Management for intussusception in children - PMC Despite widespread agreement on the use of contrast enema for initial management, debate persists on the appropriate contrast medium, imaging modality, pharmacological adjuvant, and protocol to be used for delayed repeat enema (i.e. et al. Thompson SG, A report prepared for the Steering Committee on Diarrhoeal Disease Vaccines, Vaccine Development,Vaccines and Biologicals, World Health Organization, Geneva, Switzerland. We included six randomised controlled trials (RCTs) with a total of 822 participants. Altman DG. Two infant deaths linked to intussusception without peritonitis. 4 or 5 Management of intussusception in children | Cochrane Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 3 Recurrent intussusception. et al. Two review authors (SG and RGM) screened titles and abstracts for study eligibility using the inclusion criteria of this review. Beres AL, Frontiers | Colocolic Intussusception in Children: A Case Series and (crossover* or cross over*).ti,ab. To deal with clinical heterogeneity, we analysed studies of each intervention and presented them separately. To the best of our knowledge, this is the first systematic review of nonsurgical and surgical approaches in the management of intussusception in children. It is rare in newborn babies. GarzaJordan J, Smith BM. Conclusions: For the remaining four trials, it was unclear whether outcome assessors were study personnel (i.e. Litz CN, Amankwah EK, Polo RL, Sakmar KA, Danielson PD, Chandler NM. 16. groups.ab. Further clinical research is needed to determine the most effective and least harmful nonsurgical and surgical approaches to management of intussusception in children. Symptoms of Intussusception. Intussusception Treatment & Management - Medscape 8. #1 MeSH descriptor Intussusception explode all trees We undertook an extensive literature search to examine different aspects of surgical and nonsurgical management of intussusception in children, and we sought data from each identified study. Intussusception occurs primarily in infants (boys more often than girls) but can also occur in adults and older children. Murata Y, Review authors combined barium and saline into a liquid enema group for comparison with air enema. Two review authors (SG and RGM) searched the reference lists of all eligible trials and contemporary reviews to identify further trials. Copyright 2020 Elsevier Inc. All rights reserved. In contrast to narrative reviews, systematic reviews use transparent, objective, and reproducible methods to locate and assess studies (Borenstein 2009). et al. Rescorla FJ, Khan R, et al. The investigators describe a nonrandom component in the sequence generation process. Ted Gerstle J. Epub 2015 Aug 20. Patel MM. government site. In some centres they are no longer routinely indicated in children with intussusception, unless there is coexistent septic shock or manifestations of intestinal . Cochrane Handbook for Systematic Reviews of Interventions, The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis3), Laparoscopic versus open reduction of intussusception in children: a retrospective review and metaanalysis, Journal of Laparoendoscopic & Advanced Surgical Techniques, The use of antispasmodic drugs during barium enemas. The intestine can swell and bleed. Meyer JS, Other potential causes of pathological lead points include Meckel's diverticulum, duplication cyst, polyp, and lymphoma (Daneman 2003; Daneman 2004). We could make few direct comparisons of interventions. J Pediatr Surg. No trials in this comparison reported on the number of children with bowel perforation(s) nor on the number of children with recurrent intussusception. The .gov means its official. et al. Summary. Mast TC, 8 Intussusception is the most common cause of intestinal obstruction in babies and young children. Review first published: Issue 6, 2017. Intussusception in children - UpToDate Vomiting. Kia KF, Once intussusception is diagnosed, most doctors agree on the use of enema as initial treatment. 