=
Abstract=
~0l- ~~~J~011Al ~/-J-0J:/-J-JI} 4-1f~~JI}.2.l
~7-11 011 ~"tl *~ *
Analysis of Clinical Factors and Operative Findings in Childhood Intussusception *
K um-Ja Choi, M.D.
Department of Surgery, College of Medicine, Ewha WomansUniversity Seaul, Korea
Although nonoperative reduction plays a major role in the management of un- complicated intussusception in the pediatric age group, surgical treatment is still a necessary alternative when nonoperative reduction is unsuccessfuL The author analyzed the clinical features of 68 pati~mts requiring operation in order to iden- tify factors which might influence the type of operative management. A nine- year experience at Ewha Womans University Hospital was reviewed, and the findings compared to previous reports.
Barium was used for the initial reduction attempt in 33 cases, saline in 35.
Manual reduction by milking at operation achieved success in 41 cases(60.3%).
Fifteen cases(22.1 %) required resection of bowel, and 12 patients(l7.6%) were found to have spontaneous and complete reduction of the intussusception at op- eration. Two cases had pathologic leading points. There were no perforations due to nonoperative reduction. There were no significant differences in demo- graphic data, clinical findings, laboratory data, and anatomic type of intussuscep- tion between barium and saline reduction groups. However, a significant number of cases with spontaneous reduction were in saline reduction group(p< 0.05).
There was a slight chance of spontaneous reduction in infants under 6 month of age(p<O.OOl). Age under 6 month, body temperaure over 38°C, symptom over 24 hours, and ileo-colic and ileo-ileo-colic intussusception contributed significantly to the necessity for ·bowel resection(p< 0.05-0.001). The author believes that the age, body temperature, duration of illness, and anatomic type of intussusception strongly influence operative management.
Index Words: Intussusception, Operative management
- :f:o}.2.j:ilj- : fil]2 -tI fil]2:§:. 1996\1. -
~0}7] AJ-%,-{i~ 9.1 Jf-{j7,]li~O] l:l]'T'--G:~ ~* -G:0]2.J- W;;<.]2.J-.5:. -11 * oj] {l}!jj<5}~% u:Jl~ %~ ~ 113~0] ~"-~<5}71L} ~~ {l"8"~~~O] ~% u:Jl %9.1 0]%£ ~0}9.1 20-30%~ 'T'--G:~ 7,]li~ .R<5H]
¥It:j-. l:l]'T'--G:~ ~*-G:£~ .:::L%'?l- ti}~ttAJ--G:O] 5!.
Jt!-3jc?1 ]dJ-~0]~;;<']~ ~-2- -6j~'T'-L} i'-7] ~ O]%~
-11*-G:0] ~7}<5}q1Ai ti]'T'--G:~ ~*~O] -EJl] 5!..Jl
!9.Jl ~t:j-l,2. 'T'--G:]dJ-~.Q.£::: 5:.'T'--11*-G:, AJ-~"'1]-G:
'3ol 7H*A] ;;<.}~-11*¥I AJ-Ejj~ tt;;<.] ~~~<5}Jl] !9 ::: 7J~ %0] ~t:j-. .:::LelL} %{-j!9~1ii AJ-O] 7H*A]
;;<.}~ -11*¥I 7JJf-9.1 t:Jl1f-~.':. ~.R ~TI-~ 'T'--G:0]2.J- . .JlW 'T'-
~.Q.uj
1frq1oj] Oirt!1l]'T'--G:~
Aa*-G:g A}%<5J-e.;;<.] ~oj] -'fl~~ ~113~ AJ-{ii'-g %~A]:7]:::
~0]2.J-.Jl W 'T'- ~t:j-. u:J-2.J-Ai ~O} AJ-%{-j~ojjAi ll]
'T'--G:-3j -11 *-G:.9.J ~ J1j-~ aJ] ~ <5} E..£?(i 1f-c.] ~ -11 * -G:£ ~~ ~113%.':. TIj<5}li'!Ai ~~.R~ 'T'--G:g ~ 0]C1~ .r..i2j0] 7-l]:;!9.Jl ~t:j-. ~ ~Toj]Ai~ AJ-%
~~ ~O~% TOJ78~0\1 ~~-t}~ ~:il}0\1),1 cr-~~
~O}~ %{l..2.:£ .:::L ~.Jcl-~' =i~, 7,:lA}~7,j, 'T'--G:~
A~J;!.A]d}tJ.l ql AAA?'J SA. .Ji!-Al<5l .-.1 zrzro] 'T'- -8 -, a (:) l::J ;;0::;. 12'" J -1....:. 0 e l.!.. - , r,
-G:]dJ~oj]p]7,]::: ~13J:g 1l].lll.<5}E..£?(j ~O} AJ%{-j
~.9.J ti}~-3j~ ~Lli_~ -'fl~ ~AJ-3j ;;<']lE~ ~0}5!.
