Clinical Characteristics Of 126 Children With Recurrent Intussusception

Background:Intussusception refers to a part of intestinal canal and its mesangium sinking into another segment of intestinal cavity,which is one of the most common causes of acute abdominal diseases in children.The incidence rate of children under 1 year old is 74/100,000.The occurrence of intussusception for a long time can lead to intestinal wall ischemia necrosis and systemic poisoning symptoms.Severe cases can be complicated with intestinal perforation and peritonitis,which seriously threaten the health of children.Recurrent intussusception refers to the recurrence of intussusception in 8%-15% of children after successful reduction after enema treatment or surgical treatment.Recurrence of intussusception is a problem that cannot be ignored.It is generally believed that when intussusception recurs,parents can usually find the symptoms earlier than when the intussusception first occurs,because they have a clearer understanding of the situation,but the delay in treatment of intussusception recurrence is still one of the reasons for poor prognosis.In most cases,intussusception is idiopathic,and recurrent intussusception is more likely to be related to specific pathology,including Meckel's diverticula,intestinal duplication,intestinal polyps and tumors.Therefore,it is very important to understand the clinical features of recurrent intussusception and identify its pathological factors.This study takes children with recurrent intussusception as the research object,and analyzes the clinical characteristics of children with recurrent intussusception from the aspects of gender,age,course of disease,recurrence frequency,clinical manifestations,imaging examination,presence or absence of Pathologic Lead Point(PLP),etc.,so as to provide clinical basis for early detection and diagnosis of recurrent intussusception,guiding further auxiliary examination,clarifying etiology and reducing missed diagnosis.Objective:To explore the clinical characteristics,pathological examination results and etiological diagnosis of recurrent intussusception in children,and summarize the clinical diagnosis and treatment experience.Methods:Retrospective analysis of 126 cases of recurrent intussusception in children's hospital affiliated to medical college of Zhejiang university from January 2015 to November 2019 was carried out.clinical data such as gender,age,course of disease,recurrence frequency,clinical manifestations,imaging examination,pathological examination results and etiology were collected.Results:(1)General data: Of 126 hospitalized children with recurrent intussusception,76 were male and 50 were female,with a male-female ratio of 1.52:1.The minimum age of admission was April 21,the maximum was 11.91 years old,and the median age was 2.95 years old.The shortest course is 12 hours,the longest course is 139 months(11 years and 7 months),and the median course is 3 days.(2)Recurrence times: 107 out of 126 children had definite recurrence times,at least once,up to 20 times,and 19 children with multiple attacks could not recall the specific number of attacks.Most of the children relapsed many times,of which 35 cases(27.8%)recurred once,16 cases(12.7%)recurred twice,12 cases(9.5%)recurred three times,15 cases(11.9%)recurred four times,17 cases(13.5%)recurred five times,12 cases(9.5%)recurred 6-20 times,19 cases(15.1%)recurred unclear times.Excluding 19 cases with uncertain recurrence times,the recurrence times of each age group(?1 year old,?3 year old,?5 year old,?7 year old,?12 year old)and each course(?1 day,?2 day,?3 day,?4 day,?5 day,?14 day,> 14 day)were statistically different(p < 0.05).(3)Clinical manifestations: 126 children included in the study,the clinical manifestations mainly include abdominal pain,paroxysmal crying,vomiting,bloody stool and abdominal mass,including 76 cases of abdominal pain,49 cases of paroxysmal crying,51 cases of vomiting,27 cases of bloody stool and 32 cases of abdominal mass,accounting for 60.3%,38.9%,40.5%,21.4% and 25.4% of the total cases respectively.Among children younger than 3 years old,34 cases(52.3%)saw a doctor with paroxysmal crying as the main clinical manifestation,31 cases(47.6%)saw a doctor with vomiting as the main clinical manifestation,and 46 cases(75.4%)saw a doctor with abdominal pain as the main clinical manifestation among children older than 3 years old.Abdominal pain and paroxysmal crying were significantly different in age groups(?3 years old and > 3 years old).Abdominal pain,paroxysmal crying,vomiting,bloody stool and abdominal mass are basically the same in course distribution,with no statistical difference.(4)Imaging examination: In this study,126 children were examined and diagnosed by ultrasound,with an accuracy rate of 100%.Ultrasound showed that PLP was possible in 22 patients,and 14 patients were finally diagnosed,including 5 cases of lymphoma,5 cases of juvenile polyp,2 cases of P-J syndrome,1 case of Meckel diverticulum,and 1 case of capillary hemangioma.13 cases underwent CT examination,4 cases showed abnormalities,of which 1 case was confirmed as juvenile polyp and 1 case as Meckel diverticulum.Barium enema was performed in 1 case.Colonic splenic flexure was found to occupy space.Postoperative pathology confirmed that it was juvenile polyp.(5)Etiological composition and distribution characteristics: biopsy tissues were taken for pathological examination through colonoscopy,laparoscopy or laparotomy.Combined with clinical characteristics,intraoperative findings and relevant pathological results,79(29.4%)of 126 children with recurrent intussusception had secondary cases with definite etiology,including 10(7.9%)of Meckel Diverticulum(MD);9 cases(7.1%)were juvenile polyps.Lymphoma was found in 8 cases(6.4%).3 cases(2.4%)of P-J syndrome;Gastric mucosa ectopic in 3 cases,accounting for 2.4%;Intestinal duplication was found in 2 cases(1.6%).1 case of anaphylactoid purpura,accounting for 0.8%;Capillary hemangioma was found in 1 case(0.8%).Meckel diverticulum has the most cases.There were 89 idiopathic cases of unknown etiology,accounting for 70.6%.Recurrent intussusception cases with PLP have significant differences in age groups(?3 years old and > 3 years old).Conclusion:(1)The age of children with recurrent intussusception is mainly within 5 years old,with 1-3 years old being the most frequent.(2)The clinical manifestations of recurrent intussusception do not have obvious specificity,abdominal pain,paroxysmal crying and vomiting are common.(3)Ultrasound is still the main diagnostic method in recurrent intussusception.It can not only identify intussusception,but also find other primary intestinal diseases.(4)The causes of PLP in children with recurrent intussusception include Meckel's diverticulum,juvenile polyp,lymphoma,P-J syndrome,gastric mucosa ectopic,intestinal duplication,allergic purpura and capillary hemangioma.(5)Children over 3 years old with recurrent intussusception should be alert to the existence of PLP.When necessary,CT,Magnetic Resonance Imaging(MRI),single photon Emission Computed Tomography(ECT),barium enema and even surgical exploration should be improved to make clear the diagnosis.