Arena Salvatore, Cassaro Fabiola, Maisano Giulia, Impellizzeri Pietro, Romeo Carmelo
Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy.
Int J Pediatr. 2025 Mar 24;2025:8860000. doi: 10.1155/ijpe/8860000. eCollection 2025.
Intussusception is the most common cause of acute intestinal obstruction in children. It can be initial idiopathic intussusception or a recurrent intussusception (RI), and in this latter case, there is not a validated algorithm for optimal treatment. The aim of the study is to review the international literature to evaluate the incidence of RI, to determine the rates of surgical intervention and pathological leading point (PLP), and to define the most appropriate management for children with RI. We included English-written papers with pediatric population, excluding case reports, papers with adult or mixed cases, studies focusing on ileo-ileal or colo-colic intussusception, meta-analysis studies, or papers with unclear or replaced data. A total number of 23 articles were included for a total of 26,731 patients affected by intussusception and 3164 recurrent patients (11.8%). The number of attempts of nonsurgical reduction ranged from 3 to 10 (median 5). On 2965 RI, 358 underwent surgery (12.1%). A pathologic leading point was found in 99 patients (3.95%). The presence of a PLP does not seem to be associated with the recurrence of intussusception. More than 85% of RI underwent successful nonsurgical management. RI should be safely approached in the same way as primary intussusception, and surgery should be reserved to cases where a PLP has been suspected. In cases of multiple episodes, surgery can be considered an effective way to avoid recurrences, and this possibility should be discussed with parents.
肠套叠是儿童急性肠梗阻最常见的病因。它可以是原发性特发性肠套叠或复发性肠套叠（RI），而在后一种情况下，尚无经过验证的最佳治疗算法。本研究的目的是回顾国际文献，以评估RI的发病率，确定手术干预率和病理引导点（PLP），并确定对RI患儿最合适的管理方法。我们纳入了以英文撰写的关于儿科人群的论文，排除了病例报告、包含成人或混合病例的论文、专注于回肠-回肠或结肠-结肠套叠的研究、荟萃分析研究或数据不明确或已替换的论文。总共纳入了23篇文章，涉及26731例受肠套叠影响的患者和3164例复发性患者（11.8%）。非手术复位尝试次数为3至10次（中位数为5次）。在2965例RI中，358例接受了手术（12.1%）。在99例患者中发现了病理引导点（3.95%）。PLP的存在似乎与肠套叠的复发无关。超过85%的RI接受了成功的非手术治疗。RI的处理方式应与原发性肠套叠相同，且应谨慎进行，手术应仅保留给怀疑存在PLP的病例。在多次发作的情况下，手术可被视为避免复发的有效方法，应与家长讨论这种可能性。
