Childhood intussusception: a literature review

James Jiang, Baoming Jiang, Umesh Parashar, Trang Nguyen, Julie Bines, Manish M Patel, James Jiang, Baoming Jiang, Umesh Parashar, Trang Nguyen, Julie Bines, Manish M Patel

Abstract

Background: 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.

Methods: 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.

Findings: 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.

Conclusion: 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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. PRISMA flow diagram for the…
Figure 1. PRISMA flow diagram for the intussusception literature review.
Figure 2. Global map of intussusception incidence.
Figure 2. Global map of intussusception incidence.
In countries where local, regional, and national studies were conducted, we preferentially mapped the national rates. For countries with more than one national study, average rates of the studies were used for the map. If no national rates were available, regional and/or local rates were used for the map.
Figure 3. Incidence of intussusception by month…
Figure 3. Incidence of intussusception by month of life during first year of life.
Intussusception incidence or number of cases by month of life from 22 studies extrapolated to remaining 13 studies that only presented data on rates for infants

Figure 4. Seasonality of intussusception globally.

Figure 4. Seasonality of intussusception globally.

Figure 4. Seasonality of intussusception globally.

Figure 5. Seasonality of intussusception, by WHO…

Figure 5. Seasonality of intussusception, by WHO region.

Figure 5. Seasonality of intussusception, by WHO region.

Figure 6. Diagnosis of intussusception by WHO…

Figure 6. Diagnosis of intussusception by WHO region.

Studies where diagnosis was unspecified were not…

Figure 6. Diagnosis of intussusception by WHO region.
Studies where diagnosis was unspecified were not included. Data from Central and South America were from one prospective research study that might not reflect clinical practice under routine conditions.

Figure 7. Treatment of intussusception by WHO…

Figure 7. Treatment of intussusception by WHO region.

Studies where treatment was unspecified were not…

Figure 7. Treatment of intussusception by WHO region.
Studies where treatment was unspecified were not included.
All figures (7)
Figure 4. Seasonality of intussusception globally.
Figure 4. Seasonality of intussusception globally.
Figure 5. Seasonality of intussusception, by WHO…
Figure 5. Seasonality of intussusception, by WHO region.
Figure 6. Diagnosis of intussusception by WHO…
Figure 6. Diagnosis of intussusception by WHO region.
Studies where diagnosis was unspecified were not included. Data from Central and South America were from one prospective research study that might not reflect clinical practice under routine conditions.
Figure 7. Treatment of intussusception by WHO…
Figure 7. Treatment of intussusception by WHO region.
Studies where treatment was unspecified were not included.

