Department of Pediatric Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul-Türkiye.
Department of Pediatric Surgery, BAU Göztepe Medical Park Hospital, İstanbul-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2022 Sep;28(9):1317-1322. doi: 10.14744/tjtes.2022.56954.
Intussusception is the most common cause of intestinal obstruction between 6 months and 36 months of age. There is no defined etiology in at least 75-90% of patients. Recurrent intussusception occurs in 5-16% of all intussusceptions and the treatment strategy is controversial in this patient group. The treatment of continued recurrent intussusception is a challenging problem when no lead point is revealed despite recurrence.
We aimed to review our 10 years of experience in recurrent intussusception and describe a new operative technique for recurrent intussusception cases without any lead points.
We, retrospectively, reviewed the data of patients with recurrent intussusception in our referral pediatric surgery clinic between 2007 and 2017. Ultrasound-guided hydrostatic reduction (UGHR) was performed on all patients. Surgery was performed on those patients who had findings of acute abdomen and complete intestinal obstruction or two failed attempts of UGHR for diagnostic purposes if a pathologic lead point was suspected based on patient findings and age. Laparoscopy or laparotomy was performed according to surgeon preference and experience. A total of 87 UGHRs were performed. Thirty-three patients were admitted to our clinic due to recurrent intussusception. The mean age was 12.75±14.14 (6-84) months, and 19 were male and 14 were female. Abdominal pain, agitation, and vomiting were common symptoms. UGHR was performed on all 33 patients on at least two different occasions. The time between the first and second UGHR treatments was 42.6±186.19 (0-899) days. The success rate of the second UGHR was 27 out of 33 patients (81.8%). Surgery was performed on six patients. Laparoscopy-assisted ileal folding and fixation to the cecal wall was performed on one patient with recurrent intussusceptions. Appendectomy was performed first, and then, ileal folding with cecal fixation was performed using 4/0 polyglactin sutures. The sutures were placed between the serosal layers of the adjacent terminal ileal loops and the cecal wall.
Surgeons should try to find permanent solutions for patients with multiple recurrent intussusceptions that are resistant to treatment. Surgical excision of the lead point will help prevent recurrent intussusception. Satisfactory results can also be obtained by UGHR even in patients with recurrences. Laparoscopy is helpful in diagnosis, detection of lead points, and treatment of irreducible intussusception. This new operative technique can be satisfactory for recurrent intussusceptions without any lead points.
肠套叠是 6 个月至 36 个月龄儿童中最常见的肠梗阻原因。至少有 75-90%的患者病因不明。所有肠套叠中 5-16%会反复发生肠套叠，对于这组患者，治疗策略存在争议。当尽管复发但未发现任何铅点时，持续性复发性肠套叠的治疗是一个具有挑战性的问题。
我们旨在回顾我们在复发性肠套叠方面的 10 年经验，并描述一种用于无铅点的复发性肠套叠病例的新手术技术。
我们回顾性分析了 2007 年至 2017 年间我们转诊儿科手术诊所中复发性肠套叠患者的数据。所有患者均行超声引导下水压复位术（UGHR）。对于有急性腹痛和完全肠梗阻的患者，或根据患者的发现和年龄怀疑存在病理性铅点时，为明确诊断而进行两次 UGHR 失败的患者，行手术治疗。根据外科医生的偏好和经验，行腹腔镜或剖腹手术。共进行了 87 次 UGHR。33 名患者因复发性肠套叠而就诊于我们诊所。平均年龄为 12.75±14.14（6-84）个月，男 19 例，女 14 例。腹痛、躁动和呕吐是常见症状。所有 33 例患者均至少在不同的两个场合进行 UGHR。第一次和第二次 UGHR 治疗之间的时间为 42.6±186.19（0-899）天。第二次 UGHR 的成功率为 33 例患者中的 27 例（81.8%）。对 6 例患者进行了手术治疗。对一名复发性肠套叠患者，行腹腔镜辅助回肠折叠并固定于盲肠壁。首先行阑尾切除术，然后用 4/0 聚甘醇酸缝线行回肠折叠并用盲肠固定。缝线置于相邻末端回肠环和盲肠壁的浆膜层之间。
外科医生应为治疗抵抗的多发性复发性肠套叠患者寻找永久性解决方案。切除铅点有助于预防复发性肠套叠。即使在复发患者中，超声引导下水压复位术也能获得满意的结果。腹腔镜有助于诊断、发现铅点和治疗不可复位的肠套叠。对于无铅点的复发性肠套叠，这种新的手术技术可以令人满意。
