Justification of the conservative treatment of intestinal intussusception in children without age and disease duration considerations

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Abstract

Introduction. Since the middle of the last century, the conservative treatment of ileocecal intussusception (ICI) has dominated in children. However, questions on choosing a technique for conservative treatment and indications for surgical treatment remain open.

Purpose. To assess the effectiveness of hydroechocolonoscopy (HEC) for ICI in children regardless of their age and disease duration.

Material and methods. 160 children with confirmed ICI were enrolled in the study. All children, who had developed uncomplicated ICI for the first time, had HEC regardless of their age and disease duration. Failed hydrostatic disinvagination and disease relapse after HEC were indications for surgical management (laparoscopy, colonoscopy, laparotomy). To evaluate the effectiveness of conservative treatment at different age groups and at different terms of disease duration, two comparable trials were performed: 1 – stratification of patients by age: main group (n=130) - children older than one year, comparison group (n=30) – children younger than one year; 2 – stratification of patients by disease duration: main group (n=107) – more than 12 hours, comparison group (n=53) – up to 12 hours. To assess outcomes, the following parameters were analyzed: HEC effectiveness and complications, incidence of early relapses after HEC, causes of HEC failure and relapses after HEC, frequency and surgical techniques applied for treating ICI.

Results. In the groups stratified by age, HEC effectiveness was 95.4% in the main group and 93.3% in the comparison group, p=0.216. Early relapses occurred in 10.3% in the main group and in 3.3% in the comparison group, p=0.128. In the groups stratified by the disease duration, HEC effectiveness was 93.5% in the main group and 98.1% in the comparison group, p=0.204. Early relapses occurred in 10.3% (11) in the main group and in 11.3% (6) of cases in the comparison group, p=0.841. There were no any complications during HEC procedure. Basic reasons for the conservative treatment failure were anatomical ones; for relapses – lymphoid hyperplasia of the abdominal cavity and anatomical reasons. Thus, HEC was effective in 95% of cases; relapses after HEC amounted up to 10.6%. Surgical interventions ( in 15.6%) were started with laparoscopy; laparoscopic disinvagination was effective in 68% of cases. Colonoscopy after successful laparoscopic disinvagination was performed in 5.6%, conversion to laparotomy was in 5% of the total number of observations.

Conclusion. HEC is a highly effective and safe option for HEC conservative management in children regardless of child’s age and disease duration. Indications for surgical treatment for uncomplicated ICI are hydrostatic disinvagination failure and disease relapse.

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About the authors

O. V. Karaseva

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, , Russian Federation; National Medical Research Center for Children’s Health

Email: den-izym@rambler.ru
ORCID iD: 0000-0001-9418-4418
Россия, 119180 Moscow; 119296 Moscow

Denis Е. Golikov

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Author for correspondence.
Email: den-izym@rambler.ru
ORCID iD: 0000-0001-5982-5494

researcher, department of combined trauma, Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Россия, 119180 Moscow

A. Y. Kharitonova

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: den-izym@rambler.ru
ORCID iD: 0000-0001-6218-3605
Россия, 119180 Moscow

A. L. Gorelik

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: den-izym@rambler.ru
ORCID iD: 0000-0003-1746-8446
Россия, 119180 Moscow

A. V. Timofeeva

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: den-izym@rambler.ru
ORCID iD: 0000-0002-6940-4535
Россия, 119180 Moscow

E. A. Frolov

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: den-izym@rambler.ru
ORCID iD: 0000-0003-1561-5510
Россия, 119180 Moscow

V. I. Lukyanov

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: den-izym@rambler.ru
ORCID iD: 0000-0003-1489-2719
Россия, 119180 Moscow

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Supplementary files

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2. Fig. 1. HEC procedure done in the surgical room.

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3. Fig. 2. Ultrasound examination: "honeycomb" symptom – fluid in small intestine loops.

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4. Fig. 3. ROC curve for anatomical causes.

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5. Fig. 4. Basic reasons for HEC inefficiency and ICI recurrence : a – Meckel’s diverticulum; б – Peyer’s plaque; в – Burkitt’s lymphoma (colonoscopy); г – juvenile polyp (colonoscopy); д – mesadenitis (laparoscopy); e – terminal ileitis (laparoscopy).

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6. Fig. 5. A local diagnostic protocol for ICI diagnostics and treatment in Clinical and Research Institute for Emergency Pediatric Surgery and Trauma [39].

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Copyright (c) 2023 Karaseva O.V., Golikov D.Е., Kharitonova A.Y., Gorelik A.L., Timofeeva A.V., Frolov E.A., Lukyanov V.I.

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