References

    1. Bines JE, Kohl KS, Forster J, Zanardi LR, Davis RL, et al. (2004) Acute intussusception in infants and children as an adverse event following immunization: case definition and guidelines of data collection, analysis, and presentation. Vaccine 22: 569–574.
    1. Bines JE, Patel M, Parashar U (2009) Assessment of postlicensure safety of rotavirus vaccines, with emphasis on intussusception. J Infect Dis 200 Suppl 1S282–290.
    1. WHO (2002) Acute intussusception in infants and children. Incidence, clinical presentation and management: a global perspective. Geneva: World Health Organization. Document WHO/V & B/02 (19) 1–98.
    1. Murphy TV, Gargiullo PM, Massoudi MS, Nelson DB, Jumaan AO, et al. (2001) Intussusception among infants given an oral rotavirus vaccine. N Engl J Med 344: 564–572.
    1. Patel MM, Haber P, Baggs J, Zuber P, Bines JE, et al. (2009) Intussusception and rotavirus vaccination: a review of the available evidence. Expert Rev Vaccines 8: 1555–1564.
    1. WHO (2007) Rotavirus vaccines. Wkly Epidemiol Rec 82: 285–295.
    1. Patel MM, Lopez-Collada VR, Bulhoes MM, De Oliveira LH, Bautista Marquez A, et al. (2011) Intussusception risk and health benefits of rotavirus vaccination in Mexico and Brazil. N Engl J Med 364: 2283–2292.
    1. Buttery JP, Danchin MH, Lee KJ, Carlin JB, McIntyre PB, et al. (2011) Intussusception following rotavirus vaccine administration: post-marketing surveillance in the National Immunization Program in Australia. Vaccine 29: 3061–3066.
    1. Patel MM, Glass R, Desai R, Tate JE, Parashar UD (2012) Fulfilling the promise of rotavirus vaccines: how far have we come since licensure? Lancet Infect Dis 12: 561–570.
    1. Okimoto S, Hyodo S, Yamamoto M, Nakamura K, Kobayashi M (2011) Association of viral isolates from stool samples with intussusception in children. Int J Infect Dis 15: e641–645.
    1. Abantanga FA, Amoah M, Adeyinka AO, Nimako B, Yankey KP (2008) Pneumatic reduction of intussusception in children at the Komfo Anokye Hospital, Kumasi, Ghana. East Afr Med J 85: 550–555.
    1. Ameh EA (2002) The morbidity and mortality of laparotomy for uncomplicated intussusception in children. West Afr J Med 21: 115–116.
    1. Ameh EA (2002) The morbidity and mortality of right hemicolectomy for complicated intussusception in infants. Niger Postgrad Med J 9: 123–124.
    1. Archibong AE, Usoro IN, Ikpi E, Inyang A (2001) Paediatric intussusception in Calabar, Nigeria. East Afr Med J 78: 19–21.
    1. Bode CO (2008) Presentation and management outcome of childhood intussusception in Lagos: a prospective study. Afr J Paediatr Surg 5: 24–28.
    1. Carneiro PM, Kisusi DM (2004) Intussusception in children seen at Muhimbili National Hospital, Dar es Salaam. East Afr Med J 81: 439–442.
    1. Chouikha A, Fodha I, Maazoun K, Ben Brahim M, Hidouri S, et al. (2009) Rotavirus infection and intussusception in Tunisian children: implications for use of attenuated rotavirus vaccines. J Pediatr Surg 44: 2133–2138.
    1. Edino ST, Ochicha O, Mohammed AZ, Anumah M (2003) Intussusception in Kano: a 5-year analysis of pattern, morbidity and mortality. Niger J Med 12: 221–224.
    1. Ekenze SO, Anyanwu PA, Ezomike UO, Oguonu T (2010) Profile of pediatric abdominal surgical emergencies in a developing country. Int Surg 95: 319–324.
    1. Ekenze SO, Mgbor SO (2011) Childhood intussusception: the implications of delayed presentation. Afr J Paediatr Surg 8: 15–18.
    1. Enweronu-Laryea CC, Sagoe KW, Glover-Addy H, Asmah RH, Mingle JA, et al. (2012) Prevalence of severe acute rotavirus gastroenteritis and intussusceptions in Ghanaian children under 5 years of age. J Infect Dev Ctries 6: 148–155.
