Pathological lead points in pediatric secondary intussusception

While most pediatric intussusceptions are idiopathic, secondary cases differ significantly in clinical presentation, treatment strategies, and prognosis due to the presence of pathological lead points (PLPs). Accurate PLP identification is crucial for optimizing diagnosis and treatment. This study aims to compare clinical and imaging features across PLP types to improve recognition and intervention efficiency for secondary intussusception. This study investigates common PLPs in pediatric secondary intussusception and compare their epidemiological characteristics, clinical manifestations, imaging features, treatment responses, and recurrence patterns, with the goal of enhancing preoperative PLP identification and optimizing individualized management strategies. In this single-center retrospective observational study, we analyzed clinical data from 3013 intussusception patients treated at Zhangzhou Hospital Affiliated to Fujian Medical University between January 2018 and December 2023. Among them, 111 cases confirmed surgically/pathologically as secondary intussusception were categorized into 5 PLP groups: Meckel diverticulum, intestinal polyps, intestinal duplication, lymphoma, and Henoch–Schönlein purpura (HSP). Comparisons were made across groups regarding gender, age, symptoms, intussusception type, ultrasound findings, air enema success rate, intestinal necrosis, and recurrence. