A Late Diagnosis of Intussusception May Contribute to Worse Outcomes

CHICAGO — The diagnosis of intussusception requires a high index of suspicion. In a recent retrospective review, only 22% of patients presented with the classic triad of emesis, pain, and hematochezia, and if a palpable mass is added to this constellation of signs and symptoms, only 6% met the diagnostic criteria, Dr. Alan P. Ladd said at the annual meeting of the Central Surgical Association.

Delay in presentation decreases the likelihood of successful radiologic reduction of intussusception and increases the chance that surgical intervention will be needed, he added.

The use of ultrasonography has reduced the morbidity of enema reduction in children with this still-common disorder. Reported success rates for enema reduction remain disparate, however, ranging from 42% to 95%, with better results occurring at hospitals with admission rates of 10,000 children per year. “We wanted to look at the trends for contemporary management at our hospital, which has 11,000 admissions each year,” he said.

During 1990 through 2004, 244 children were admitted with a diagnosis of intussusception, said Dr. Ladd of the Riley Hospital for Children and Indiana University, both in Indianapolis.

A retrospective review showed 162 were boys, 68% were young- er than 1 year old, and 86% had ileocolic intussusception. The most common presenting symptoms were emesis, seen in 81% of patients; hematochezia (61%); and abdominal pain (59%).

Either air- or liquid-contrasted enemas were performed in 190 children, with an overall success rate of 46%, he said. Air-contrasted enemas were more successful than liquid-contrasted enemas (54% vs. 34%, respectively).

A significantly greater success rate of 59% was seen in patients who presented within 24 hours after symptom onset, compared with a success rate of 36% seen in those who presented later.

A total of 155 patients required surgical intervention. Those who presented more than 24 hours after symptom onset had a greater risk of needing surgical intervention (relative risk 1.6) and of requiring bowel resection (RR 2.25). Of 42 patients who had a repeated attempt at reduction after a failed attempt at another hospital, 48% were successful. “Prior outside attempts at reduction did not preclude the possibility of radiologic success,” he said.

There was a recurrence rate of 5%; median time of occurrence was 3 weeks later. All were diagnosed radiologically and successfully reduced. There were no complications during the radiologic procedures, and postoperative complications were primarily infection. Two patients died after presenting in shock.

A combination contrast and air enema shows intussusception in the lumen. Courtesy Dr. Alan P. Ladd

CHICAGO — The diagnosis of intussusception requires a high index of suspicion. In a recent retrospective review, only 22% of patients presented with the classic triad of emesis, pain, and hematochezia, and if a palpable mass is added to this constellation of signs and symptoms, only 6% met the diagnostic criteria, Dr. Alan P. Ladd said at the annual meeting of the Central Surgical Association.

Delay in presentation decreases the likelihood of successful radiologic reduction of intussusception and increases the chance that surgical intervention will be needed, he added.

The use of ultrasonography has reduced the morbidity of enema reduction in children with this still-common disorder. Reported success rates for enema reduction remain disparate, however, ranging from 42% to 95%, with better results occurring at hospitals with admission rates of 10,000 children per year. “We wanted to look at the trends for contemporary management at our hospital, which has 11,000 admissions each year,” he said.

During 1990 through 2004, 244 children were admitted with a diagnosis of intussusception, said Dr. Ladd of the Riley Hospital for Children and Indiana University, both in Indianapolis.

A retrospective review showed 162 were boys, 68% were young- er than 1 year old, and 86% had ileocolic intussusception. The most common presenting symptoms were emesis, seen in 81% of patients; hematochezia (61%); and abdominal pain (59%).

Either air- or liquid-contrasted enemas were performed in 190 children, with an overall success rate of 46%, he said. Air-contrasted enemas were more successful than liquid-contrasted enemas (54% vs. 34%, respectively).

A significantly greater success rate of 59% was seen in patients who presented within 24 hours after symptom onset, compared with a success rate of 36% seen in those who presented later.

A total of 155 patients required surgical intervention. Those who presented more than 24 hours after symptom onset had a greater risk of needing surgical intervention (relative risk 1.6) and of requiring bowel resection (RR 2.25). Of 42 patients who had a repeated attempt at reduction after a failed attempt at another hospital, 48% were successful. “Prior outside attempts at reduction did not preclude the possibility of radiologic success,” he said.

There was a recurrence rate of 5%; median time of occurrence was 3 weeks later. All were diagnosed radiologically and successfully reduced. There were no complications during the radiologic procedures, and postoperative complications were primarily infection. Two patients died after presenting in shock.

A combination contrast and air enema shows intussusception in the lumen. Courtesy Dr. Alan P. Ladd

CHICAGO — The diagnosis of intussusception requires a high index of suspicion. In a recent retrospective review, only 22% of patients presented with the classic triad of emesis, pain, and hematochezia, and if a palpable mass is added to this constellation of signs and symptoms, only 6% met the diagnostic criteria, Dr. Alan P. Ladd said at the annual meeting of the Central Surgical Association.

Delay in presentation decreases the likelihood of successful radiologic reduction of intussusception and increases the chance that surgical intervention will be needed, he added.

The use of ultrasonography has reduced the morbidity of enema reduction in children with this still-common disorder. Reported success rates for enema reduction remain disparate, however, ranging from 42% to 95%, with better results occurring at hospitals with admission rates of 10,000 children per year. “We wanted to look at the trends for contemporary management at our hospital, which has 11,000 admissions each year,” he said.

During 1990 through 2004, 244 children were admitted with a diagnosis of intussusception, said Dr. Ladd of the Riley Hospital for Children and Indiana University, both in Indianapolis.

A retrospective review showed 162 were boys, 68% were young- er than 1 year old, and 86% had ileocolic intussusception. The most common presenting symptoms were emesis, seen in 81% of patients; hematochezia (61%); and abdominal pain (59%).

Either air- or liquid-contrasted enemas were performed in 190 children, with an overall success rate of 46%, he said. Air-contrasted enemas were more successful than liquid-contrasted enemas (54% vs. 34%, respectively).

A significantly greater success rate of 59% was seen in patients who presented within 24 hours after symptom onset, compared with a success rate of 36% seen in those who presented later.

A total of 155 patients required surgical intervention. Those who presented more than 24 hours after symptom onset had a greater risk of needing surgical intervention (relative risk 1.6) and of requiring bowel resection (RR 2.25). Of 42 patients who had a repeated attempt at reduction after a failed attempt at another hospital, 48% were successful. “Prior outside attempts at reduction did not preclude the possibility of radiologic success,” he said.

There was a recurrence rate of 5%; median time of occurrence was 3 weeks later. All were diagnosed radiologically and successfully reduced. There were no complications during the radiologic procedures, and postoperative complications were primarily infection. Two patients died after presenting in shock.

A combination contrast and air enema shows intussusception in the lumen. Courtesy Dr. Alan P. Ladd