2022 Apr 6;9:873624. doi: 10.3389/fsurg.2022.873624. If we identified cluster trials, we planned to involve a statistician to ensure that we did not create unit of analysis errors. Franken, Desai R, In the United States, about 35 to 40 of every 100,000 babies younger than age 1 is hospitalized for intussusception. #4 MeSH descriptor Infant explode all trees and transmitted securely. Lin 2000 did not report how data were collected after participants were discharged, and Meyer 1993 and Mortensson 1984 did not report all expected outcomes. Please enable it to take advantage of the complete set of features! One trial did not stipulate whether fluoroscopy or ultrasound guidance was used (Lin 2000). Methods: Intussusception is a condition in which part of the intestine folds into the section next to it. Baird R, Intussusception is one of the most common abdominal emergencies in children. Studies show that yogurt with live cultures or probiotics can help ease diarrhea caused by antibiotics. doi: 10.1002/14651858.CD006476.pub3. The use of glucagon in hydrostatic reduction of intussusception: a doubleblind study of 30 patients, Childhood intussusception: a comparative study of nonsurgical management, Decreasing early recurrence rate of acute intussusception by the use of dexamethasone, Decrease early recurrence rate of childhood acute intussusception by dexamethasone, Proceedings from The 11th Asia Pacific Congress of Doppler Echocardiography and 8th APCDE. We attempted to contact study authors but received no response. Following treatment, your child was watched in Children's Emergency Services for at least 6 hours to be sure their symptoms resolved after treatment. 18. exp animals/ not humans.sh. We also identified three ongoing trials. Unable to load your collection due to an error, Unable to load your delegates due to an error. Boys are affected two to eight times more often than girls (Bines 2002), and peak incidence occurs between five and nine months of age (Daneman 2003; Samad 2012). We found no data on surgical interventions that were suitable for analysis, and no evidence regarding the relative effectiveness and safety of different imaging modalities or protocols for delayed repeat enemas. Wong J, We contacted study authors via email when data were unclear or missing. Uba FA. Hirschl RB, Intussusception - NIDDK Repeated enema reductions may be attempted when clinically appropriate. We planned to assess differences among subgroups using analysis of variance (Altman 1996). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Air enema may be superior to liquid enema for successfully reducing intussusception in children (reported in two trials, 199 participants; RR 1.28, 95% CI 1.10 to 1.49; I = 0%; Analysis 3.1). Destefano F, 17. The episodes typically last 15 to 20 minutes. Intussusception is a common abdominal emergency in children with significant morbidity. SG: running searches, selecting studies, extracting data, analysing results, and writing the main review. We applied no language, publication date, or publication status restrictions. Intussusception in children is a medical emergency that requires prompt diagnosis and management. It is the most common cause of intestinal obstruction in this age group and occurs roughly equally in male and female children < 4 years of age . Diagnosis is challenging because the symptoms of intussusception are wideranging and nonspecific (Beasley 1988); the classic triad of symptoms associated with intussusception comprises vomiting, colicky abdominal pain, and bloody stool, but this triad is noted in less than half of cases (Blanch 2007; Lehnert 2009; Samad 2012). 12. placebo.ab. Use of the adjunct, dexamethasone, may be beneficial in reducing intussusception recurrence with liquid or air enema (two trials, 299 participants; RR 0.14, 95% CI 0.03 to 0.60; low quality of evidence). However, we were unable to perform the planned sensitivity analysis owing to the limited number of included studies. et al. We identified no studies that exclusively evaluated surgical interventions for management of intussusception. Intussusception refers to the invagination (telescoping) of a part of the intestine into itself. Discomfort during doublecontrast barium enema examination: a placebocontrolled doubleblind evaluation of the effect of glucagon and diazepam, Cochrane Handbook for Systematic Reviews of Interventions. This list of 15 cases was used repeatedly throughout the study (10 times) with random sequence every time. This allocation sequence is predictable, No missing data (randomisation post exclusion). Rolle U. Intussusception in children clinical presentation, diagnosis and management, The International Journal of Colorectal Disease, Intussusception: the paediatric radiologist's perspective. Lack of trials on surgical management might reflect the nature of treatment of children with intussusception, and might suggest that cases are managed largely by nonsurgical means, although this suggestion does not seem to be based on trial evidence. A third review author (ACW) adjudicated disagreements about study eligibility. Colocolic Intussusception in Children: A Case Series and Review of the Literature. Of these conditions, lymphoid hypertrophy seems to be the most common (Applegate 2009; Staatz 1998), implicating a viral or bacterial origin for most cases (Nylund 2010; Okimoto 