Objective To investigate the risk factors associated with recurrence after air enema (AE) reduction in pediatric primary intussusception (PPI). Methods A retrospective analysis was performed on clinical data of children with primary intussusception who underwent air enema reduction in our hospital from January 2022 to December 2023. A total of 1,449 cases were included and divided into a recurrence group (181 cases) and a non-recurrence group (1,268 cases) based on whether recurrence occurred within 72 h after AE reduction. Clinical data were collected for retrospective analysis. Age, sex, disease duration, mass diameter, ileocecal edema, vomiting, abdominal pain, bloody stool, somnolence, recent history of respiratory or gastrointestinal viral infection, white blood cell count, and C-reactive protein (CRP) were compared between two groups. Logistic regression analysis, Spearman analysis, and ROC curve analysis were used to identify factors associated with recurrence after AE reduction in primary intussusception and explore their correlations. Results There were no significant differences in age, sex, disease duration, ileocecal edema, vomiting, abdominal pain, somnolence, or white blood cell count between recurrence and non-recurrence groups (all P>0.05). There were significant differences in recent history of respiratory or gastrointestinal viral infection, CRP level, bloody stool, and mass diameter (all P<0.05). Logistic regression analysis showed that recent history of respiratory or gastrointestinal viral infection, CRP level, bloody stool, and mass diameter were independent risk factors for recurrence after AE reduction (OR=1.513, 1.545, 1.685, 2.018; all P<0.05). Spearman analysis indicated significant correlations between these factors and recurrence after AE reduction (r=0.221, 0.364, 0.238, 0.412; all P<0.05). ROC curve analysis showed that these factors had predictive value for recurrence (AUC=0.711, 0.675, 0.693, 0.604; all P<0.05). Conclusions Recent history of respiratory or gastrointestinal viral infection, CRP level, bloody stool, and mass diameter are closely associated with recurrence after AE reduction in primary intussusception. Independent risk factors may include recent viral infection, elevated CRP level, bloody stool, and mass diameter >35 mm.
Key words
Pediatric primary intussusception /
/
/
Air enema /
/
/
Reduction /
/
/
Recurrence /
/
/
Risk factors
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Alam F, Chikukuza S, Okkeh O, et al. Small bowel lipoma and intussusception: a case report[J]. J Surg Case Rep, 2024(5): 327. DOI: 10.1093/jscr/rjae327.
[2] Shavit I, Levy N, Dreznik Y, et al. Practice variation in the management of pediatric intussusception: a narrative review[J]. Eur J Pediatr, 2024, 183(11):4897-4904. DOI: 10.1007/s00431-024-05759-1.
[3] Riera A, Langhan M, Silva CT. Terminal ileitis presenting with a spontaneously reduced ileocolic intussusception diagnosed by point-of-care ultrasonography[J]. Pediatr Emerg Care, 2020, 36(1): e30-e32. DOI: 10.1097/PEC.0000000000001879.
[4] Snyder EJ, Pruthi S, Hernanz-Schulman M. Making intussusception reductions easier: use of medical air in lieu of manual pump[J]. Pediatr Radiol, 2023, 53(2): 217-222. DOI: 10.1007/s00247-022-05461-0.
[5] Bines JE, 刘娜, 左树岩. 作为接种后不良事件的婴儿及儿童急性肠套叠: 病例定义和数据收集、分析及报告指南[J]. 中国疫苗和免疫, 2017, 23(5): 597-600. DOI: 10.19914/j.cjvi.2017.05.025.
Bines JE, Liu N, Zuo SY. Acute intussusception in infants and children as a post-vaccination adverse event: case definition and guidelines for data collection, analysis and reporting[J]. Chinese Journal of Vaccines and Immunization, 2017,23(5): 597-600. DOI: 10.19914/j.cjvi. 2017. 05.025.
[6] Sturgeon JP, Zanetti B, Lindo D. C-Reactive Protein (CRP) levels in neonatal meningitis in England: an analysis of national variations in CRP cut-offs for lumbar puncture[J]. BMC Pediatr, 2018, 18(1): 380. DOI: 10.1186/s12887-018-1354-x.
[7] Ayaz UY, Dilli A, Ayaz S, et al. Ultrasonographic findings of intussusception in pediatric cases[J]. Med Ultrason, 2011, 13(4): 272-276.
[8] 朱珍妮, 王明芳, 王凤革, 等. 双气囊小肠镜在儿童Peutz-Jeghers综合征引起肠套叠中的初步治疗经验[J]. 中华消化内镜杂志, 2022, 39(4): 322-325. DOI: 10.3760/cma.j.cn321463-20210329-00890.
Zhu ZN, Wang MF, Wang FG, et al. Preliminary therapeutic experience of double-balloon enteroscopy in pediatric intussusception caused by Peutz-Jeghers syndrome[J]. Chinese Journal of Digestive Endoscopy, 2022, 39(4): 322-325. DOI: 10.3760/cma.j.cn321463-20210329-00890.
