Endotoxin, cytokines and lipid peroxides in children with intussusception

Intussusception is a relatively common paediatric surgical emergency. The a im of this study was to investigate selected inflammatory mediators in chil dren with acute intussusception and to identify potentially useful plasma m arkers of clinical outcome. Clinical, radiographic, operative and pathological details were recorded pr ospectively of all children presenting to a single institution with a confi rmed diagnosis of acute intussusception during 1 year. Paired acute and con valescent venous blood samples were collected in a standard manner for blin ded analysis of the following: malondialdehyde, C-reactive protein (CRP), i nterleukin (IL) 6, neopterin, tumour necrosis factor alpha, endotoxin, and immunoglobulin (Ig) G and IgM antiendotoxin core antibody (EndoCAb). Thirty-two consecutive children (23 boys, nine girls) with a median age of 4 months were studied. Acute ileocolic intussusception was managed by air e nema reduction (n = 19), operative reduction (n = 8) or surgical resection (n = 5). Peripheral blood cultures were sterile. Acute levels of plasma IL- 6, neopterin and CRP were significantly raised in comparison to both normal laboratory ranges and convalescent samples (P < 0.001). Using stepwise dis criminant analysis, CRP was identified as the best variable at distinguishi ng between the three treatment groups (P < 0.001). IgM EndoCAb concentratio ns were significantly greater in the convalescent sera of all the patients (P < 0.001). Acute ileocolic intussusception in childhood is associated with endotoxinae mia and significantly raised levels of circulating inflammatory cytokines. Plasma CRP at diagnosis showed a statistically significant positive correla tion with disease severity.