2011; Parashar 2000; Staatz 1998). However, air enema may be superior to liquid enema for successfully reducing intussusception in children. Usually, the description would involve some systematic, nonrandom approach, for example: Criteria for the judgement of Unclear risk of bias. Platt R, Intussusception is most commonly encountered in children and has been reported to be the most common abdominal emergency in early childhood and the second most common cause of intestinal obstruction after pyloric stenosis. Sutcliffe AG, Any child, younger than age 18, with a clinical diagnosis of intussusception as determined by study authors. We expected the following areas to contribute to study heterogeneity, and we planned to conduct subgroup analyses of relevant models when necessary. Maglinte DD, Fischer TK, Davis RL, Compared with idiopathic intussusception, intussusception caused by lead points is associated with poorer outcomes and may not be amenable to standard treatment owing to different intussusception locations (Applegate 2009; Loukas 2011). 21. Pharmacological adjuvants can facilitate nonsurgical management, but their efficacy remains controversial. Insufficient information to permit judgement of Low risk or High risk. Using a computer random number generator; Sequence generated by odd or even date of birth; Sequence generated by some rule based on date (or day) of admission; Sequence generated by some rule based on hospital or clinic record number. We planned to investigate publication bias by visually assessing funnel plots for the primary outcome if the number of identified and included trials exceeded 10. Demarche M, Sato K, (doubl* adj blind*).ti,ab. Chernish SM, We identified six completed trials of 822 participants in which all children had presented for management of intussusception. Cachat 2012 performed a metaanalysis of studies examining children with radiologically confirmed intussusception, including RCTs and retrospective comparative studies, to compare rates of recurrence. Of these, we excluded 423 after reviewing titles and abstracts. However, we did not identify any clusterrandomised trials for this systematic review. Farley TA. (infant* or child* or newborn*).mp. Inpatient Admission versus Emergency Department Management of Intussusception in Children: A Systemic Review and Meta-Analysis of Outcomes. Jordan R. Intussusception: an anatomical perspective with review of the literature. AyusoGonzalez L, Schmit P, Ko HS, Eng PM, 9. Babies and young children are more likely than adults to get intussusception. Preparation included a nasogastric tube with drainage of the stomach, intravenous fluid deficit replacement, and intravenous metronidazole and cefotaxime, "randomisation was based on a table of random numbers, wherein 15 consecutive random numbers were selected and assigned to cases 1 through 15. Eur J Pediatr Surg. The remaining trial used unclear methods. We conducted a comprehensive literature search to identify all published and unpublished randomised controlled trials with no language or date of publication restrictions. See summary of findings tables (Table 1; Table 2; Table 3). Although postoperative complications were reported (Outcome 2.9), Essa 2011 presented data in such a way that analysis was not possible. In particular, research on the surgical management of intussusception is needed. We judged five of six trials as having high risk of bias in at least one domain. When possible, we extracted the following primary and secondary outcome measures. We identified only sparse information on intraoperative and postoperative complications and on other adverse events. 3. SalcedoMunoz B, Jiang B, Summarize the treatment options for intussusception. 6. Care Instructions After Air Enema Reduction. Outpatient management of intussusception: a systematic review and meta-analysis. SoaresWeiser K, Ein SH, Intussusception is a serious illness that can cause damage to the intestines if left untreated. Ward JI, Major changes and new citation, Criteria for a judgement of Low risk of bias. 9. randomized controlled trial.pt. SINGLEBLIND PROCEDURE.sh. An official website of the United States government. Staggs NW, ((intestin* and invagination*) or intususcep* or intussuscep*).mp. Li Z, Song C, Huang J, Li J, Huang S, Qian B, Chen X, Hu S, Shu T, Yu G. Gastroenterol Res Pract. Debate persists on specifics regarding what type of substance should be used for the enema, how the substance is visualised during the process, whether extra medications should be given to enhance treatment, and how one should deal with treatment failure, as well as the best approach to surgical management of intussusception in children. 