title: Operative indications in recurrent ileocolic intussusception.
abstract: 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.
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Jeremy G
authors.initials: JG
authors.lastname: Fisher
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Sparks
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Christopher G B
authors.initials: CG
authors.lastname: Turner
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Justin D
authors.initials: JD
authors.lastname: Klein
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Elliot
authors.initials: E
authors.lastname: Pennington
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Faraz A
authors.initials: FA
authors.lastname: Khan
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Emily T
authors.initials: ET
authors.lastname: Durkin
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Dario O
authors.initials: DO
authors.lastname: Fauza
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA. Electronic address: biren.modi@childrens.harvard.edu.
authors.forename: Biren P
authors.initials: BP
authors.lastname: Modi
mesh_terms: D000328:Adult; D000368:Aged; D004733:Enema; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000601:surgery*; D007443:Intussusception / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence
keywords: Air contrast enema; Intussusception; Operative indications; Recurrence; Surgery