.Jl;;<.} <5}~ t:j-.
1987\:1 l-%l1f-Ei 1995\1 12-%l7J};;<.] 0]§j-t:Jl~113~
oj]Ai ~]li~ 15"-1] pJ~.9.J AJ%{-j~ ~O}% l:l]'T-G:,
~ -11*-G:ojl {l}!jj<5}a:j .<?JJ1j-ojjAi 'T-G:~ 68aJ] ~ t:Jl AJ.Q.£ <5}a:j 'T'--G:~ A].5:. ~ l:l] 'T'--G:~ -11 *-G:oj] u:J-
4
ti}~78*-it-J1j- ~~'T'--11*-it-.Q.£Y--'f-.Jl, :E~ t:Jl AJ ~O}~ 'T'--G:]dJ~oj] u:J-2.J- .5:.'T'--11*-it-, AJAJ."'1]-it-~ ;;<.}'?:l-11*-it-.Q.£ Y--'f-Oi ~T~~ '3ol ~AJ~ =i 7cl, 7,:lA}~7,j, 'T'-~~7,j, ~113~ %g l:l].lll.<5}a:j
lIJ
7}'5}~t:j-. tt l:l]9-~-3j 78~~g A]"8"]<5}~.Q.Y- -11*
0\] {llI1l~ ~ 7H*<5}~g u:Jl %{-j¥I 7.J-.':. ~ 'T ict .Jl -11*¥l AJg ~~ <5}~1ii ~O}-it-g ;;<.}'?:l-11*-it- .Q..£. -11.9.J <5} ~ t:j-. .
~~oj]Ai A]"8"~¥I ~~'T'--11*-G:.':. 37'C -11.5:.£ 7}
..2.(3-' L~ A1Col.h l u T 1....!.dr2. .:...L-o..!.'-f :f!l-A~OllA. 7. A. ,,1 %.5:.<5H] 9-'fH} ~
% "'1]~<5}q1 ~1fr~~ ti}~78*-G:oj]Ai9} %~<5}~
ej-.
7@J1j-oj] t:Jl~ -"t7-l]~-6:j.':. chi-square test£ 7,:l~<5}
a:j P<0.05~ ~g -"t7-l]-3j.Q.£ %.9.J<5}ej-.Jl <5}~t:j-.
t:JlAJ~O} 68oj]% ti}~-11*-it-.':.33aJl. ~~'T'--11*
-it- 35aJ]0]~q. Aa~~.¥.::: 'JO} 44aJj(64.7%), a:j O} 24aJl (35.3%)£ ';:j-o}oj] ~~.Jl, ~0}.9.J 't!~~
~.¥.::: 67H-%l 0]<5}7} 36aJ](52.9%), 7-127H-%l0]
18oJ](26.5%), 13-247H-%l0] 9aJ](13.2%)0]~.Q.uj 2A1] O]AJO] 5 oj] (7.4%)omq. 9.R ~AJ-~AJ-.':.
.:r-
so. 79.4%, *-"t t.H;;<.1::: 5!.~J 76.5%, ~ ~~ 45.6
% 0]~.Jl, 1-Jl~A] 38'C O]AJ.9.J .Jl~ AJEjjO]~1ii 7J
~7} 23.5%0]~t:j-. ~AJ~~ ~ 1-Jl~7J};;<'].9.J ~AJ
;;<.]4;=-A]~.':. 12A]~01t.Hojl 1-Jl~~ 7J~7} 27.9%, 13-24Al~0] 32.4%, 25-48A]~0] 25.0%o]~.Jl,
~AJO] 48A]~ °VJ 7JJ1j-<5}a:j t.H~~ 7J~::: 17.4
%o]~t:j-. 1-Jl~Al ~~~«lj ~~T'T'-7} 10,000/mm 3 0]<5}~ 7JJf-7} 32.4% 10,000-15,000/30] 41.2%, 15,000-20,000/mm30] 17.6 %, 20,000/mm3o]AJO]
8.8% o]~t:j-. 7.J%{-j~ol AH~~ 7J~::: 6 oj] (8.8
%)o]~t:j-.
