TREATMENT TACTICS FOR INTESTINAL INTUSSUSCEPTION RELAPSES IN CHILDREN

Abstract

Today, despite the significant achievements in the treatment of intestinal intussusception in children, a number of issues associated with this condition are still remaining disputable. One of these issues is the choice of treatment tactics for relapses of intestinal invagination. Some authors support the idea of emergency surgery, considering the anatomical factors (Meckel diverticulas, enterocolitis, polyps, etc.) as being causative. Advocates of conservative tactics note the low frequency of anatomical causes in clinical practice, including cases of relapse of intestinal intussusception in children over the age of one year. The aim of this study was to assess the managing tactics effectively applied in cases of intestinal intussusception in children. For the period from 1986 to 2016, 247 children with intestinal intussusception aged from 3 months to 13 years underwent the treatment in the Pediatric Surgical Department, Poltava. Recurrences of intestinal intussusception were observed in 16 (6.1%) cases in 11 (4.45%) patients. Over the past 15 years, the techniques in managing relapses of intestinal intussusception have changed significantly. By 2003, 4 children had been treated with 7 cases of relapse of intestinal intussusception. 3 children were operated on without attempts of conservative disinvagination, 1 child was subjected to four procedures of conservative disinvagination. Since 2004, the main managing technique for intussusception relapses was conservative disinvagination. There were treated 7 children with 9 cases of intussusception relapses, and in 8 cases conservative disinvagination was performed on; in one case only operative intervention was applied. The surgical interventions revealed no cases when morphological factors could cause invagination were found out. Conservative disinvagination was performed by the method of pneumocompression reduction with its effectiveness control by M. I. Gritsenko. X-ray methods for controlling the effectiveness of disinvagination were not applied. To exclude the likelihood of anatomical causes, children were thoroughly evaluated. Radiographic contrast techniques for investigating the small intestine and colon to determine possible morphological causes of relapse due to their low diagnostic efficacy, sensitivity and specificity were not used. All children with recurrent intestinal intussusception underwent ultrasound scanning before and after the procedure of conservative disinvagination. No cases of relapses due to morphological causes were detected. To exclude anatomical causes of recurrent invagination, diagnostic laparoscopy is the most effective. Relapses of intestinal intussusception in children can not be considered as absolute indications for emergency surgical intervention. An attempt to perform conservative disinvagination by using pneumocopression reduction technique with the control of its effectiveness by M. I. Gritsenko is justified in all cases of intestinal invagination relapses when there no presentations of intra-abdominal complications. The prospects for further research cover improving in the treatment techniques for managing children intestinal intussusception lasing over 24 hours, in patients over 1 year old and children with relapses of invagination with the expansion of indications for conservative treatment.

Keywords

• intestinal intussusception
• relapse
• children