From the Department of Pediatric Surgery, Başkent University, Ankara, Turkey.
Department of Pediatrics, Başkent University, Ankara, Turkey.
Pediatr Emerg Care. 2023 Nov 1;39(11):841-847. doi: 10.1097/PEC.0000000000003061. Epub 2023 Oct 2.
Intussusception is one of the most common surgical emergencies in children. We aimed to analyze the current clinical characteristics of intussusception.
We retrospectively reviewed 209 children diagnosed with intussusception, who were admitted to our hospital between January 2009 and August 2022. We grouped the patients according to symptom duration (before and after 12 hours and before and after 24 hours) and age (younger and older than 1 year, and younger and older than 2 years).
The median age at admission was 31 months (2-204 months). The median symptom duration was 12 hours (1-420 hours). Most patients (91.4%) were admitted due to abdominal pain, irritability, and/or vomiting. The most common symptoms were vomiting (70.8%) and abdominal pain (60.6%). The classical triad of symptoms was seen in 9 cases (4.3%). In patients aged younger than 1 year, bloody stool, abnormal abdominal radiography findings, and a longer intussusceptum segment were more frequent. In patients aged younger than 2 years, abdominal pain, fever, and defense on physical examination were less frequent, and irritability, bloody stool, and recurrence were more frequent. Patients aged younger than 2 years had a longer intussusceptum segment and less lymphadenopathy based on ultrasonography (USG). The patients admitted more than 12 hours after symptom onset had more diarrhea, fever, abnormal x-ray, peritoneal fluid on USG, and recurrences, and less vomiting. After the symptoms had lasted for 24 hours, fever, mass palpation, and abnormal abdominal radiography findings were more frequent.
We recommend performing abdominal USG, especially in young children admitted to the emergency department with complaints of abdominal pain and/or vomiting, to rule out intussusception. In countries that have reported a high mortality rate from intussusception, we advise precautions such as increasing the availability of USG in emergency departments and educating the population to seek early medical assistance.
肠套叠是儿童最常见的外科急症之一。本研究旨在分析肠套叠的临床特征。
回顾性分析 209 例 2009 年 1 月至 2022 年 8 月我院收治的肠套叠患儿的临床资料。根据发病时间（12 小时内和 12 小时后，24 小时内和 24 小时后）和年龄（＜1 岁、1~2 岁、＞2 岁）分组。
中位入院年龄为 31 个月（2204 个月）。中位发病时间为 12 小时（1420 小时）。91.4%的患儿因腹痛、易激惹和（或）呕吐就诊。呕吐（70.8%）和腹痛（60.6%）是最常见的症状。9 例（4.3%）患儿出现典型三联征。＜1 岁患儿便血、异常腹部 X 线表现、回盲部肠管积气扩张较常见；＜2 岁患儿腹痛、发热、腹部抵抗感少见，易激惹、便血、复发较常见。超声（USG）显示＜2 岁患儿回盲部肠管积气扩张较长，且淋巴结肿大少见。症状出现 12 小时后就诊的患儿腹泻、发热、X 线异常、USG 提示腹腔积液、复发较多，呕吐较少。症状出现 24 小时后，发热、腹部包块、腹部 X 线异常较常见。
建议对以腹痛和（或）呕吐为主诉就诊的急腹症患儿行腹部 USG 检查，尤其是＜2 岁的患儿。在报告有较高肠套叠死亡率的国家，建议增加 USG 在急诊科的可用性并对公众进行早期医疗救助教育等预防措施。
