title: Surgical approach to intussusception in older children: influence of lead points.
abstract: BACKGROUND
  The likelihood of a lead point as the cause of ileocolic intussusception increases as children get older. This study looks at whether a different management strategy should be employed in older patients.
  
  
  METHODS
  7 year multi-institutional retrospective study of intussusception in patients aged <12 years.
  
  
  RESULTS
  Ileocolic intussusception with complete data was found in 153 patients: 109 0-2 years, 34 3-5 years, and 10 6-12 years, respectively. Bloody stools occurred in 42/143 of 0-5 years and 0/10 of 6-12 years, p<0.001. Combined hydrostatic and/or surgical reduction was successful in 113/143 0-5 year olds vs 5/10 6-12 year olds, p<0.001. Enemas were safe but reduced only 1 patient over age 5. Resections were required in 29 patients (15 idiopathic, 14 lead points). Lead points were found in 4/109 children under 3 years, in 5/34 aged 3-5 years and 5/10 aged 6-12 years (p=0.04 vs 3-5 years and p <0.001 vs 0-5 years). Lead points consisted of 7 Meckel's diverticula and 7 others.
  
  
  CONCLUSIONS
  Children older than 5 years are much more likely to have a pathologic lead point and early surgical intervention should be considered. In this study, enema reduction was safe but minimally beneficial in this age group.
authors.affiliation: Kaiser Los Angeles Medical Center, Department of Surgery, 4760 Sunset Blvd., 3rd fl, Los Angeles, CA 90027. Electronic address: pooya.banapour@kp.org.
authors.forename: Pooya
authors.initials: P
authors.lastname: Banapour
authors.affiliation: Kaiser Los Angeles Medical Center, Department of Surgery, 4760 Sunset Blvd., 3rd fl, Los Angeles, CA 90027. Electronic address: roman.m.sydorak@kp.org.
authors.forename: Roman M
authors.initials: RM
authors.lastname: Sydorak
authors.affiliation: Kaiser Los Angeles Medical Center, Department of Surgery, 4760 Sunset Blvd., 3rd fl, Los Angeles, CA 90027. Electronic address: donald.b.shaul@kp.org.
authors.forename: Donald
authors.initials: D
authors.lastname: Shaul
mesh_terms: D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007443:Intussusception / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Hydrostatic; Ileocolic intussusception; Intussusception; Pediatric