Postoperative intussusception: Experience with 36 cases in children

K. W. West, B. Stephens, Frederick Rescorla, D. W. Vane, J. L. Grosfeld

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Intestinal obstruction is a common postoperative complication and is usually related to peritoneal adhesion formation. A less well-recognized cause is postoperative intussusception (POI). Thirty-six instances of POI in children (aged 1 month to 18 years) were treated between 1970 and 1987. POI followed Nissen fundoplication in 9 patients, neuroblastoma resection in 5, small-bowel procedures in 4, inguinal herniorrhaphy in 3, pull-through procedures in 3, ureterostomy in 2, thoracic procedures in 2, ventral hernia in 1, nephrectomy in 1, hepatic resection in 1, Heller myotomy in 1, ventriculo-atrial shunt in 1, and gastrocystoplasty in 1. Initial symptoms included bilious vomiting or increased nasogastric drainage (after initial return of gut function) in 26 patients, abdominal distension in 24, irritability in 10, intermittent pain in 7, palpable abdominal mass in 2, rectal bleeding in 2, and lethargy in 1. The symptoms occurred 1 to 24 days (mean, 8 days) after the initial surgery. Plain abdominal radiographs revealed multiple air-fluid levels in 31 and an 'adynamic ileus' in five patients. Barium contrast techniques could successfully reduce two ileocolic and one distal ileo-ileal lesions. The remainder necessitated operative management. Manual reduction was possible in 29 cases, and four children with diagnostic delay required bowel resection and an anastomosis for intestinal necrosis. The site of intussusception was ileo-ileal in 23 patients, jejunojejunal in 6, ileocolic in 5, and jejuno-ileal in 2. The diagnosis of POI should be considered in children with signs of bowel dysfunction in the early postoperative period. Contrast studies are of limited value, since most cases are confined to the small bowel. A high index of suspicion and prompt laparotomy will usually allow manual reduction of the lesion. Diagnostic delay may result in bowel necrosis.

Original languageEnglish
Pages (from-to)781-787
Number of pages7
JournalSurgery
Volume104
Issue number4
StatePublished - 1988

Fingerprint

Intussusception
Necrosis
Ureterostomy
Ventral Hernia
Fundoplication
Lethargy
Ileus
Groin
Intestinal Obstruction
Herniorrhaphy
Barium
Nephrectomy
Neuroblastoma
Postoperative Period
Laparotomy
Vomiting
Drainage
Thorax
Air
Hemorrhage

ASJC Scopus subject areas

  • Surgery

Cite this

West, K. W., Stephens, B., Rescorla, F., Vane, D. W., & Grosfeld, J. L. (1988). Postoperative intussusception: Experience with 36 cases in children. Surgery, 104(4), 781-787.

Postoperative intussusception : Experience with 36 cases in children. / West, K. W.; Stephens, B.; Rescorla, Frederick; Vane, D. W.; Grosfeld, J. L.

In: Surgery, Vol. 104, No. 4, 1988, p. 781-787.

Research output: Contribution to journalArticle

West, KW, Stephens, B, Rescorla, F, Vane, DW & Grosfeld, JL 1988, 'Postoperative intussusception: Experience with 36 cases in children', Surgery, vol. 104, no. 4, pp. 781-787.
West KW, Stephens B, Rescorla F, Vane DW, Grosfeld JL. Postoperative intussusception: Experience with 36 cases in children. Surgery. 1988;104(4):781-787.
West, K. W. ; Stephens, B. ; Rescorla, Frederick ; Vane, D. W. ; Grosfeld, J. L. / Postoperative intussusception : Experience with 36 cases in children. In: Surgery. 1988 ; Vol. 104, No. 4. pp. 781-787.
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