    1. Kuremu RT (2004) Childhood intussusception at the Moi teaching and Referral Hospital Eldoret: management challenges in a rural setting. East Afr Med J 81: 443–446.
    1. Moore SW, Kirsten M, Muller EW, Numanoglu A, Chitnis M, et al. (2010) Retrospective surveillance of intussusception in South Africa, 1998–2003. J Infect Dis 202 Suppl: S156–161
    1. Wiersma R, Hadley GP (2004) Minimizing surgery in complicated intussusceptions in the Third World. Pediatr Surg Int 20: 215–217.
    1. Muyembe VM, Suleman N (2000) Intestinal obstruction at a provincial hospital in Kenya. East Afr Med J 77: 440–443.
    1. Ogundoyin OO, Afolabi AO, Ogunlana DI, Lawal TA, Yifieyeh AC (2009) Pattern and outcome of childhood intestinal obstruction at a tertiary hospital in Nigeria. Afr Health Sci 9: 170–173.
    1. Steele AD, Patel M, Cunliffe NA, Bresee JS, Borgstein E, et al. (2012) Workshop on intussusception in African countries–meeting report. Vaccine 30 Suppl 1A185–189.
    1. Bahl RS, M., Bhandari N, Taneja S, Mathur M, Parashar UD, et al. (2009) Population-based incidence of intussusception and a case-control study to examine the association of intussusception with natural rotavirus infection among indian children. J Infect Dis 200 Suppl 1S277–281.
    1. Bhowmick K, Kang G, Bose A, Chacko J, Boudville I, et al. (2009) Retrospective surveillance for intussusception in children aged less than five years in a South Indian tertiary-care hospital. J Health Popul Nutr 27: 660–665.
    1. Ramachandran P, Gupta A, Vincent P, Sridharan S (2008) Air enema for intussusception: is predicting the outcome important? Pediatr Surg Int 24: 311–313.
    1. Raman T, Mukhopadhyaya A, Eapen CE, Aruldas V, Bose A, et al. (2003) Intussusception in southern Indian children: lack of association with diarrheal disease and oral polio vaccine immunization. Indian J Gastroenterol 22: 82–84.
    1. Zaman K, Breiman RF, Yunus M, Arifeen SE, Mahmud A, et al. (2009) Intussusception surveillance in a rural demographic surveillance area in bangladesh. J Infect Dis 200 Suppl 1S271–276.
    1. Bines JE, Liem NT, Justice FA, Son TN, Kirkwood CD, et al. (2006) Risk factors for intussusception in infants in Vietnam and Australia: adenovirus implicated, but not rotavirus. J Pediatr 149: 452–460.
    1. Chen SC, Wang JD, Hsu HY, Leong MM, Tok TS, et al. (2010) Epidemiology of childhood intussusception and determinants of recurrence and operation: analysis of national health insurance data between 1998 and 2007 in Taiwan. Pediatr Neonatol 51: 285–291.
    1. Giak CL, Singh HS, Nallusamy R, Leong TY, Ng TL, et al. (2008) Epidemiology of intussusception in Malaysia: a three-year review. Southeast Asian J Trop Med Public Health 39: 848–855.
    1. Hong Kong Intussusception Study G (2007) Intussusception trends in Hong Kong children. Hong Kong Med J 13: 279–283.
    1. Jo DS, Nyambat B, Kim JS, Jang YT, Ng TL, et al. (2009) Population-based incidence and burden of childhood intussusception in Jeonbuk Province, South Korea. Int J Infect Dis 13: e383–388.
    1. Justice FA, de Campo M, Liem NT, Son TN, Ninh TP, et al. (2007) Accuracy of ultrasonography for the diagnosis of intussusception in infants in Vietnam. Pediatr Radiol 37: 195–199.
    1. Khumjui C, Doung-ngern P, Sermgew T, Smitsuwan P, Jiraphongsa C (2009) Incidence of intussusception among children 0–5 years of age in Thailand, 2001–2006. Vaccine 27 Suppl 5F116–119.
    1. Kruatrachue A, Wongtapradit L, Nithipanya N, Ratanaprakarn W (2011) Result of air enema reduction in 737 cases of intussusception. J Med Assoc Thai 94 Suppl 3S22–26.
