Small Bowel Intussusception in Children: Spontaneous Resolution vs. Surgical Intervention

Mi Ran Park; Mi Sun Lim; Jeong Kee Seo; Jae Sung Ko; Ju Young Chang; Hye Ran Yang; Yoon Joung Lim; Woo Sun Kim

doi:10.5223/kjpgn.2010.13.2.128

Original Article

Korean J Pediatr Gastroenterol Nutr 2010;13(2):128-133.

Published online: 30 September 2010

DOI: https://doi.org/10.5223/kjpgn.2010.13.2.128

Small Bowel Intussusception in Children: Spontaneous Resolution vs. Surgical Intervention

Mi Ran Park, Mi Sun Lim, Jeong Kee Seo, Jae Sung Ko, Ju Young Chang, Hye Ran Yang, Yoon Joung Lim^*, Woo Sun Kim^*

Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea

^*Department of Radiology, Seoul National University College of Medicine, Seoul, Korea

Corresponding author : E-mail jkseo@snu.ac.kr

Received 7 August 2010 Revised 11 August 2010 Accepted 24 August 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Intussusception is one of the most common causes of an acute abdomen in infancy. The majority of pediatric cases of intussusception are of the ileocolic type and usually idiopathic. Small bowel intussusception is rarely diagnosed in children, and few cases have been reported. The purpose of this study was to determine the clinical features and causes of small bowel intussusception in children.

Methods

We retrospectively reviewed the clinical and radiologic findings of 21 children with small bowel intussusception who were admitted to Seoul National University Children's Hospital between March 2005 and January 2010.

Results

The clinical presentation of small bowel intussusception included abdominal pain or irritability (85%), vomiting (23%), fever (14%), bloody stools (14%), and abdominal masses (4%). Six patients required surgical management. Ultrasonography showed that the mean diameter of the lesions and mean thickness of the outer rims were 1.6±0.7 and 1.7±1.8 mm, respectively. Eleven lesions were located in the left abdominal or paraumbilical regions. Children who underwent surgical management were older than children with transient small bowel intussusception (mean age, 51 vs. 109 months). The mean diameter of the lesions and mean thickness of the outer rims were greater in the surgically-managed group. The location of intussusception was not significantly different between the two groups.

Conclusion

Small bowel intussusception was spontaneously reduced in a large number of pediatric patients. However, sonographic demonstration of larger size, older age, and pathologic lead point warrant surgical intervention.

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Keywords: Small bowel intussusception, Children, Surgical, Spontaneous reduction

Fig. 1.

Typical benign small bowel intussusceptions (jeju-nojejunal) in a 4 year old boy with abdominal pain. Transeverse (A) and longitudinal (B) US scan showed doughnut (A) and sandwich signs (B).

Fig. 2.

US (A) and CT scan (B) of a 5-year-old boy with recurrent abdominal pain and melena who underwent surgical reduction of small bowel intussusceptions at multiple sites (arrow). Based on biopsy, he was diagnosed with Burkitt lymphoma.

Table 1.

Clinical Characteristics of Small Bowel Intussusception

Case	Age (months)	Sex	Irritability/Pain	Vomiting	Bloody stool	Abdominal mass	Underlying disorder	Management
1	6	M	＋	＋	−	−	-	SR^*
2	17	M	＋	＋	−	−	-	SR
3	17	M	＋	＋	−	−	-	SR
4	22	F	＋	＋	＋	−	-	SR
5	27	M	＋	−	−	−	-	SR
6	38	M	＋	−	−	＋	-	SR
7	39	M	＋	＋	−	−	-	SR
8	51	M	＋	＋	−	−	-	SR
9	56	M	＋	＋	−	−	-	SR
10	57	M	＋	−	−	−	-	SR
11	57	M	＋	＋	−	−	Duplication cyst	SR
12	149	M	−	−	−	−	T-cell lymphoma	SR
13	173	F	＋	＋	−	−	Peutz-Jeghers	SR
14	34	M	＋	−	−	−	Hydronephrosis	SR
15	23	M	−	−	−	−	-	SR
16	179	M	−	−	−	−	DLBL^†	OP^‡ (resection)
17	67	M	＋	−	＋	−	Burkitt lymphoma	OP (manual)
18	119	M	＋	＋	−	−	-	OP (manual)
19	19	M	＋	＋	−	−	-	OP (manual)
20	164	M	＋	＋	−	−	Peutz-jeghers	OP (resection)
21	107	F	＋	−	＋	−	Peutz-jeghers	OP (resection)

^* SR: spontaneous reduction,

^† DLBL: diffuse large B cell lymphoma,

^‡ OP: operation.

Table 2.

Transient Small Bowel Intussusception and Surgically Managed Small Bowel Intussusception

			Transient SBI (n=15)	Surgically managed SBI^* (n=6)	p value
Clinical features
	Male：Female^†		13：2	5：1	0.658
	Mean age^‡ (mo) (range)		51±20 (6 mo∼14 yrs)	109±17 (19 mo∼14 yrs)	0.045
	Symptoms
		Pain/irritability^†	12 (85%)	5 (83%)	0.658
		Bloody stool^†	1 (6%)	2 (33%)	0.184
		Mass^†	1 (6%)	0 (0%)	0.714
	Bowel ischemia/necrosis^†		0 (0%)	2 (33%)	0.071
	Recurrence^†		3 (18%)	1 (16%)	0.684
Sonographic findings
	Location (Right; Left; Middle)^†		7; 6; 2	2; 2; 1 (1: multifocal)	0.956
	Transverse diameter^‡ (cm)		1.6±0.4 (0.9∼2.0)	3.2±0.5 (2.3∼3.5)	0.004
	Thickness of outer rim^‡ (mm)		1.6±0.8 (1.0∼2.5)	5.8±1.4 (4.4∼7.8)	0.004
	Lead point^†		1 (6%)	4 (67%)	0.031
	Ascites^†		1 (6%)	4 (67%)	0.017
	Bowel distention^†		8 (53%)	5 (83%)	0.221

^* SBI: small bowel intussusception,

^† Fisher’s exact test,

^‡ Mann-Whitney U-test.

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