Johnson Brian, Gargiullo Paul, Murphy Trudy V, Parashar Umesh D, Patel Manish M
Department of Emergency Medicine, Highland General Hospital, Oakland, CA, USA.
Pediatr Emerg Care. 2012 Jun;28(6):529-32. doi: 10.1097/PEC.0b013e3182587d12.
Intussusception is the most common cause of infant bowel obstruction. Because delays in diagnosis can lead to severe outcomes, differentiating milder cases from those with potentially serious outcomes is important.
The objective of this study was to identify factors associated with bowel resection among intussusception cases using data from a large nationwide study, which investigated the association between intussusception and Rotashield.
We examined characteristics of 376 intussusception cases not associated with Rotashield use. Cases were confirmed by a radiologic procedure, surgery, or autopsy. Clinical characteristics of infants with and without bowel resection were compared.
During the week before hospitalization, 93% of the 376 infants with intussusception had vomiting, 72% reported bloody stool, 63% had hemoccult positive stool, 51% had diarrhea, 43% reported fever, and 14% had documented fever. Surgery was performed on 209 cases (56%). Of these 209 cases, 33% (67/209) required bowel resection. Documented fever on admission significantly increased the risk of bowel resection (odds ratio, adjusted for race and sex, 2.7; 95% confidence interval, 1.2-6.0). Among infants with intussusception, the presence of a reported symptom for at least 2 days before hospital admission was also an independent predictor of bowel resection (adjusted odds ratio, 2.7; 95% confidence interval, 1.5-4.8).
Bowel resection appears to be more likely among intussusception patients with documented fever and symptoms for at least 2 days. However, because resection also occurred among those without fever or prolonged symptoms, severe disease must also be considered in absence of these symptoms.
肠套叠是婴儿肠梗阻最常见的原因。由于诊断延误可能导致严重后果，因此区分病情较轻的病例与可能出现严重后果的病例非常重要。
本研究的目的是利用一项全国性大型研究的数据，确定肠套叠病例中与肠切除相关的因素，该研究调查了肠套叠与Rotashield之间的关联。
我们检查了376例与使用Rotashield无关的肠套叠病例的特征。病例通过放射学检查、手术或尸检确诊。比较了有肠切除和无肠切除婴儿的临床特征。
在住院前一周，376例肠套叠婴儿中93%有呕吐，72%有血便，63%隐血试验阳性，51%有腹泻，43%有发热报告，14%有发热记录。209例（56%）进行了手术。在这209例病例中，33%（67/209）需要肠切除。入院时记录的发热显著增加了肠切除的风险（校正种族和性别后的优势比为2.7；95%置信区间为1.2 - 6.0）。在肠套叠婴儿中，入院前至少2天出现报告症状也是肠切除的独立预测因素（校正优势比为2.7；95%置信区间为1.5 - 4.8）。
有发热记录且症状持续至少2天的肠套叠患者似乎更有可能接受肠切除。然而，由于无发热或症状未延长的患者也有接受切除手术的情况，因此在没有这些症状时也必须考虑严重疾病的可能性。