    1. Latipov R, Khudoyorov R, Flem E (2011) Childhood intussusception in Uzbekistan: analysis of retrospective surveillance data. BMC Pediatr 11: 22.
    1. Nakagomi T, Takahashi Y, Arisawa K, Nakagomi O (2006) A high incidence of intussusception in Japan as studied in a sentinel hospital over a 25-year period (1978–2002). Epidemiol Infect 134: 57–61.
    1. Nelson EA, Tam JS, Glass RI, Parashar UD, Fok TF (2002) Incidence of rotavirus diarrhea and intussusception in Hong Kong using standardized hospital discharge data. Pediatr Infect Dis J 21: 701–703.
    1. Pruksananonda P, Athirakul K, Worawattanakul M, Varavithya W, Pisithpun A, et al. (2007) Intussusception in a private tertiary-care hospital, Bangkok, Thailand: a case series. Southeast Asian J Trop Med Public Health 38: 339–342.
    1. Takeuchi M, Osamura T, Yasunaga H, Horiguchi H, Hashimoto H, et al. (2012) Intussusception among Japanese children: an epidemiologic study using an administrative database. BMC Pediatr 12: 36.
    1. Tan N, Teoh YL, Phua KB, Quak SH, Lee BW, et al. (2009) An update of paediatric intussusception incidence in Singapore: 1997–2007, 11 years of intussusception surveillance. Ann Acad Med Singapore 38: 690–692.
    1. Zhang Y, Bai YZ, Li SX, Liu SJ, Ren WD, et al. (2011) Sonographic findings predictive of the need for surgical management in pediatric patients with small bowel intussusceptions. Langenbecks Arch Surg 396: 1035–1040.
    1. Abate H, Linhares AC, Venegas G, Vergara RF, Lopez P, et al. A multi-center study of intussusception in Latin America: first year results [abstract]. Presented at: ICP; August 15–20, 2004; Cancun, Mexico.
    1. O'Ryan M, Lucero Y, Pena A, Valenzuela MT (2003) Two year review of intestinal intussusception in six large public hospitals of Santiago, Chile. Pediatr Infect Dis J 22: 717–721.
    1. Perez-Schael I, Escalona M, Salinas B, Materan M, Perez ME, et al. (2003) Intussusception-associated hospitalization among Venezuelan infants during 1998 through 2001: anticipating rotavirus vaccines. Pediatr Infect Dis J 22: 234–239.
    1. Saez-Llorens X, Guevara JN (2004) Intussusception and rotavirus vaccines: what is the background risk? Pediatr Infect Dis J 23: 363–365.
    1. Tota-Maharaj R, Rampersad B, Indalsingh R (2010) Barium enema reduction of intussusception in a developing country. West Indian Med J 59: 535–539.
    1. Al-Malki TA (2005) Pediatric intussusception in a Saudi Arabian tertiary hospital. West Afr J Med 24: 309–310.
    1. Crankson SJ, Al-Rabeeah AA, Fischer JD, Al-Jadaan SA, Namshan MA (2003) Idiopathic intussusception in infancy and childhood. Saudi Med J 24 Suppl: S18–20
    1. Eshed I, Witzling M, Gorenstein A, Serour F (2003) [Reduction of intussusception by air enema in children–experience over a 13-year period]. Harefuah 142: 659–661, 720, 719.
    1. Greenberg D, Givon-Lavi N, Newman N, Wheeler J, Cohen Z, et al. (2008) Intussusception in children in Southern Israel: disparity between 2 populations. Pediatr Infect Dis J 27: 236–240.
    1. Saleem MM, Al-Momani H, Abu Khalaf M (2008) Intussusception: Jordan University Hospital experience. Hepatogastroenterology 55: 1356–1359.
    1. Buettcher M, Baer G, Bonhoeffer J, Schaad UB, Heininger U (2007) Three-year surveillance of intussusception in children in Switzerland. Pediatrics 120: 473–480.
    1. Fischer TK, Bihrmann K, Perch M, Koch A, Wohlfahrt J, et al. (2004) Intussusception in early childhood: a cohort study of 1.7 million children. Pediatrics 114: 782–785.
