Lorraine I Kelley-Quon1, L Grier Arthur2, Regan F Williams3, Adam B Goldin4, Shawn D St Peter5, Alana L Beres6, Yue-Yung Hu7, Elizabeth J Renaud8, Robert Ricca9, Mark B Slidell10, Amy Taylor11, Caitlin A Smith4, Doug Miniati12, Juan E Sola13, Patricia Valusek14, Loren Berman15, Mehul V Raval7, Ankush Gosain16, Matthew B Dellinger4, Stig Sømme17, Cynthia D Downard18, Jarod P McAteer19, Akemi Kawaguchi20. 1. Division of Pediatric Surgery, Children's Hospital Los Angeles and the Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA. Electronic address: lkquon@chla.usc.edu. 2. Division of Pediatric Surgery, St. Christopher's Hospital for Children, Philadelphia, PA. 3. Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN. 4. Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA. 5. Department of Surgery, Children's Mercy Hospital, Kansas City, MO. 6. Division of Pediatric General, Thoracic and Fetal Surgery, University of California, Davis, CA. 7. Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL. 8. Alpert Medical School at Brown University, Hasbro Children's Hospital, Providence, RI. 9. Division of Pediatric Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia. 10. Section of Pediatric Surgery, The University of Chicago Medicine, Comer Children's Hospital, Chicago, IL. 11. Texas Medical Center Library, Houston, TX. 12. Division of Pediatric Surgery, Kaiser Permanente Roseville Women and Children's Center, Roseville, CA. 13. Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL. 14. Pediatric Surgical Associates, Ltd., Children's Minnesota, Minneapolis, MN. 15. Division of Pediatric surgery, Department of Surgery, Nemours-AI DuPont Hospital for Children and Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, DE. 16. Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN.; Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN. 17. Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO. 18. Division of Pediatric Surgery, Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville, Louisville, KY. 19. Alaska Pediatric Surgery, Anchorage, AK. 20. Department of Pediatric Surgery, University of Texas McGovern Medical School and Children's Memorial Hermann Hospital, Houston, TX.
Abstract
OBJECTIVE: The goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to develop recommendations for the management of ileocolic intussusception in children. METHODS: The ClinicalTrials.gov, Embase, PubMed, and Scopus databases were queried for literature from January 1988 through December 2018. Search terms were designed to address the following topics in intussusception: prophylactic antibiotic use, repeated enema reductions, outpatient management, and use of minimally invasive techniques for children with intussusception. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Consensus recommendations were derived based on the best available evidence. RESULTS: A total of 83 articles were analyzed and included for review. Prophylactic antibiotic use does not decrease complications after radiologic reduction. Repeated enema reductions may be attempted when clinically appropriate. Patients can be safely observed in the emergency department following enema reduction of ileocolic intussusception, avoiding hospital admission. Laparoscopic reduction is often successful. CONCLUSIONS: Regarding intussusception in hemodynamically stable children without critical illness, pre-reduction antibiotics are unnecessary, non-operative outpatient management should be maximized, and minimally invasive techniques may be used to avoid laparotomy. LEVEL OF EVIDENCE: Level 3-5 (mainly level 3-4) TYPE OF STUDY: Systematic Review of level 1-4 studies.
OBJECTIVE: The goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to develop recommendations for the management of ileocolic intussusception in children. METHODS: The ClinicalTrials.gov, Embase, PubMed, and Scopus databases were queried for literature from January 1988 through December 2018. Search terms were designed to address the following topics in intussusception: prophylactic antibiotic use, repeated enema reductions, outpatient management, and use of minimally invasive techniques for children with intussusception. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Consensus recommendations were derived based on the best available evidence. RESULTS: A total of 83 articles were analyzed and included for review. Prophylactic antibiotic use does not decrease complications after radiologic reduction. Repeated enema reductions may be attempted when clinically appropriate. Patients can be safely observed in the emergency department following enema reduction of ileocolic intussusception, avoiding hospital admission. Laparoscopic reduction is often successful. CONCLUSIONS: Regarding intussusception in hemodynamically stable children without critical illness, pre-reduction antibiotics are unnecessary, non-operative outpatient management should be maximized, and minimally invasive techniques may be used to avoid laparotomy. LEVEL OF EVIDENCE: Level 3-5 (mainly level 3-4) TYPE OF STUDY: Systematic Review of level 1-4 studies.
Authors: Elisabeth M Lessenich; Amir A Kimia; Katherine Mandeville; Joyce Li; Assaf Landschaft; Andy Tsai; Richard G Bachur Journal: Acad Emerg Med Date: 2015-08-20 Impact factor: 3.451
Authors: Christoph Heinrich Houben; Xiang-Nan Feng; Sheung-Ho Tang; Edwin Kin Wai Chan; Kim Hung Lee Journal: ANZ J Surg Date: 2015-12-23 Impact factor: 1.872