Basic reasons for the inefficiency of conservative treatment of ileocecal intussusception in children

Abstract

Introduction. Currently, the conservative treatment of ileocecal intussusception (ICI) has proven its effectiveness; indications for surgical treatment are increasingly narrowing and do not depend on disease duration and child’s age. And yet, there are situations when conservative treatment is ineffective, and surgical intervention is a must.Purpose. To analyze reasons leading to ineffective conservative treatment of ileocecal intussusception in children and, accordingly, to specify current indications for surgical treatment.Material and methods. 160 children with ICI, who were treated in the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) in Moscow from 2011 to 2021, were taken in the trail. Boys prevailed and amounted to 67.5% (108), girls – to 32.5% (52). Average age of patients was 2.9±2.02. 81.2% (130 children ) were older than one year. If the disease was diagnosed for the first time and if there were no complications, patients with ICI had hydrocolonoscopy (HCS), regardless of child’s age and disease duration. If HCS was ineffective, laparoscopy was done. Laparoscopy was also made in case of disease recurrence. If laparoscopic disinvagination was ineffective or impossible, laparotomy was performed. In case of effective laparoscopic disinvagination but in disease relapse and in the absence of intra-abdominal anatomical problems in the postoperative period, colonoscopy was made to rule out intraluminal anatomical pathologies. In the present trial, the researchers assessed causes of ineffective HCS: anatomical problems including volumetric lymphadenopathy, invaginate necrosis and disease relapses. Types of surgical intervention and their effectiveness were also analyzed. Additionally, the authors compared studied parameters obtained in the hospital earlier when HCS protocol (n=160; 2011–2021) and laparoscopic disinvagination protocol were used (n =40, 2007–2010).Results. Surgical intervention by HCS protocol was made in 9.4% (15); HCS effectiveness was as high as 90.6%. Laparoscopy was performed in 6 children (3.75%) after ineffective HCS and in 9 children (5.6%) after disease relapse. Laparoscopic disinvagination was effective in 60.0% of cases (9) from the surgical group; laparoscopy was changed for laparotomy in 6 patients (40%). Anatomical problems accounted for 73.3% (11) in the surgical group and for 6.9% in the study group, respectively. In the rest of patients (4–26.7%), ineffectiveness of conservative disinvagination was caused by severe lymphoid hyperplasia of the ileocecal angle. In early disease relapses, 42.9% of such patients had anatomical problems. In the surgical group, invaginate necrosis was registered in 20% (3), and bowel resection with anastomosis was made in 26.7% (4); in the study group, these indexes were 1.9 and 2.5%, respectively.Conclusion. The basic reason for ICI conservative treatment failure was an anatomical problem which is a leadpoint of disease pathogenesis that causes both intussusception necrosis and intussusception relapses. Currently, the main indications for surgical ICI management are ineffectiveness of conservative treatment and ICI relapses regardless of child’s age and disease duration.