Patterns of recurrence of intussusception in children: a 17-year review

Purpose. Patterns of recurrence of intussusception (INT) were reviewed to d etermine whether changes in management have affected the rate and patterns of recurrence as well as long-term outcome in children with multiple (i. e. , 2 or more) recurrences. Materials and methods. Review was done of 763 children with 876 intussuscep tions, including (1) recurrence rate, (2) patterns of recurrence (number of and interval between recurrences), (3) reducibility, (4) pathologic lead p oints (PLP), (5) operative findings and (6) longterm follow-up in those wit h multiple recurrences. Results. Above features (1)-(6) were the same in those managed with barium enema (1979-1935) and those managed with air enema (1985-1996). Overall rec urrence rate was 9%, 11% with barium enema and 8% with air enema. Sixty-nin e patients had 113 recurrences: 47/69 (68%) and 1 recurrence and 22/69 (32% ) had multiple recurrences. Multiple recurrences presented as isolated epis odes or in clusters up to 8 years. Reducibility was 100% for initial INT an d 95% for recurrent episodes; there were no perforations. Surgery, in 4 wit h irreducible recurrence, revealed no PLP. PLP were present in 5 (8%): 2 (4 %) with 1 recurrence and 3 (14%) with multiple recurrences. No pattern of r ecurrence was predictive for PLP. Long-term followup (up to 15 years) avail able in II with multiple recurrences revealed a favourable outcome. Conclusions. Rates and patterns of recurrence did not change with altered m anagement. Because of the high reduction rate of recurrences, lack of perfo ration and favourable long-term follow-up, we recommend radiological reduct ion for recurrent INT. Multiple recurrences are not a contraindication. A c areful search for PLP is mandatory. Surgery should be reserved for irreduci ble recurrences or for demonstrated PLP.