Recurrent Intussusception: when Should Surgical Intervention be performed?
OBJECTIVE
To determine the optimal timing of surgery for recurrent intussusception.


METHODS
We retrospectively reviewed medical records of patients aged from 0 to 18 years old with diagnosis of intussusception in the Pediatric Department at Mackay Memorial Hospital between January 1995 and May 2010.


RESULTS
During the study period, there were 686 children (divided into three age groups: 367 < 2 years, 289 aged 2 to 5 years, 30 > 5 years) with diagnoses of intussusception. Eighty-five of the 686 patients had recurrent intussusception, of whom 56 had two, 16 had three, 11 had four, and 2 had five episodes. The recurrence rate after the first, second, third, and fourth barium enema reductions were 15.7%, 37.7%, 68.4%, and 100.0%, respectively. The incidence of recurrence and failure rate of barium enema reduction did not differ significantly among these three age groups. Surgery was performed in 177 children (146 during the first episode and 31 in recurrent cases). The probability of eventual surgery after first enema reduction was 21.8%, after the second 35.7%, and after the third 70.0%. Lead points were found in 15 children, and all of them were found during surgery for the first episode of intussusception.


CONCLUSIONS
The probability of recurrence was 100% after the fourth episode of intussusception in our study. After the third episode of intussusception, the probability of recurrence and eventual surgery were 68% and 70%, respectively. From this study, surgical intervention should be considered at the third episode of intussusception.
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Wei-Lun
WL
Hsu
Hung-Chang
HC
Lee
Chun-Yan
CY
Yeung
Wai-Tao
WT
Chan
Chuen-Bin
CB
Jiang
Jin-Cherng
JC
Sheu
Nein-Lu
NL
Wang
Shin-Lin
SL
Shih
D000293:Adolescent; D000367:Age Factors; D001466:Barium Sulfate; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D004733:Enema / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007443:Intussusception / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D007813:Laparotomy / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D001466:Barium Sulfate