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PurposeTo develop a model to identify risk factors and predict recurrent cases of intussusception in children.MethodsConsecutive cases and recurrent cases of intussusception in children from January 2016 to April 2022 were screened. The cohort was divided randomly at a 4:1 ratio to a training dataset and a validation dataset. Three parallel models were developed using extreme gradient boosting (XGBoost), logistic regression (LR), and support vector machine (SVM). Model performance was assessed by the area under the receiver operating characteristic curves (AUC).ResultsA total of 2469 cases of intussusception were included, where 225 were recurrent cases. The XGBoost (AUC = 0.718) models showed the best performance in the validation dataset, followed by the LR model (AUC = 0.652), while the SVM model (AUC = 0.613) performed worst among the three models. Based on the Shapley Additive exPlanation values, the most important variables in the XGBoost models were air enema pressure, mass size, age, duration of symptoms, and absence of vomiting.ConclusionsMachine learning models, especially XGBoost, could be used to predict recurrent cases of intussusception in children. The most important contributing factors to the models are air enema pressure, mass size, age, duration of symptoms and absence of vomiting.

Postlicensure data has identified a causal link between rotavirus vaccines and intussusception in some settings. As rotavirus vaccines are introduced globally, monitoring intussusception will be crucial for ensuring safety of the vaccine programs. To obtain updated information on background rates and clinical management of intussusception, we reviewed studies of intussusception in children <18 years of age published since 2002. We assessed the incidence of intussusception by month of life among children <1 year of age, seasonality, method of diagnosis, treatment, and case-fatality. We identified 82 studies from North America, Asia, Europe, Oceania, Africa, Eastern Mediterranean, and Central & South America that reported a total of 44,454 intussusception events. The mean incidence of intussusception was 74 per 100,000 (range: 9-328) among children <1 year of age, with peak incidence among infants 5-7 months of age. No seasonal patterns were observed. A radiographic modality was used to diagnose intussusception in over 95% of the cases in all regions except Africa where clinical findings or surgery were used in 65% of the cases. Surgical rates were substantially higher in Africa (77%) and Central and South America (86%) compared to other regions (13-29%). Case-fatality also was higher in Africa (9%) compared to other regions (<1%). The primary limitation of this review relates to the heterogeneity in intussusception surveillance across different regions. This review of the intussusception literature from the past decade provides pertinent information that should facilitate implementation of intussusception surveillance for monitoring the postlicensure safety of rotavirus vaccines.

Background Intussusception is common in children but rare in adults. The goal of this study was to review retrospectively the symptoms, diagnosis, and treatment of intussusception in adults. Methods From 1997 to 2013, we experienced 44 patients of intussusception in patients older than 18 years. The patients were divided into enteric, ileocolic, ileocecal, and colocolonic (rectal) types. The diagnosis and treatment of these patients were reviewed. Results Of the 44 patients of adult intussusception, 42 were diagnosed with abdominal ultrasonography and abdominal computed tomography. There were 12 patients of enteric intussusception, six patients of ileocolic intussusception, 16 patients of ileocecal type intussusception, and 10 patients of colonic (rectal) intussusception. Among them, 77.3 % were associated with a tumor. Among 12 patients of enteric intussusception, three were associated with a metastatic intestinal tumor, and one was associated with a benign tumor. Among six patients of ileocolic intussusception, two patients were associated with malignant disease. Also, 93.8 % of ileocecal intussusceptions were associated with tumors, 80.0 % of which were malignant. Similarly, 90.0 % of colonic intussusceptions were associated with malignant tumors. Intussusception was reduced before or during surgery in 28 patients. Surgery was performed in 41 patients, and laparoscopy-assisted surgery was performed for ab underlying disease in 12 patients. Conclusions Preoperative diagnoses were possible in almost all patients. Reduction greatly benefited any surgery required and the extent of the resection regardless of the underlying disease and surgical site.