1. exp Intussusception/ Perch M, We described results while taking into account the quality of evidence and the importance (size) of the effect as follows. aDowngraded two levels for serious concerns for high risk of selection, attrition, and performance bias, aDowngraded two levels for serious concerns for high risk of attrition and performance bias, bDowngraded one level for serious imprecision (95% CI is wide and includes null effect), cDowngraded one level for concerns for high risk of performance bias, aDowngraded two levels for serious concerns for high risk of selection, performance, and detection bias. Intussusception is a condition in which one segment of intestine "telescopes" inside of another, causing an intestinal obstruction (blockage). Interventions: number of participants for each intervention, a detailed description of interventions and comparison interventions including, when relevant, type, dose, concentration, and duration of application. and transmitted securely. 7. 8 and 19, 1. exp intussusception/ In the 'Summary of findings' tables, we included all primary outcomes, as well as secondary outcomes, reported by included studies for the following comparisons: enema plus glucagon versus enema alone; enema plus dexamethasone versus enema alone; and air enema versus liquid enema. We conducted our analysis according to the guidelines set out in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011). Kamagata S, 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 Pulling the knees up to the chest like a child is trying to poop. Protocol first published: Issue 2, 2007 Fletcher BD, GonzalezSpinola J, EA, Intussusception among young children in Europe, Antibiotic use and intussusception in early childhood. CROSSOVER PROCEDURE.sh. To assess the safety and effectiveness of nonsurgical and surgical approaches in the management of intussusception in children. Gargiullo PM, When there is clinical suspicion, imaging has a valuable role. Participants: inclusion and exclusion criteria, age, gender, presence of pathological lead points, anatomical location of intussusception, criteria used to diagnose intussusception, total number of participants, country of origin, number of dropouts or withdrawals and reasons if recorded. Buonomo C, 2022 Sep 6;10:966839. doi: 10.3389/fped.2022.966839. At this time, it is safe for your . We obtained only data for the outcomes 'liquid enema plus glucagon versus liquid enema alone' and 'air enema versus liquid enema' from two trials each, and data for all other outcomes from single trials only, most with small sample sizes. Only 76 patients came to follow up examinations; however these data were not used in this review, By definition, the paediatric surgeon or radiologist was aware of the procedure each was conducting, Outcome assessment involved a treating surgeon or radiologist capable of interpreting sonographic criteria for successful reduction (disappearance of intussusception and visualisation of the passage of fluid and air bubbles from the caecum well into the terminal ileum), "We designed a randomised, doubleblind study", Data on participants lost to followup not reported, Method of data collection post discharge not reported, "We designed a randomised, doubleblind study, It was not specified who assessed outcomes, Randomization was based on a table of random numbers, wherein 20 consecutive random numbers were selected and assigned to cases 1 through 20. Intussusception: Definition, Symptoms, Treatment, and More This site needs JavaScript to work properly. Okimoto S, Use of dexamethasone as an adjunct may reduce the rate of recurrence of intussusception. It is rarer in adults and is usually due to an underlying condition. Reporting of methods was incomplete for most trials, as shown in Figure 2 and Figure 3. Guiney EJ, Bethesda, MD 20894, Web Policies Curns AT, open laparotomy required) in the case of laparoscopic intervention, Time to resumption of full diet (measured in hours), as defined by study authors, Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8) in the Cochrane Library (, MEDLINE Ovid (1950 to 16 September 2016) (, Embase Ovid (1974 to 16 September 2016) (, Science Citation Index (via Web of Science) (1900 to 16 September 2016) (, BIOSIS Previews (1969 to 16 September 2016) (. Owing to the nature of some treatments, blinding was not possible, for example, liquid versus air enema in Hadidi 1999 and Meyer 1993. Intussusception risk after rotavirus vaccination in U.S. infants, Developing optimal search strategies for detecting clinically sound treatment studies in EMBASE, Journal of the Medical Library Association, The Cochrane Database of Systematic Reviews, Subgroup analysis and investigation of