Study On The Related Factors Of Air Enema Failure And Recurrence And Intestinal Necrosis In Children With Acuteintussusception

Backgrounds and objectiveAcute intussusception is one of the common abdominal emergencies in children,which is usually caused by abnormal peristaltic rhythm.A segment of the intestine is sheathed into the adjacent lumen of the distal intestine and the passage of intestinal contents is obstructed.The prognosis is satisfactory after reduction or operation,but the air enema failure(1.7-11.2%)and recurrence(2-12%)of acute intussusception in children are not rare.And acute intussusception may cause intestinal necrosis and endanger the life of the child,which causes great worries to the clinical staff and parents.This study is to analyze the related factors of air enema failure and recurrence and intestinal necrosis in children with acute intussusception and to improve the understanding ofthe occurrence and development ofacute intussusception and to provide some help for the clinical diagnosis and treatment of acute intussusception in children.MethodsFrom January 2011 to December 2019,the clinical datas of 153 children with intussusception who failed in the first air enema,109 children with recurrence of intussusception during hospitalization and 57 children with intestinal necrosis were collected,including age,gender,time of onset,month of onset,mode of delivery,clinical manifestations(abdominal pain or crying,vomiting,bloody stool,fever,abdominal mass,etc.),the location of the intussusception caps,the shape of the intussusception caps,involvement of appendix or lymph node,effusion in the gut and abdominal cavity,enlarged abdominal lymph nodes,WBC,CRP and PCT.At the same time,180 children with successful air enema and without recurrence and without intestinal necrosis were selected as the control group.Univariate and multivariate analysis were used to analyzethe related factors of air enema failure and recurrence and intestinal necrosis in children with acute intussusception.Furthermore,the prediction models of three cases of intussusception in children were obtained,and the performance of logistic regression model was evaluated by ROC curve.Results1.Compared with the control group:(1)Univariate analysis showed that:the air enema failure group of intussusception had younger age(?2=8.646,P=0.013),longer onset time(?2=19.646,P<0.001),higher proportion ofintussusception capslocated in distal part of colon(?2=16.998,P<0.001),higher proportion of lobulated intussusception caps(?2=7.169,P<0.007),higher proportion of involvement of appendix or lymph node(?2=4.098,P<0.043).There was no significant difference between the two groups in gender,mode of delivery,month of onset,abdominal pain or crying,vomiting,bloody stool,fever,abdominal mass,enlarged abdominal lymph nodes,WBC,CRP and PCT(P>0.05).(2)Logistic regression analysis showed that the time of onset(OR=2.768,95%CI:1.801?4.254),the location of the intussusception caps(OR=6.417,95%CI:1.424?28.909),the shape of the intussusception caps(OR=1.906,95%CI:1.13 8?3.192)and enlarged abdominal lymph nodes(OR=2.632,95%CI:1.725?4.014)were independent risk factors for air enema failure of intussusception.At the same time,according to logistic regression analysis,the prediction model was established as follows:in(P/1-P)=-4.644+1.018*onset time+1.859*the location of the intussusception caps+0.645*the shape of the intussusception caps+0.968*enlarged abdominal lymph nodes.P represents the probability of air enema failure.The area under ROC curve of the prediction model was 0.897,and 95%confidence interval was 0.861?0.933.2.Compared with the control group:(1)Univariate analysis showed that:the recurrence group of intussusception had older age(?2=22.510,P<0.001),higher proportion of cesarean section(?2=4.924,P=0.026),higher proportion of enlarged abdominal lymph nodes(?2=5.251,P=0.022),higher WBC(t=3.721,P<0.001),higher CRP(t=10.947,P<0.001),higher PCT(t=9.559,P<0.001).There was no significant difference between the two groups in gender,month of onset,time of onset,abdominal pain or crying,vomiting,bloody stool,fever,abdominal mass,the location of the intussusception caps,the shape of the intussusception caps,involvement of appendix or lymph node,effusion in the gut and abdominal cavity(P>0.05).(2)Logistic regression analysis showed that age(OR=4.708,95%CI:1.240?17.870),cesarean section(OR=2.198,95%CI:1.359?3.556),enlarged abdominal lymph nodes(OR=2.632,95%CI:1.725?4.014),CRP(OR=9.180,95%CI:2.536?33.226)were independent risk factors for recurrence of intussusception.According to logistic regression analysis,the prediction model was established as follows:in(P/1-P)=-7.224+1.549*age+0.778*cesarean section+0.957*enlarged abdominal lymph nodes+2.217*CRP.P represents the probability of recurrence of intussusception.The area under ROC curve of the prediction model was 0.856,and the 95%confidence interval was 0.833-0.879.3.Compared with the control group:(1)Univariate analysis showed that:the intestinal necrosis group of intussusceptions had younger age(?2=6.922,P=0.031),higher proportion of cesarean section(?2=5.028,P=0.025),longer onset time(?2=11.150,P=0.004),higher proportion of bloody stool(?2=15.800,P<0.001),higher proportion of lobulated intussusception caps(?2=7.809,P=0.005),higher proportion of involvement of appendix or lymph node(?2=13.887,P<0.001),higher proportion of effusion in the gut and abdominal cavity(?2=21.136,P<0.001),higher WBC(t=5.835,P<0.001),higher CRP(t=14.715,P<0.001),higher PCT(t=21.863,P<0.001).There was no significant difference between the two groups in gender,month of onset,abdominal pain or crying,vomiting,fever,abdominal mass,the location of the intussusception caps,enlarged abdominal lymph nodes(P>0.05).(2)Logistic regression analysis showed that bloody stool(OR=3.408,95%CI:1.217?9.554),involvement of appendix or lymph node(OR=1.895,95%CI:1.136?3.161),effusion in the gut and abdominal cavity(OR=6.435,95%CI:1.927?21.613),PCT(OR=14.025,95%CI:3.847?51.126)and cesarean section(OR=2.018,95%CI:1.299?3.136)were independent risk factors of intestinal necrosis of intussusception.According to logistic regression analysis,the prediction model was established as follows:in(P/1-P)=-9.247+1.226*bloody stool+0.639*involvement of appendix or lymph node+1.865*effusion in the gut and abdominal cavity+2.641*PCT+0.702*cesarean section,P represents the probability of intestinal necrosis in intussusception.The area under ROC curve was 0.922 and 95%confidence interval was 0.898?0.946.Conclusion1.The independent risk factors of air enema failure in children with acute intussusception were young age,long onset time,intussusception capslocated in distal part of colon and lobulated intussusception cap.2.The independent risk factors of recurrence in children with acute intussusception were old age,cesarean section,enlarged abdominal lymph nodes and high CRP.3.The risk factors of intestinal necrosis in children with acute intussusception were effusion in the gut and abdominal cavity,involvement of appendix or lymph node,bloody stool,high PCT and cesarean section.