Background Intussusception in adults is a rare condition characterized by a low incidence, which complicates the establishment of standardized management protocols unlike those readily available for pediatric cases. This study presents a case series from our institution alongside a systematic review of existing literature. The objective is to delineate effective management strategies for adult intussusception. Methods A systematic search of databases was conducted covering the period from January 2000 to May 2024. The study focused on adult patients diagnosed with intussusception either pre-operatively or intraoperatively and managed with either surgical intervention or conservative methods. The analysis also included retrospective review of patient records from our institution, specifically targeting individuals over 18 years of age, to determine the predominant types of intussusception and identify any pathological lead points associated with these cases. Results In our study, a total of 1,902 patients were included from 59 selected articles, with a mean age of 52.13 ± 14.95 years. Among them, 1,920 intussusceptions were diagnosed, with 98.3% of cases identified preoperatively. Computed tomography (CT) scan was the primary diagnostic modality used in 88.5% of cases. Abdominal pain was the predominant presenting symptom, observed in 86.23% of cases. Only 29 out of 1,920 cases underwent attempted reduction, while the majority required surgical resection due to the high incidence of malignancy in adult cases. The most common type of intussusception identified was colocolic (16.82%), followed by enteric (13.28%), ileocolic (4.89%), and ileocaecal (0.78%) types. A pathological lead point was observed in 302 out of 673 patients (44.84%), with a notably higher frequency of malignancy associated with colocolic intussusception. Conclusion Surgical management remains the cornerstone in treating adult intussusception, particularly in cases involving the colocolic type, where there is a significant risk of underlying malignancy. Attempts at reduction are generally avoided due to the potential risk of tumor dissemination, which could adversely impact patient outcomes. Contrast-enhanced computed tomography (CECT) of the abdomen is pivotal for accurately diagnosing intussusceptions and guiding appropriate management strategies. It is imperative to adhere strictly to oncological principles during surgical interventions to ensure optimal patient care and outcomes.

Gastroduodenal intussusception is a rare but important cause of gastric outlet obstruction, particularly in elderly patients. We present the case of an 81-year-old female who arrived at the emergency department with complaints of epigastric pain, nausea, and vomiting. A CT scan revealed gastroduodenal intussusception, while subsequent endoscopy identified a submucosal mass, raising suspicion for either a gastrointestinal stromal tumor (GIST) or pancreatic rest. This case report highlights the diagnostic process, therapeutic considerations, and clinical outcomes, with a review of the relevant literature.

Background Intussusception is the leading cause of acute abdominal conditions in infants, yet it is frequently under-recognised in those younger than 3 months, potentially resulting in serious complications such as bowel necrosis, peritonitis, or even death if not promptly treated. This retrospective study aims to enhance clinicians’ understanding of the diagnosis and management of acute intussusception in this age group to prevent poor prognosis. Methods The clinical data of 38 infants aged ≤ 3 months diagnosed with intussusception at Wuhan Children’s Hospital between January 2013 and July 2024 were retrospectively analyzed. Patients were categorized into two groups based on the outcome of nonoperative reduction: the successful group and the failed group. The study examined demographic characteristics, clinical presentations, imaging findings, treatment modalities, and outcomes to identify patterns and evaluate the effectiveness of diagnostic and therapeutic approaches. Results During the study period, 12,206 children were diagnosed with intussusception, including 38 (0.31%) infants aged 3 months or younger (mean age: 73.6 days; 20 males and 18 females). The most frequently reported symptoms were vomiting (36 cases), bloody stool (27 cases), and intermittent crying (18 cases). Ultrasonography (USG) confirmed the diagnosis in 97.4% of cases. A total of 27 (71.1%) infants treated with enema reduction, with a success rate of 48.1% (13/27). Enema-related perforation occurred in 2 cases (7.4%). An additional 11 cases (28.9%) proceeded directly to laparotomy, with 5 (15.8%) diagnosed as secondary intussusception. Bowel resection was necessary in 6 of the 25 surgical cases due to necrosis. Each infant responded well to treatment and was discharged in stable condition. Conclusions The clinical manifestations of intussusception in infants aged 3 months and below are sometimes atypical. Early USG should be performed to make a clear diagnosis, and the effect of early intervention is satisfactory. In infants with good general condition, enema reduction can be attempted first with appropriate pressure monitoring to avoid bowel perforation.