AAA"'A~ 7.}~i=.-.:Il~ \{'j~.Jl 7.J-%{-j.9.J 113~'tl I e J,.../L1 d 0 1....:. 0 ' / L- ...
{l"8"]~'t.lg 7}~lii 7J~~ B}~-11*-it-ojH Henoch- Shoenlein;;<.}1fr113oj] .9.J~ ~tt~7.J.9.J ~* 1aJ].2f- ~ , ColA o T-tj,l:!..-
A.~l2.=,..]]A~
... , 'I Col r'lL:. -, OI-'F1 uH~Jl]{),
1 oj]~o] ~q.
AH~~ 7J~::: 6oj](8.8%)0]~.Jl 0]% 2aJ]::: .6j~'T'-, -11*-G:~ .:lc.].Jl 4 oj] ::: ti}~Aa*-G:~ 3~ 1-jj;;<.] 8 7U -%l ~oj] AU ~<5} ~ t:j-. t:Jl.Jcl-~O} 68 oj] .9.J AJ%{-j.9.J 5jj1f-~-3j % -&J.':. ~ AJ. t:Jl 7.J--&J 0] 24 aJ] (35.2 %), §j 7.J-. ~7.J-. t:Jl7.J-tIJ 0] 21 aJ](30.9%), ~AJ. U~7.J~ 0]
18oJj(26.5%), ~AJ-.~7.J--&J0] 5oJj(7.4%) tr0l~
t:j-.
O]AJ.9.J 't.lT~~ ~ ~AJ-3j =i7cl, 7,:lA}~7,jJ1j- 7.J%
{-j.9.J 5jj1f-~~ %-&J ~.':. ti*~*-it-J1j- ~ ~'T'--11*-it
A}O]oj]Ai %.9.J~ ~}0]7} ict~q(P>0.005, .If 1) .
- ~~At : :::::.ot "J-*"J%oJ]Al 0JAJ-0JAJ-~ 'T-~:::::'7,:1jlt9-] Jt!-fli ojl Jt!-~ */.-'1 -
Table 1. Background Data of Nonoperative Treatment Groups*
Barium reduction( %) Saline reduction( %) Total( %)
(n=33) (n=35) (n=68)
Sex
male 22 22 44(64.7)
female 11 13 24(35.3)
Age(month)
under 6 21 15 36(52.9)
7-12 6 12 18(26.5)
13-24 5 4 9( 13.2)
over 24 4 5( 7.4)
Symptoms
vomiting 27 27 54(79.4)
pain to irritability 27 25 52(76.5 )
bloody stool 12 19 31(45.6)
pyrexia ( > 38°C) 9 7 16 (23.5)
Symptom duration (hour)
under 12 12 7 19(27.9)
13-24 7 15 22(32.4 )
25-48 7 10 17(25.0)
over 48 7 3 10(17.4)
WBe count(/mm3)
under 10,000 12 10 22( 32.4)
10,001-15,000 12 16 28(41.2)
15,001-20,000 4 8 1207.6)
over 20,000 5 1 6( 8.8)
Recurrence 5 6( 8.8)
Pathologic lead point" 1 2( 2.9)
Anatomic type of intussusception
ileo-ileal 4 5( 7.4)
ilea-cecal 6 12 18(26.5)
ilea-colic 15 9 24(35.2)
ileo-ileo-colic 11 10 21(30.9)
* : insignificant differences
@ : Enlarged Peyer's patch or mesenteric lymph nodes are excluded.
~qj%~0}oJ];'1 ;']i5~B -T-~<lJ-t{l~ '~-T-1l*~ 41 oJj(60.3%), :§:lAJ-, :§:l .1J~AJ-
sr:.::
qjAJ- ~Aj]~ 15oj](22.1%) ~ %-{-lB AJ-o] 7R*A] A},?:!1l*B ~&
~'?l"6} jl. *-T-AJAj]~'il-% A]i5~ ~ r;j 7cJ .!j'-7} 12oj]
(17.6%)0]~q .
.:::z.c,Y-
l:l}~1l*-;;:- 33oJ]oJ];'1 A]i5~B -T-~<lJ-t{l2. z.)-z.)- 23 oj] (69.7 %), 8oJj( 24.2 %),
2oJj( 6.1 %) 0]~.Jl ~ 'El'T-1l*~oJ]}lc z.)-z.)- 18oJ]
(51.4%), 7 oj] (20.0%), 10oJ](28.6%).'£ ~'El-T-1l
*~oJ];'1 A},?:!1l*B oJ]7} %91"6}71] i'i"~q(p<O.
005,.H. 2).