    1. Hilal A, MacMahon P, Cosgrove JF (2002) Outcome of acute intussusception in a regional paediatric centre. Ir Med J 95: 58–59.
    1. Jenke AC, Klaassen-Mielke R, Zilbauer M, Heininger U, Trampisch H, et al. (2011) Intussusception: incidence and treatment-insights from the nationwide German surveillance. J Pediatr Gastroenterol Nutr 52: 446–451.
    1. Kohl LJ, Streng A, Grote V, Koletzko S, Liese JG (2010) Intussusception-associated hospitalisations in southern Germany. Eur J Pediatr 169: 1487–1493.
    1. Lappalainen S, Ylitalo S, Arola A, Halkosalo A, Rasanen S, et al. (2012) Simultaneous presence of human herpesvirus 6 and adenovirus infections in intestinal intussusception of young children. Acta Paediatr 101: 663–670.
    1. Rubi I, Vera R, Rubi SC, Torres EE, Luna A, et al. (2002) Air reduction of intussusception. Eur J Pediatr Surg 12: 387–390.
    1. Samad L, Marven S, El Bashir H, Sutcliffe AG, Cameron JC, et al. (2012) Prospective surveillance study of the management of intussusception in UK and Irish infants. Br J Surg 99: 411–415.
    1. Saxena AK, Seebacher U, Bernhardt C, Hollwarth ME (2007) Small bowel intussusceptions: issues and controversies related to pneumatic reduction and surgical approach. Acta Paediatr 96: 1651–1654.
    1. Shapkina AN, Shapkin VV, Nelubov IV, Pryanishena LT (2006) Intussusception in children: 11-year experience in Vladivostok. Pediatr Surg Int 22: 901–904.
    1. Sonmez K, Turkyilmaz Z, Demirogullari B, Karabulut R, Kale N, et al. (2012) Intussusception in children: Experience with 105 patients in a department of paediatric surgery, Turkey. S Afr J Surg 50: 37–39.
    1. Tareen F, Ryan S, Avanzini S, Pena V, Mc Laughlin D, et al. (2011) Does the length of the history influence the outcome of pneumatic reduction of intussusception in children? Pediatr Surg Int 27: 587–589.
    1. Wei BS, Streng A, Kries R, Liese J, Wirth S, et al. (2011) Incidence of intussusception in early infancy: a capture-recapture estimate for Germany. Klin Padiatr 223: 419–423.
    1. Yalcin S, Ciftci AO, Karaagaoglu E, Tanyel FC, Senocak ME (2009) Presenting clinical features and outcome in intussusception. Indian J Pediatr 76: 401–405.
    1. Willetts IE, Kite P, Barclay GR, Banks RE, Rumley A, et al. (2001) Endotoxin, cytokines and lipid peroxides in children with intussusception. Br J Surg 88: 878–883.
    1. Gay N, Ramsay M, Waight P (1999) Rotavirus vaccination and intussusception. Lancet 354: 956.
    1. Burjonrappa SC (2007) Laparoscopic reduction of intussusception: an evolving therapeutic option. JSLS 11: 235–237.
    1. Cortese MM, Staat MA, Weinberg GA, Edwards K, Rice MA, et al. (2009) Underestimates of intussusception rates among US infants based on inpatient discharge data: implications for monitoring the safety of rotavirus vaccines. J Infect Dis 200 Suppl 1S264–270.
    1. Eng PM, Mast TC, Loughlin J, Clifford CR, Wong J, et al. (2012) Incidence of intussusception among infants in a large commercially insured population in the United States. Pediatr Infect Dis J 31: 287–291.
    1. Fike FB, Mortellaro VE, Holcomb GW 3rd, St Peter SD (2012) Predictors of failed enema reduction in childhood intussusception. J Pediatr Surg 47: 925–927.
    1. Nylund CM, Denson LA, Noel JM (2010) Bacterial enteritis as a risk factor for childhood intussusception: a retrospective cohort study. J Pediatr 156: 761–765.
    1. Shekherdimian S, Lee SL (2011) Management of pediatric intussusception in general hospitals: diagnosis, treatment, and differences based on age. World J Pediatr 7: 70–73.
