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Intussusception in children: lessons learned from intestinal lymphoma as a rare lead-point


Bussell, H R; Kroiss, S; Tharakan, S J; Meuli, M; Moehrlen, U (2019). Intussusception in children: lessons learned from intestinal lymphoma as a rare lead-point. Pediatric Surgery International, 35(8):879-885.

Abstract

BACKGROUND:
Most cases of intussusception in children are idiopathic. Rarely, a malignant disease such as intestinal lymphoma may cause intussusception. Due to dramatic changes of expected outcome with chemotherapy regime alone, the surgical management of patients with intestinal lymphoma presenting with intussusception has to be reevaluated.
METHODS:
Retrospective chart review from May 2011 to February 2017. We included all patients with intestinal lymphoma presenting with intussusception.
RESULTS:
We found five patients with a mean age of 6.4 years (range 3-16). The most common presenting symptom was abdominal pain for several weeks which had acutely worsened. In all but one patient an ultrasound before pneumatic or hydrostatic reduction showed a finding suspicious of a pathological lead-point. Pneumatic or hydrostatic reduction was attempted in all patients, no complications were noted. In one patient reduction was not successful. Recurrence after reduction occurred in two patients. Two patients needed surgery, three had a percutaneous ultrasound-guided biopsy for diagnostic purposes. All patients had aggressive mature B cell non-Hodgkin lymphoma.
CONCLUSION:
A high index of suspicion for the presence of a pathological lead-point in children older than 4 years and children with recurrent intussusception is necessary in patients presenting with intussusception. Malignant, highly aggressive B cell non-Hodgkin lymphoma, although rare, must actively be searched for. Pneumatic or hydrostatic reduction should remain the first line treatment in most cases.

Abstract

BACKGROUND:
Most cases of intussusception in children are idiopathic. Rarely, a malignant disease such as intestinal lymphoma may cause intussusception. Due to dramatic changes of expected outcome with chemotherapy regime alone, the surgical management of patients with intestinal lymphoma presenting with intussusception has to be reevaluated.
METHODS:
Retrospective chart review from May 2011 to February 2017. We included all patients with intestinal lymphoma presenting with intussusception.
RESULTS:
We found five patients with a mean age of 6.4 years (range 3-16). The most common presenting symptom was abdominal pain for several weeks which had acutely worsened. In all but one patient an ultrasound before pneumatic or hydrostatic reduction showed a finding suspicious of a pathological lead-point. Pneumatic or hydrostatic reduction was attempted in all patients, no complications were noted. In one patient reduction was not successful. Recurrence after reduction occurred in two patients. Two patients needed surgery, three had a percutaneous ultrasound-guided biopsy for diagnostic purposes. All patients had aggressive mature B cell non-Hodgkin lymphoma.
CONCLUSION:
A high index of suspicion for the presence of a pathological lead-point in children older than 4 years and children with recurrent intussusception is necessary in patients presenting with intussusception. Malignant, highly aggressive B cell non-Hodgkin lymphoma, although rare, must actively be searched for. Pneumatic or hydrostatic reduction should remain the first line treatment in most cases.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Children's Hospital Zurich > Medical Clinic
04 Faculty of Medicine > University Children's Hospital Zurich > Clinic for Surgery
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Pediatrics, Perinatology and Child Health
Health Sciences > Surgery
Uncontrolled Keywords:Pediatrics, Perinatology, and Child Health, Surgery, General Medicine
Language:English
Date:1 August 2019
Deposited On:10 Jan 2020 14:41
Last Modified:29 Jul 2020 12:21
Publisher:Springer
ISSN:0179-0358
OA Status:Closed
Publisher DOI:https://doi.org/10.1007/s00383-019-04488-z
PubMed ID:31139892

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