Table 2. Methods and Rates of Operation after Nonoperative Reductions
. Manual reduction· Resection of bowel Spontaneously reduced
*: significant difference
Barium reduction( %) (n=33) 23(69.7)
8(24.2) 2( 6.1)
. ~ ~~]olJ1{loJ] utct %~~ ~}017} 'ilJ~q(p>O.
05) . .:IclY- ~~oJ] ut.e T~]olJ1{loJ];'i ;AJ~Aj]~~
~o}~ ~~o] 67n-%l u]'il-,()
7cH-::
36 oj] "6'- 10oj](27.8%) o]~.:il ~7H-%l 0VJoJ];'l:: 32 oj] "6'- 5 oj] (15.
6%)£ ~~o) 67n-%l pl'il-,() ~o}oJ];,i ;AJ~Al]%ol
~':<l-&-] ~~.Q.t9 .:<}~~*%~ Z{Z{ 2.8%(1/36)
Table 3. Factors in Different Operation Methods Man. Reduction
(n=41)
Vomiting 31
32 22 Abdominal pain to irritability
Bloody stool Age*
<6 months
>6 months Body temperature**
25 16
<38'C 37
>
38'C 4Symptom duration***
<24 hours 29
>24 hours 12
WBC count
<10,OOOmm3 14
> lO,OOOmm3 27
Anatomical type of intussusception***
ileo-ileal 2
ileo-cecal 14
ileo-colic 14
ileo-ileo-colic 11
Saline reduction ( %) (n= 35) 18(51.4) 7(20.0) 10(28.6)*
Total( %) (n=68) 41(60.3) 15(22,1) 12(17.6)
.«t
34.4%(11/32)£ 67H-%l v]'il-°}oJl;'l %~-&-}711 '7t~q.(P<O.OOl). l.Jl~;,] ~1].g.oJ] ute ~.AJAj]%~~1].g.o] 38'C o]'il-,() 78J(- 5Zoj] "6'- 9 oj] (17.3%)0]
~.:il 38'C 0VJoJ];'l:: 16oj] % 6 oj] (37.5%)£ .:il
~ ~o}oJl;,i ;AJ~ft\l%ol ~~q(P<O.Ol). ~~ ~
AJ.:<14i'A1Z!oJl ute ;AJ;AJAj]~~ ~AJ~~~ 24A]Z!
Bowel Resection Spont. Reduced 'fotal( %)
(n=15) (n=12) (n=68)
12 11 54(79.4)
12 8 52(76.5)
7 2 31(45.6)
10 1 36(52.9)
5 11 32(47.1)
9 6 52(76.5)
6 6 16(23.5)
4 8 41(60.3)
11 4 27(39.7) .
3 5 22(32.4)
12 7 46(67.6)
0 3 5( 7.4)
0 4 18(26.5)
5 5 24(35.3)
10 0 21(30.9)
There are statistically significant differences in proportion of bowel resection for each item from manual
reduction and spontaneous reduction. , .
*: P<O.OOI
**: P<O.Ol
***: P<O.05
Abbreviation: Man; manual, Spont;spontaneously
Table 4. Complications Complication
Persistent fever(>38°C)*
Intestinal obstruction Relapsed H-S purpura
No. of cases 3 1 1
* : Body temperature over 38°C for more than three days postoperativly.
Abbreviation: H-S; Henoch-Schoenlein
011..)1011 1..)1~~ 7(lJf- 410jl ~ 4ojl(9.8%)01~..2..\..}
24A1Zl- 0l AJ ol 7(lJI}i>}~~ u:Jl~ 270jl ~ 11oj](40.
7%) £. ~.71011},i ;;<J;;<J:;(l~ol ~ ~ 9)711 ~9J"q(P<
0.05). :E~ ;;<J~{j~ %-OS011 ut~ ~*loIJl:i:J~ :§:l;;<J 'qj;;<J-osJI} :§:l;;<J·:§:l;;<J·qj;;<J-OS01Vi ;;<J;;<J:;(11 %°1 %~
i>}711 ~9J"q(P<O.05) . .::r2.i\"} W::E~~ lfll~-=r-~
~ ~* loIJl:i:J011 ute.} ~}017} \l).~q(P>0.005, R 3).
qjAJ~O} ~ 5ojl011 Ai ~~~01 ~}.~i>}oj ~~~
~}.~~;: 7.4%01~q. 01~ 3ojl~ 38°coVJ~ Jl '?i!.oj ~~.f:. 3'?J. OjAJ ?-:j4:f!8 7c5Jf-oj9iJl, lojj-c
.s:.~11**+ 8'?J.~011 ;;<JSljl~~..2..£' 'tl"5R ;;<J%3j-J:!}
C1*~ ~9J"..2..uj, \..}Dl'-l lojl~ Henoch-Schoen-
lein?-:}~~011},i %~B ;;<J~{j'%..2..£' 'tliiR :i!1},}~
W~:§:lAJ~ £.W~ Jf-~ qj;;<JAJA11*+ ?-:rJti-,%oj AR
~5Oj9i~ 7(lJf-0]~q(.R 4).
