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Clinical characteristics and surgical outcome in children with intussusceptions secondary to pathologic lead points: retrospective study in a single institution

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Abstract

Background

Intussusception secondary to pathologic lead points (PLPs) is a potential surgical emergency and almost all cases need surgery. The aim of this study was to evaluate the clinical manifestations, physical examinations and surgical outcomes of secondary intussusception (SI) caused by PLPs, as well as to improve the diagnosis and treatment of PLPs in children and infants.

Materials and methods

We retrospectively reviewed the records of 83 children and infants who were diagnosed with intussusception secondary to PLPs in our institution. The ultimate diagnosis was dependent on histopathological findings under a microscope by a pathologist. Patients were divided into a younger group (< 2 years old) and the older group (> 2 years old) according to age. Patient demographics, clinical manifestations, duration of symptoms, auxiliary examinations, and the presence of pathological lead point were recorded.

Results

A total of 83 patients were found with intussusception secondary to PLPs in this study. Patients were aged from 4 days to 14 years, with a mean age of 3.8 years (median 1.5; range 0–14 years). There were 47 cases in the younger group and 36 cases in the older group. The main clinical symptoms were intermittent crying or abdominal pain. PLPs were observed in only ten patients on US (12%). Ten patients underwent enteroscopy examination for further diagnosis, and all the patients had positive findings including seven cases of Peutz–Jeghers syndrome and three cases of benign polyps. Technetium-99 m pertechnetate scans were performed in ten patients and five patients had positive results (50%). Based on the surgical findings, complex/compound is the most common type of intussusception, followed by small intestinal and ileo-colic type. The main types of PLPs were Meckel’s diverticulum (n = 31), duplication cyst (n = 19) and benign polyps (n = 13). Meckel’s diverticulum and intestinal duplication were the most common causes of secondary intussusception among children younger than 2 years, accounting for 81% (38/47) of the cases. The most common causes of secondary intussusception in children older than 2 years were intestinal polyps, Meckel’s diverticulum and Peutz–Jeghers syndrome, accounting for 72% (26/36) of the cases.

Conclusions

The presence of a pathological lead point is more likely in older children. The most common types of intussusception secondary to PLPs are complex/compound and small intestinal. Meckel’s diverticulum and intestinal duplication were the most common causes of secondary intussusception among younger children and Peutz–Jeghers syndrome and intestinal polyps were commonly seen in older children.

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Author notes

  1. Lingling Zhao, Shaoguang Feng, Peng Wu and Xin-He Lai contributed equally to the work.

Authors and Affiliations

  1. Department of Pathology, Zhejiang Provincial Hospital of TCM, The First Affiliated Hospital of Zhejiang University of TCM, Hangzhou, 310006, China

    Lingling Zhao

  2. Department of Pediatric Surgery, Hangzhou Children’s Hospital, Hangzhou, 310015, China

    Shaoguang Feng

  3. Department of Pediatric Surgery, Northwest Women and Children’s Hospital, Xi’an, China

    Peng Wu

  4. School of Biology and Food Science, Shangqiu Normal University, Shangqiu, Henan, China

    Xin-He Lai

  5. Department of Pediatric Surgery, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China

    Chengjie Lv

  6. Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

    Guorong Chen

Authors
  1. Lingling Zhao
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  2. Shaoguang Feng
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  3. Peng Wu
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  4. Xin-He Lai
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Correspondence to Guorong Chen.

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Zhao, L., Feng, S., Wu, P. et al. Clinical characteristics and surgical outcome in children with intussusceptions secondary to pathologic lead points: retrospective study in a single institution. Pediatr Surg Int 35, 807–811 (2019). https://doi.org/10.1007/s00383-019-04471-8

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  • DOI: https://doi.org/10.1007/s00383-019-04471-8

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