    1. Somme S, To T, Langer JC (2006) Factors determining the need for operative reduction in children with intussusception: a population-based study. J Pediatr Surg 41: 1014–1019.
    1. Tate JE, Simonsen L, Viboud C, Steiner C, Patel MM, et al. (2008) Trends in intussusception hospitalizations among US infants, 1993–2004: implications for monitoring the safety of the new rotavirus vaccination program. Pediatrics 121: e1125–1132.
    1. Velazquez FR, Luna G, Cedillo R, Torres J, Munoz O (2004) Natural rotavirus infection is not associated to intussusception in Mexican children. Pediatr Infect Dis J 23: S173–178.
    1. Yen C, Tate JE, Steiner CA, Cortese MM, Patel MM, et al. (2012) Trends in intussusception hospitalizations among US infants before and after implementation of the rotavirus vaccination program, 2000–2009. J Infect Dis 206: 41–48.
    1. Blanch AJ, Perel SB, Acworth JP (2007) Paediatric intussusception: epidemiology and outcome. Emerg Med Australas 19: 45–50.
    1. Chen YE, Beasley S, Grimwood K, New Zealand Rotavirus Study G (2005) Intussusception and rotavirus associated hospitalisation in New Zealand. Arch Dis Child 90: 1077–1081.
    1. Justice FA, Auldist AW, Bines JE (2006) Intussusception: trends in clinical presentation and management. J Gastroenterol Hepatol 21: 842–846.
    1. Kodikara H, Lynch A, Morreau P, Vogel S (2010) Ten-year review of intussusception at Starship Hospital: 1998–2007. N Z Med J 123: 32–40.
    1. Lloyd-Johnsen C, Justice FA, Donath S, Bines JE (2012) Retrospective hospital based surveillance of intussusception in children in a sentinel paediatric hospital: benefits and pitfalls for use in post-marketing surveillance of rotavirus vaccines. Vaccine 30 Suppl 1A190–195.
    1. Reid R, Kulkarni M, Beasley S (2001) The potential for improvement in outcome of children with intussusception in the South Island. N Z Med J 114: 441–443.
    1. Webby RJ, Bines JE, Barnes GL, Tindall H, Krause V, et al.. (2006) Intussusception in the Northern Territory: the incidence is low in Aboriginal and Torres Strait Islander children. J Paediatr Child Health 42: 235–239; discussion 227–238.
    1. Awasthi S, Agarwal GG, Mishra V, Nag VL, El Sayed HF, et al. (2009) Four-country surveillance of intestinal intussusception and diarrhoea in children. J Paediatr Child Health 45: 82–86.
    1. Tate JE, Steele AD, Bines JE, Zuber PL, Parashar UD (2012) Research priorities regarding rotavirus vaccine and intussusception: a meeting summary. Vaccine 30 Suppl 1A179–184.
    1. Patel MM, Clark AD, Sanderson CF, Tate J, Parashar UD (2012) Removing the age restrictions for rotavirus vaccination: a benefit-risk modeling analysis. PLoS Med 9: e1001330.
    1. Shui IM, Baggs J, Patel M, Parashar U, Rett M, et al. (2012) Risk of intussusception following administration of a pentavalent rotavirus vaccine in US infants. JAMA 307: 598–604.
    1. Haber P, Patel M, Pan Y, Baggs J, Haber M, et al. (2013) Intussusception After Rotavirus Vaccines Reported to US VAERS, 2006–2012. Pediatrics 131: 1042–1049.
    1. Johnson B, Gargiullo P, Murphy TV, Parashar UD, Patel MM (2010) Sociodemographic and dietary risk factors for natural infant intussusception in the United States. J Pediatr Gastroenterol Nutr 51: 458–463.
    1. Simonsen L, Morens D, Elixhauser A, Gerber M, Van Raden M, et al. (2001) Effect of rotavirus vaccination programme on trends in admission of infants to hospital for intussusception. Lancet 358: 1224–1229.
    1. Farrington CP (2004) Control without separate controls: evaluation of vaccine safety using case-only methods. Vaccine 22: 2064–2070.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner