" 대한소아소화기영양학회 13 (13): 128-133, 2010

2 May AN, "Yersinia intussusception : case report and review" 50 : 91-95, 2014

3 Williams K, "Use of fluoroscopy to study in vivo motility in mouse pups" 52 : 679-685, 2011

4 Buettcher M, "Three-year surveillance of intussusception in children in Switzerland" 120 : 473-480, 2007

5 Yoo ES, "The risk factors related to recurrent intussusception by ultrasonography" 39 : 1707-1716, 1996

6 Ravitch MM, "The nonoperative treatment of intussusception : hydrostatic pressure reduction by barium enema" 36 : 1495-1500, 1956

7 Killoran KE, "Role of innate immunity and altered intestinal motility in LPS-and MnCl2-induced intestinal intussusception in mice" 306 : G445-53, 2014

8 Fallon SC, "Risk factors for surgery in pediatric intussusception in the era of pneumatic reduction" 48 : 1032-1036, 2013

9 Guo WL, "Risk factors for recurrent intussusception in children : a retrospective cohort study" 7 : e018604-, 2017

10 Bines JE, "Risk factors for intussusception in infants in Vietnam and Australia : adenovirus implicated, but not rotavirus" 149 : 452-460, 2006

11 Champoux AN, "Recurrent intussusception. Risks and features" 148 : 474-478, 1994

12 Eklöf O, "Recurrent intussusception. Analysis of a series treated with hydrostatic reduction" 19 : 250-258, 1978

13 Ksia A, "Recurrent intussusception in children and infants" 10 : 299-301, 2013

14 Esmaeili-Dooki MR, "Pediatric intussusception in Northern Iran: comparison of recurrent with non-recurrent cases" 26 : e3898-, 2016

15 Daneman A, "Patterns of recurrence of intussusception in children : a 17-year review" 28 : 913-919, 1998

16 Carty HM, "Paediatric emergencies : non-traumatic abdominal emergencies" 12 : 2835-2848, 2002

17 Niramis R, "Management of recurrent intussusception : nonoperative or operative reduction?" 45 : 2175-2180, 2010

18 Smith JL, "Malignant lymphomas of the stomach. its diagnosis, distinction and biologic behavior" 34 : 553-, 1958

19 Kim KH, "Inverted Meckel diverticulum as a lead point of small bowel intussusception : misinterpreting case as a lipoma" 40 : 840-842, 2016

20 Wang Z, "Intussusception patients older than 1 year tend to have early recurrence after pneumatic enema reduction" 31 : 855-858, 2015

21 Minney-Smith CA, "Intussusception is associated with the detection of adenovirus C, enterovirus B and rotavirus in a rotavirus vaccinated population" 61 : 579-584, 2014

22 Orloff MJ, "Intussusception in children and adults" 102 : 313-329, 1956

23 Bruce J, "Intussusception : evolution of current management" 6 : 663-674, 1987

24 Siminas S, "Inflammatory fibroid polyp : a rare benign tumor of the alimentary tract in children presenting as intussusception-case report and review of literature" 2 : 16-19, 2014

25 Dias AR, "Ileal duplication causing recurrent intussusception" 64 : 51-53, 2007

26 Simon AK, "Evolution of the immune system in humans from infancy to old age" 282 : 20143085-, 2015

27 Chen SC, "Epidemiology of childhood intussusception and determinants of recurrence and operation : analysis of national health insurance data between 1998 and 2007 in Taiwan" 51 : 285-291, 2010

28 Hasegawa T, "Colonoscopic diagnosis of lymphoid hyperplasia causing recurrent intussusception : report of a case" 28 : 301-304, 1998

29 이용욱, "Clinical Features and Role of Viral Isolates from Stool Samples of Intussuception in Children" 대한소아소화기영양학회 16 (16): 162-170, 2013

30 Saka R, "Chronic ileocolic intussusception due to transmural infiltration of diffuse large B cell lymphoma in a 14-year-old boy : a case report" 4 : 366-, 2015

31 Nylund CM, "Bacterial enteritis as a risk factor for childhood intussusception : a retrospective cohort study" 156 : 761-765, 2010

32 Clarke EJ Jr, "Adenovirus infection in intussusception in children in Taiwan" 208 : 1671-1674, 1969

33 Bhisitkul DM, "Adenovirus infection and childhood intussusception" 146 : 1331-1333, 1992

34 Kim SH, "A clinical evaluation of the pediatric recurrent intussusception" 48 : 548-557, 1995