1927\'l. Retan o] X---:j .!'f-A1i>H1 Ai Jl~ J:lHH1}
;;<J..2..s. ;;<J~{j~ ~ 11*01] },cl"*~ ~ X---:j .!f-A]i>}
J:l}~:tl-;;<J :il**;: ~o}~ ;;<J~{j~ ~ ~1[l-JI} ~]li 01] .!tJt1-3:j..2..£ o]%5'jir 9)r:}. l:lr~11*~011 Acl"*i>}
7]~-t}oj~ :::t:7]~~O] ~~-3:j'?J.l{i!-"?} o}Ye.} .::rljl.j"
011 ~o}~ ~~, ~P'J~AJ, lfll~-=r-~, ;;<J~{j~ % -OS, ~C1-3:j --:j"8~~'tl ~ ~0}~lliA1Zl- %01 ~lli011
trllJs:J:: JH1%£ 5l..Jls:J~r:}34. l:)J~ Glucagon
°1y. {ll8-~1 '; ~ oj1l:llJf-Q{-t}E.£Mi J:l14-*-3:j 11*
*~ Acl"*~~ ~'tlq~ .!tJl.s:. 9)..2..\..}56, ~AJ~
;;<J:tl-~ II}~£ 'tl~ J:l}~*"'-f'?:lJI} ~~ {lZf~ ~~
~o] ::E211~ ~ 9)..2..E.£. J:l].ll2-3:j 5:~-3:j..2..£ AJ"8~
i>}-C 7(lJf-.s:. 9)Oi}'i J:l}%11**~ 11*%~ 42-80
%£. .!i!.Jl5OjOi 9) r:} 7 . .::r2.iy. ~-2-011 ~ 5:0} ;;<J~{j '%~ ~1i1.j}} ~lli011 ::E%II}~oJi>} ~'?:l~;;<cl**JI}
X---:j .!f-Ali>} "*711l** Al"8~Ol ~7}i>}1?1Ai tll~*
-3:j 11*%01 ~0}?-:1 ~ 7StiJolr:}1.28-1O. l{i!-~o}'-le.}
;;<J~{j~ ~0}011},i ~S:·:~2.i ::EgII} %g °1%~
~~.!f- ~*%1j'-~ ¥!1l-&}01] ~{j~ ;;<J~ 11*7}-'6- AclJI} :i!1AH.!f-~ oj]~i>}oj .!tq -3:j~-3:j'tl 1l*0]
}'ls:.5OjJl 9)C}ll. ?-:i?-:}~ ~~011Ais:. 1987\1 0]211s.
;;<J~{j~~ ~1[l- ~ ~lli011 ~'?:l~l1**g J:l}%11
**JI} ~"8~i>}oj .::r ?:cl*~g 81 %s. .!tJl~tl}
9.1
r:}12.
"*71?:cl**01\..} ~'?:l4-11** A1"8~~ ~7}-c J:l]
~*3:j 11.J;j-~% tiJAJAmq· .::r2.iy. J:l1~*-3:j 11*
*01] ~1Ill~ 7(lJf- ~*011 ~~ s:.~1l*%;: ~5:
A]'Xl...2..\..} ~*},] ~~~1 ~ Jli>}~ ~o}~ J:ll%oJ '%7}i>}:'=. 7StiJ olq. ~ ~-=r-~JI}011},is:. s:.~11*%
60.3%9} ;;<J~~l~ 22.1 % ~ J:l1~*3:j ~llis. J:l}%
11.J;j-*~ }']"8~i>rt;i A]7]2.1 ~~ s:.*11*% 72.6%
9} ;;<J;;<J~]% 15.5%9} J:l1.ll2i>}1?1 s:.~11.J;j-%~ ~5:
i>}~Jl ;;<J~~]~~ '%7}i>}~q13.