[9] 郭建康, 柏艳红, 刘雅娜, 等. 超声引导下水压灌肠治疗儿童急性肠套叠的效果研究[J]. 影像科学与光化学, 2022, 40(4): 878-882. DOI: 10.7517/issn.1674-0475.220119.
Guo JK, Bai YH, Liu YN, et al. Effect study of ultrasound-guided hydrostatic enema for treatment of acute intussusception in children[J]. Imaging Science and Photochemistry, 2022, 40(4): 878-882. DOI: 10.7517/issn.1674-0475.220119.
[10] 秦鸣, 董娟, 张琛, 等. 儿童梅克尔憩室内翻继发肠套叠的声像图特征[J]. 中国超声医学杂志, 2022, 38(5): 586-589. DOI: 10.3969/j.issn.1002-0101.2022.05.031.
Qin M, Dong J, Zhang C, et al. Sonographic characteristics of intussusception secondary to Meckel's diverticulum inversion in children[J]. Chinese Journal of Ultrasound in Medicine, 2022, 38(5): 586-589. DOI: 10.3969/j.issn.1002-0101.2022.05.031.
[11]Farahmandinia Z, Nakhaie M, Rukerd MRZ. Ileocecal intussusception as a first presentation of Burkitt's lymphoma with multi-organ involvement[J]. Clin Case Rep, 2023, 11(5): e7347. DOI: 10.1002/ccr3.7347.
[12]Sharaan M, Okba MM, El Badawy MA, et al. Gastrogastric Intussusception 10 Years After Laparoscopic Gastric Greater Curvature Plication: a Case Report[J]. Obes Surg, 2024, 34(9): 3543-3548. DOI: 10.1007/s11695-024-07402-2.
[13]Takamoto N, Konishi T, Fujiogi M, et al. Outcomes Following Laparoscopic Versus Open Surgery for Pediatric Intussusception: Analysis Using a National Inpatient Database in Japan[J]. J Pediatr Surg, 2023, 58(11): 2255-2261. DOI: 10.1016/j.jpedsurg.2023.07.004.
[14]Lee JY, Kim JH, Choi SJ, et al. Point-of-care ultrasound may be useful for detecting pediatric intussusception at an early stage[J]. BMC Pediatr, 2020, 20(1): 155. DOI: 10.1186/s12887-020-02060-6.
[15]Arroyo AC, Zerzan J, Vazquez H, et al. Diagnostic Accuracy of Point-Of-Care Ultrasound for Intussusception Performed by Pediatric Emergency Medicine Physicians[J]. J Emerg Med, 2021, 60(5): 626-632. DOI: 10.1016/j.jemermed.2020.11.030.
[16]Li Y, Li Y, Liu W, et al. Th2/Th1 cytokine imbalance is associated with higher recurrent intussusception incidence in children: A 10-year retrospective study of 1657 patients[J]. Medicine (Baltimore), 2023, 102(13): e33391. DOI: 10.1097/MD.0000000000033391.
[17]吴佩群, 杨敏, 耿岚岚. 儿童肠息肉继发肠套叠27例临床分析[J]. 临床儿科杂志, 2021, 39(9): 703-705. DOI: 10.3969/j.issn.1000-3606. 2021.09.015.
Wu PQ, Yang M, Geng LL. Clinical analysis of 27 cases of intussusception secondary to intestinal polyps in children[J]. Journal of Clinical Pediatrics, 2021, 39(9): 703-705. DOI: 10.3969/j.issn.1000-3606.2021.09.015.
[18]Vo A, Levin TL, Taragin B, et al. Management of Intussusception in the Pediatric Emergency Department: Risk Factors for Recurrence[J]. Pediatr Emerg Care, 2020,36(4):e185-e188. DOI: 10.1097/PEC.0000 000000001382.
[19]Tang XB, Hu DY, Mu XQ, et al. Association of air temperature with pediatric intussusception in northeastern China: A 10-year retrospective study[J]. Am J Emerg Med, 2021, 42: 211-216. DOI: 10.1016/j.ajem. 2020.11.012.
[20]Lee JY, Byun YH, Park JS, et al. Lactic acid level as an outcome predictor in pediatric patients with intussusception in the emergency department[J]. BMC Pediatr, 2020, 20(1): 184. DOI: 10.1186/s12887-020-02095-9.
[21]周宇翔, 刘登辉, 文佳冰, 等. 儿童复发性肠套叠的临床特点及危险因素分析:单中心回顾性研究[J]. 临床小儿外科杂志, 2022, 21(7): 653-657. DOI: 10.3760/cma.j.cn101785.
Zhou YX, Liu DH, Wen JB, et al. Clinical characteristics and risk factor analysis of recurrent intussusception in children: a single-center retrospective study[J]. Journal of Clinical Pediatric Surgery, 2022, 21(7): 653-657. DOI: 10.3760/cma.j.cn101785.
[22]Adhikari S, Koirala DP, Pokhrel RP, et al. Risk factors for recurrent intussusception after successful reduction in pediatric patients in a tertiary care hospital of Nepal: A prospective study[J]. Ann Med Surg (Lond), 2022, 76:103427. DOI: 10.1016/j.amsu.2022.103427.
PDF(2388 KB)
