Patterns of recurrence of intussusception in children: a 17-year review.
OBJECTIVE
Patterns of recurrence of intussusception (INT) were reviewed to determine whether changes in management have affected the rate and patterns of recurrence as well as long-term outcome in children with multiple (i. e., 2 or more) recurrences.


METHODS
Review was done of 763 children with 876 intussusceptions, including (1) recurrence rate, (2) patterns of recurrence (number of and interval between recurrences), (3) reducibility, (4) pathologic lead points (PLP), (5) operative findings and (6) long-term follow-up in those with multiple recurrences.


RESULTS
Above features (1)-(6) were the same in those managed with barium enema (1979-1985) and those managed with air enema (1985-1996). Overall recurrence rate was 9 %; 11 % with barium enema and 8 % with air enema. Sixty-nine patients had 113 recurrences: 47/69 (68 %) and 1 recurrence and 22/69 (32 %) had multiple recurrences. Multiple recurrences presented as isolated episodes or in clusters up to 8 years. Reducibility was 100 % for initial INT and 95 % for recurrent episodes; there were no perforations. Surgery, in 4 with irreducible recurrence, revealed no PLP. PLP were present in 5 (8 %): 2 (4 %) with 1 recurrence and 3 (14 %) with multiple recurrences. No pattern of recurrence was predictive for PLP. Long-term follow-up (up to 15 years) available in 11 with multiple recurrences revealed a favourable outcome.


CONCLUSIONS
Rates and patterns of recurrence did not change with altered management. Because of the high reduction rate of recurrences, lack of perforation and favourable long-term follow-up, we recommend radiological reduction for recurrent INT. Multiple recurrences are not a contraindication. A careful search for PLP is mandatory. Surgery should be reserved for irreducible recurrences or for demonstrated PLP.
Daneman
A
A
Department of Diagnostic Imaging, Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
Alton
D J
DJ
Lobo
E
E
Gravett
J
J
Kim
P
P
Ein
S H
SH
D000293:Adolescent; D001466:Barium Sulfate / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D004733:Enema; D005260:Female; D006801:Humans; D007223:Infant; D007422:Intestines / Q000000981:diagnostic imaging; D007443:Intussusception / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D011029:Pneumoradiography; D012008:Recurrence; D012189:Retrospective Studies
D003287:Contrast Media; D001466:Barium Sulfate