Background Adult small-bowel intussusception (ASI) is a rare condition with pathological etiologies in most patients. Previously, surgical intervention was the primary treatment modality; however, the introduction of balloon-assisted enteroscopy (BAE) has allowed preoperative BAE in some cases to confirm the leading point, thereby guiding management and reducing surgical need. In this study, we investigated whether the introduction of BAE has altered the diagnostic and therapeutic strategies for ASI by retrospectively analyzing and comparing the clinicopathological features of patients before and after its introduction. Methods Fifty-three patients with ASI, initially diagnosed via abdominal computed tomography scanning at Korea University Guro Hospital from 2000 to 2023, were included in our study. Patients were grouped based on double-balloon enteroscopy (DBE) usage, and clinicopathological outcomes were compared retrospectively. Results Of the 53 patients, 38 (71.7%) had enteroenteric-type intussusception and 15 (28.3%) had enterocolic-type intussusception. Among the patients with enteroenteric-type intussusception, 15.8% had a malignant cause, whereas in the enterocolic type, 60% had a malignant cause ( p  = 0.001). Of 38 patients with enteroenteric ASI, 15 (39.5%) underwent preoperative DBE. The surgical resection rate was significantly lower in the DBE group (40%) than in the non-DBE group (73.9%) ( p  = 0.037). Pathological diagnoses of patients who underwent surgical resection without preoperative DBE revealed 17.6% malignancies and 82.4% benign causes, including idiopathic intussusception (four cases) and Peutz–Jeghers syndrome (two cases). No morbidity, mortality, or recurrence was observed. Conclusion Preoperative BAE is a valuable diagnostic and therapeutic modality for ASI, particularly in cases of low-grade small-bowel obstruction, reducing surgical resection rates in most ASI cases. The introduction of the BAE has significantly improved ASI management, achieving high successful reduction rates and few surgical interventions. BAE should be considered a first-line diagnostic and therapeutic tool for ASI management.

Pediatric intussusception is a serious condition that carries with it a high risk of morbidity and mortality. This review highlights the pearls and pitfalls of pediatric intussusception, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence. Intussusception is one of the most common pediatric abdominal emergencies. This is associated with one part of the intestine telescoping into another, resulting in bowel edema. If the intussusception remains untreated, obstruction, ischemia, necrosis, and perforation may result. Most cases are idiopathic, with 10–25 % associated with a pathologic mass or lead point. The most common age group affected includes those between 3 months to 5 years. The triad of intermittent abdominal pain, currant jelly stool, and sausage-shaped mass is uncommon, though most patients will present with intermittent abdominal pain. Nonbilious emesis and bloody stools (gross blood or guaiac positive) are also common. Younger patients can present atypically, including altered mental status or lethargy. Thus, intussusception should be considered in pediatric patients with abdominal pain, emesis, and a sausage-shaped mass, as well as those with atypical presentations such as altered mental status or lethargy if there is no other etiology found on testing. The diagnostic modality of choice is ultrasound. Plain radiography may assist in evaluating for obstruction and perforation. Treatment includes prompt reduction of the intussusception. In patients who are stable and have no evidence of perforation, non-operative reduction with hydrostatic or pneumatic reduction should be attempted. Operative intervention is necessary in those who are unstable, peritonitic, or have a focal lead point. Discharge may be appropriate for patients following successful non-operative reduction if the patient is able to tolerate clear fluids, is asymptomatic, and can return for any recurrence of symptoms. An understanding of pediatric intussusception and its many potential mimics can assist emergency clinicians in diagnosing and managing this high risk disease.

Gastroduodenal intussusception is a relatively rare condition in adults and is typically caused by mobile pedunculated submucosal tumors arising from the stomach. Its clinical presentation often includes nonspecific signs of gastric outlet obstruction, such as nausea, vomiting, abdominal pain, epigastric fullness, or abdominal distention. We report a case of gastroduodenal intussusception in a 38-year-old woman who presented with severe anemia but no symptoms of gastric outlet obstruction. The preoperative diagnosis was established through esophagogastroduodenoscopy and computed tomography of the abdomen, and it was confirmed during surgery. Postoperative pathology and immunohistochemistry identified the tumor as a gastric leiomyoma.

Objectives To report a rare case of adult gastroduodenal intussusception caused by a gastric gastrointestinal stromal tumor (GIST) and review its diagnostic and therapeutic approaches.  Methods We present a 68-year-old female with gastroduodenal intussusception secondary to a gastric GIST, diagnosed through combined endoscopy and computed tomography (CT). A systematic PubMed review identified 28 published cases, which were analysis for clinical presentation, imaging findings, and management strategies. Results The patient initially underwent laparoscopic-endoscopic cooperative surgery, which was unsuccessful and required conversion to open partial gastrectomy. Intraoperative findings confirmed a fundus mass extending into the duodenum, with histopathology confirming a low-risk GIST. Among the reviewed cases, all involved GISTs of gastric origin. Diagnostic evaluation consistently relied on CT and endoscopy, with surgical approaches varying based on tumor characteristics. Conclusions Gastric GISTs are a rare but clinically significant cause of adult gastroduodenal intussusception, typically necessitating surgical intervention. Multimodal imaging, particularly CT, plays a crucial role in preoperative diagnosis, while histopathological examination remains essential for definitive diagnosis and risk stratification. Treatment should be individualized based on tumor size, location, and patient factors.