J:l1~ ~ 0j-=r-qjAJO] T*~lli~ ;;<J%{j~'?J.?-:]e.}
s:. ~o}~ Acltl]-c ~;"(1] ;;<J~{j~~oH]Ai9} %A}i>}
~q . .::r2.i\"} ~~-lf-£':: 67R-%l o]~~ 0Jo}7} ~
;"(1] 7.J~{j~ ~o}~ qjAJ..2..£ ~ E.Hf·~.!tq ~~
J:l]~g ~}?-:]i>}~Jll4, 9*::'<]li~ ~o}~~ -If--6::j~
11 %lS~ .!tJl9}~ ~::'<li>}~q. r:i
"'*
0] 67R-%l o]"?}0}01]Ai-c ?-:}~11*%s:. %~i>}1l1 ';;to}Ai 67R-%l 0]
'?}0}01]Ai ~ J:l1~*3:j ::'<]li~ ~1Ill%01 ~ g ~ y.F.j-
\B.r:}Jl ~ ~ 9)q.
~AJ~~~ ~~7J}?-:]2.1 A]Zl-0] 7.J~{j~ ~ ::,<]li loIJl:i:J01j oJtiJ% "r~ ~R~ 'tl?-:}'iJ ~ "r?-:]~ },}~
cluj ~AJ?-:l4i-},]Zl-0l 4S A1Zl- O]AJ 7(lJI}~ 7(lJf- J:l]
~*3:j ::'<]li~ ~1Ill7}*J.cl01 ~qJl -&}~q416 . .::r 2.i\"} AiA}~ '?1-=r-qj"J ol ~*~]li~ ~o}~ '?d01]s:.
~-=r-i>}Jl ~AJ~~+ 24A1Zl- 011..)101] 1..)1~~ ~0}7}
\'i:9J"Jl ~AJ?-:]4i-A1Zl-°1 24A1Zl- OjAJ'tl 7(lJf- 7.J~~l
~ol %~i>}711 ~9J"q. "riL 'iJAJ~AJ'(l -=r-.£, .J;j-l8-
~ ~~~ ~~~ ~*BJl:i:J01] oatiJ~ 4-?-:]?J-9J"..2..uj, ZfZf 79.4%, 76.5%, 45.6%£ 7i~ ~ oj101]Ai .!t '(lqJl ~ -If:-~17JI} J:l].ll!.W u:Jl Ai?-:}~ ~JI}01]},i ~
- ~o}.2j:;tJ- : All 2 i'l A-l12 ~ 1996\1 -
~A-l"6] '7t~~ ell ole ~Ad-7.]4f-A]:zl-0] 24A]:zl- 0]t.l1
~ ~0}9.J 1:l]%0] ~~71 u:Jl~.Q...£ A}.E..{!q. ~ -l!!:- '?:!T cJVd-.g. ;<d-~1"l~9.J ~-osZ;j'(l ~Ad-%Ad-O] 5:'...'j'-
~~~7l ~ ~7Joll zlB'{! ~Jf-7} m-~qJl
w
"T-~q. 1fr~oJ] t.l1-'tlA] 38'C O]Ad-9.J Jl~Ad-El1~ .!I!.'(l
oJ]~ 23.5%01] *4"6}7.l1il ;<d-;<JjJ] 7}-'6-}.,:j ~ ~7H
31q.
;<d-?:JA11 %0] ~.g. ~Ad-:±'7,j.Q...£~ ~0}9.J y.o] 1 Al] p]1il, %Ad-7.]4f-A]:zl- 48A]:zl-, lJll~T"T- 20,000/
mm3: ;<d-~1"l~9.J %-os~ :§:j?:d-':§:j;<d-.t:jj;<d--OS %0] .!i!.
J1. ~~.Q..1lj4,14,18,19, Al7.}9.J ~4~ ~0}9.J Y.O]7}
67R-%! p]1il, ~Ad-7.]4f-A]:zl-O] 24A]:zl- 0Vd-, t.l1-'tlA] 71]~01 38'C oi-'-d-, ;<,J-~:1"J 9.J %-os 0] :§:j;<,J-. cJV,J-f§4 :§:j?:d- . :§:j?:d-. t:jj?:d--os ~Hl 1:l] Jl!.Z;j Zl ;<d--B-0] {j *1 A-j
~1"l0] .{! ~Jf-oJ] ;<,J-;;<JjJ] %0] ~o}).-j %).}~ ~4
~ y.qt.l1~q.
:±.o} ;<,J-~-"J~oJ]).le zlBA]9t 7~~~X\-01oJ1 ~
0}9.J 5-7%oJH A}'?:! 1l~~ .!i!.'(lqJ1. "6}~q-5,15.
.:::rcjy. Al7.}9.J ~4~ 17.6%.£ 1:l]Jl!..6j ~;: A}'?:!