heterogeneity, Further research is very unlikely to change our confidence in the estimate of effect, Further research is likely to have an impact on our confidence in the estimate of effect and may change the estimate, Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate, Improves/decreases/prevents/leads to [outcome], Improves slightly/decreases slightly/leads to slightly fewer (more) [outcome], Results in little or no difference in [outcome], Probably improves/decreases/prevents/leads to [outcome], Probably improves slightly/decreases slightly/leads to slightly fewer (more) [outcome], Probably leads to little or no difference in [outcome], May improve/decrease/prevent/lead to [outcome], May slightly improve/slightly decrease/lead to slightly fewer (more) [outcome], May lead to little or no difference in [outcome], It is uncertain whether [intervention] improves, decreases, prevents, leads to [outcome] because the quality of the evidence is very low, [Outcome] was not measured or was not reported, or no studies were found that evaluated the impact of [intervention] on [outcome], Enema plus glucagon versus enema alone summary of findings table, Enema plus dexamethasone versus enema alone summary of findings table, Air enema versus liquid enema summary of findings table, New search performed. Prompt diagnosis and management reduces associated risks and the need for surgical intervention. Meier DE, Intussusception is a common abdominal emergency in children with significant morbidity. It is uncertain whether use of enema plus dexamethasone reduced the number of participants with bowel perforation or perforations because the quality of the evidence is low (reported in one trial, 75 participants; RR 2.63, 95% CI 0.11 to 62.66; Analysis 2.2). 3 and 7 Bratton SL, Approximately 90% of ileocolic intussusception cases are idiopathic, and most can be resolved by nonoperative reduction with therapeutic enema ( 2, 3 ). This is both a diagnostic procedure and a treatment. Insufficient information about the sequence generation process to permit judgement of Low risk or High risk. 4. exp child/ Goldberg E, Dexamethasone as an adjuvant may be more effective in reducing intussusception recurrence rates following air enema or liquid enema, but these results are also based on a few studies of small numbers of participants. Treatments for Intussusception If your child's doctor diagnoses intussusception, they may order another diagnostic imaging test that is also a form of treatment, called an air contrast enema. Other adjuvants include antibiotics (Ein 2006; Moss 2000; Pepper 2012). Patel MM, 14. allocat*.ti,ab. Management of intussusception in children: A systematic review The side effects of intussusception are same as the symptoms and are due to obstruction or ischemia or gangrene of the intestine. #6 (infant* or child* or newborn*):ti,ab,kw We examined the reference lists of all eligible trials to identify additional studies. No study reported adequate sequence generation or adequate allocation concealment. We identified three ongoing trials. #2 Topic=((infant* or child* or newborn*)) Halsey N, Treatment with enema plus dexamethasone compared with enema alone may reduce the recurrence rate of intussusception (reported in two trials, 299 participants; RR 0.14, 95% CI 0.03 to 0.60; I = 0%; Analysis 2.3). We analysed data for all participants in the group to which they were allocated, regardless of whether they received the allocated intervention. 1 or 2 Ugwu BT, Intussusception - Pediatrics - MSD Manual Professional Edition Sadigh 2015 compared the efficacy of air versus liquid enema for reduction of intussusception in children and found that air enema was superior to liquid enema. Parashar U, For rate data, we planned to present results as rate ratios with 95% CIs, and for survival data, we planned to present results as hazard ratios (HRs) with 95% CIs. When data were missing, we sought clarification from the authors of the trial. et al. Intussusception is the most common cause of intestinal blockage in children between ages 3 months and 3 years. Mony VK, We did not perform a quantitative analysis of this outcome owing to poor reporting and high risk of bias. Curns AT, 18. Had a potential source of bias related to the specific study design used; or, Has been claimed to have been fraudulent; or, Insufficient information to assess whether an important risk of bias exists; or. Budwig K, We planned to assess publication bias by visually inspecting funnel plots and using Egger's linear regression (minimum 10 studies required). An official website of the United States government. Intussusception in children: current concepts in diagnosis and enema reduction.