Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Management of Pediatric Intussusception: Review of the Treatment Algorithm (Retrospective Study)
Pediatrik İnvajinasyon Yönetimi: Tedavi Algoritmasının Gözden Geçirilmesi (Retrospektif Çalışma)
Samir HASANa , Ülgen ÇELTİKa , Emre DİVARCIa , Orkan ERGÜNa , Geylani ÖZOKa , Ahmet ÇELİKa
aDepartment of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Türkiye
Turkiye Klinikleri J Med Sci. 2023;43(3):246-53
doi: 10.5336/medsci.2022-95180
Article Language: EN
Full Text
ABSTRACT
 Objective: In large series, the clinical features, management steps, and treatment results of intussusceptions have been studied. Material and Methods: Retrospective study including intussusception patients in a single center between 2008-2021. Results: There were 406 patients: 353 (86.9%) patients with ileocolic, 30 (7.4%) patients with small bowel, and 23 (5.7%) patients colocolic intussusception. In small bowel intussusceptions, 60% (18/30) of patients were treated surgically and in 40% (12/30) spontaneous reduction happened. Pathological lead points (PLPs) were found in 23.3% (7/30) of patients. In colocolic intussusception, the nonoperative reduction was used in 22/23 patients with a 90.9% success rate. The rate of PLPs was 4.3% (1/23). In ileocolic intussusception, spontaneous reduction happened in 18% (64/353) of cases. Nonoperative reduction was used as initial treatment in 272/353 patients with 79% (215/272) success rate and surgical management was used in 22.2% (78/353) of patients. The recurrence rate was 17.2% (61/353) with 85 attacks. Nonoperative reduction was used in 65/85 of attacks with 93% success rate. PLPs rate in different age groups was: 3.8% (0-2 years), 8% (2-5 years) and 17.4% (>5 years) (p value5 years old the frequency of Burkitt lymphoma was remarkable 10.8%. Conclusion: Although the first-line approach in small bowel intussusceptions is surgical exploration, the frequency of spontaneous reduction is high in cases with short segments (5 years old with ileocolic intussusceptions because of the high incidence of PLPs and Burkitt's lymphoma.

Keywords: Intussusception; acute abdomen; Burkitt lymphoma
ÖZET
 Amaç: Geniş hasta serisinde, pediatrik invajinasyonun klinik özellikleri, tedavi basamakları ve tedavi sonuçları incelenmiştir. Gereç ve Yöntemler: 2008-2021 yılları arasında tek merkezde tüm invajinasyon hastalarının dosyaları retrospektif olarak incelenmiştir. Bulgular: Dört yüz altı hasta çalışmaya dâhil edildi: 353 (%86,9) ileokolik, 30 (%7,4) ince bağırsak ve 23 (%5,7) kolokolik invajinasyon hastası mevcuttu. İnce bağırsak invajinasyonlarında hastaların %60'ı (18/30) cerrahi olarak tedavi edildi, %40'ında (12/30) spontan redüksiyon gerçekleşti. Hastaların %23,3'ünde (7/30) patolojik lead point (PLP) bulundu. Kolokolik invajinasyonda 22/23 hastada %90,9 başarı oranıyla nonoperatif redüksiyon uygulandı. PLP oranı %4,3 (1/23) idi. İleokolik tipte olguların %18'inde (64/353) spontan redüksiyon gerçekleşti, 272/353 hastada %79 (215/272) başarı oranıyla nonoperatif redüksiyon uygulandı, %22,2 (78/353) hastada cerrahi tedavi uygulandı. Nüks oranı %17,2 (61/353) (85 atak) idi. Atakların 65/85'inde %93 başarı oranıyla nonoperatif redüksiyon uygulandı. Farklı yaş gruplarında PLP oranı: %3,8 (0-2 yaş), %8 (2-5 yaş) ve %17,4 (>5 yaş) (p değeri <0,001) idi. Ülkemize özel son yaş grubunda (>5 yaş) Burkitt lenfoma sıklığı %10,8 dikkat çekiciydi. Sonuç: İnce bağırsak invajinasyonlarında temel yaklaşım cerrahi eksplorasyon olmakla beraber kısa segmentli (<4 cm) vakalarda spontan redüksiyon sıklığı yüksektir. Nonoperatif redüksiyon, ileokolik ve kolokolik invajinasyonlarda tüm yaş grupları için standart tedavi yaklaşımı olmalıdır. Beş yaş ve üzeri ileokolik invajinasyon hastalarında PLP ve Burkitt lenfoma insidansının yüksek olması nedeniyle tedavi dikkatli yapılmalıdır.

Anahtar Kelimeler: İntussusepsiyon; akut karın; Burkitt lenfoma
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