~*%g .!i!.~.Q..1lj ~"6] "T-~~ A]~~~ 1l*~~
~'?:l"T- 1l*iCoJ]).-j A}'?:!;;<a~ oJ]7} %9.J"6}7l] m-~q-.
o]~ 1:l}%1l~~A]~ ~.g. 1m~0]oJ] ~~ ~'?:l"T-
9.J ~?:j;: 1:l}%%'2!j.!i!.q- '7t7] u:Jl~.Q..~ AJ~W "T-
~~q-20. EE~ A1A}9.J '?:!TcJVd-~ ~Ad-7]:zl-0]24A]
:zl- 0]t.l1't.l ~0}9.J 1:l]%01 ~.g. ?;ls=. ~;: A},?:!1l*
%:i!}s=. %-B-"6}q-Jl ~ "T- ~q-.
~~Z;j.Q..~ A1A}9.J ~4~ ~Ad-~%O]Y. {jAr:±.
7,j;: "T-~A] ~1"l'{! ;;<d-9.J 1l~*7} '0 o]y. ;;<,J-:v]A}9.J
~~~ ~Ad-Z;j .±E~o] ~7.]~ *"6}~.Q..y. ~0}9.J '?:!~, ~A,J-7.]4f-A1:zl-, t.l1-'tl A1 ~1~ '3<l ;<,J-~1"l9.J '5]].!f-
~.6j %-os %;: "T-~ll,J-~4 ~1l]Z;j.Q..~ %9.J~ -B- 1l]7} ~~q-. ~ ?:d-~1"l~ ~0}9.J y.o] 67R-%! 0Vd-, t.l1-'tl A] 71]~ 38'C 0]"6}, ~Ad-~~~ 24 A]:zl- 0]t.l1 % 9.J ~ %::t. 7,j 1il.Q..~s=. ;;<d-?:J jJ] 7} '0 "B;: Z;j q-J1. W
"T- ~q-.
1987\1 l-%!.!f-El 1995\1 12-%!7J}7.] 0l§}r!l~~-'tl
oJH "T-~~lii.~ ;;<d-~1"l'6' ~o} 68oJ] ~. t:jjAd-.Q..~
~%~~"6}aj q-g:i!} ~;: ~3l}~ ~~q-.
"T-~~ A]~~~ 1:l]"T-~Z;j 1l*~;: 1:l}~1l*iC 33 oj], ~'?:l"T-1l~iC 35oJ]omJ1., "T-~ll,J-~.Q..~~ s=.
"T-1l*~ 41 oj] (60.3%), ;;<,J-?:JjJ]~ 15oJ](22.1%),
A}'?:!1l~'{! ~Jf- 12oJ] (17.6%)omq-. '?:!~ ~ :A,:j 1:l], ~Ad-::t.7,j, {jA}::t.7,j, ;;<,J-~1"l%9.J '5R.!f-~.6j %-os
%;: 1:l}%1l*iC4 ~'?:l"T-1l*iC A}O]oJ] %9.J~ ~}
0]7} \il,~q-. ;;<,J-?:JjJ]%;: ~0}9.J '?:!~ 67R-%l pl1i'l, L.11-'tl Al ~l~ 38'c ol%, ~A,J-7.l4f-Al:zl- 24Al:zl- °lA,J-,
;;<,J-%1"l~9.J %-os% :§:j;<,J-·t:jj;;<,J--OS4 :§:j;;<,J-.:§:j;;<d-.t:jj;;<d- -os ~oj]A-l %9.J"6}71] ~~q-. .A},?:!~*%;: 1:l]"T-~.6j 1l*~% -6J'?:l"T-1l*iCojjA-l %9.J"6}71] ~~J1., ~o}
'?:!~iC% 67H-%! pl 1i'liCoJ] Al ~Al"61 '7t~q-. "T-~
~ A}o,J-oJl~ \il,~.Q..1lj ~~~~A~%;: 7.4% o]~
J1., "T-~~ "T-'ff1l*~ ll,J-~ o]y. 4-~ll,J-!fJ;: ~~ ~
~A~%oJ] OJ'8"J=g "r7.l U~q.
u:tc}Al ~0}9.J '?:!~, 71]~, %Ad-7.l4f-A]:zl- ~ ?:,J-%
:1"J ~ %t§% .Jl~"6}aj ;<.,J-~jJ171 '0 Aa 01 .6j;: ~Jf-oJl
~ .!I!.q- .6j~.6j't.l 1:l1"T-~Z;j 1l*~g ).ls=."6}E-~~
*~iL~ "T-~~ ~~ "T- ~.Qj:·lC} A}ii..{!q-.
1. Zhang J, Wang Y, Wei L: Rectal inflation recuction of intussusception in infants. j
Pediatr Surg 21: 30-32, 1986
2. Wang G, Liu S: Enema reductioin of intus- susception by hydrostatic pressure under ul- trasound guidance: A report of 377 cases. J Pediatr Surg 23:814-818,1988
3. Stephenson CA, Seibert JJ, Strain JD et al:
Intussusception; . Clinical and radiographic factors influencing reducibility. Pediatr Ra- dioI20:57-60, 1989
4. Reijnen JAM, Festen C, van Roosmalen RP:
Intussusception: Factors related to treat- ment. Arch Dis Child 65:871-873, 1990 5. Franken Jr. EA, Smith WL, Chernish SM et
al: The use of glucagon in hydrostatic reduc- tion of intussusception; A double-blind study of 30patients. Radiol 146: 687-689, 1983
6. Touloukian RJ, O'Connell JB, Markowitz RI et al: Analgesic premedication in the man- agement of ileocolic intussusception. Pediatr 79: 432-434, 1987
7. Shermann JO, Consentino CM: Intussuscep- tion, in Ashcraft KW, Holder TM(eds): Pe- diatric Surgery(ed 2), chapter 34. Philadel- phia, WB Saunders, 1993, Pp 416-419 8. Katz ME, Kolm P: Intussusception reduction
1991 : an international survey of pediatric ra- diologists. Pediatr Radiol 22: 318-322, 1992 9. Choi ~O, Park WH, Woo SK:Ultrasound-
guided water enema: an alternative method of nonoperative treatment for childhood in- tussusception. J Pediatr Surg 29: 498-500, 1994
10. {lAj~, ~o8Al, itA]fC- %: i'"7] ~ tl}c.1%.tJ.- AJ-ol] 91~ AJ-%-{;l~91 78*, 9.jJ1}9.}~z] 50:
227-233,1996
11. llR.AJ-~, '?:lJt-2-, -S:-TAJ ';: ~o} ~~AJ- AJ-%-
-'3j~91 Ac!* 7}'QAjol] t:11~ +~.;:iJ7}:~:s:.~c-l .::\'::%}Ij- 7a A}91 7}7-1. t:11~.::\'::g IIj-91~~A] 13:
117-122, 1994
12. 0].::\'::"511. *ZC!~, 78-€:-~ %: ~o}AJ-'3'-{;l~91 zl
~ ~ 7-]liol] :tog IIj-~o8J1} "T'-Cf} ~ ~+tJ:AJ-91
0]%, t:11~9.J~~~z] 32:1119-1125, 1989 13. &Ji5-A}:"T'-~7-]li~ ~o} AJ-'3'-{l~ol] t:11~ ~
T. o]:§}91t:11z] 13:181-188,1990
14. o]~"T'-, %;<J-~, 787VJ '; :tl}~ 78,*~J1} "T'-~
-'3j 78'*~.£ 7-]%-'8 AJ-'3'-t1 ~0}9.J tl].lli t!-~.
~0}:i1} 31: 1146-1152, 1988
15. AcHl-€:-, lol}-1lSf:l, 0Va~ %::::::o} AJ-'3'-t1~91"T'
~3j 7-]li. 9.jJ1}~~A] 40:529-535, 1991 16. 7J~fC-, 7J~-{j, E-%'6"}:~0} AJ-'3'-{;l~ol] ~Ol
Ai tl}c.1%t!-AJ- 78'*-£ol] °8~~ u]7-]:::: ~A}.
9JJ1}9.}~A] 38:394-399, 1990
17. Rowe MI, O'Neill, JA Jr, Grosfeld JA et al (eds): Essential of Pediatric Surgery, chap- ter 61; Intussusception. St. Louis, Mosby, 1995, Pp542-544
18. Ching E, Ching LT, Lynn HB et al: Intussus- ception in children. Mayo Clin Proc 45:
724-728, 1970
19. Potts SR, Murphy N: The obstructed intus- susception in childhood. Ulster Med J 53:
140-142, 1984, cited from Reijnen JAM, Festen C, van Roosmalen RP: Intussusce- ption; Factors related to treatment. Arch Dis Child 65: 871-9873, 1990
20. Sargent MA, Wilson BPM: Are hydrostatic and pneumatic methods of intussusecption reduction comparable? Pediatr Radiol 21:
346-349, 1991
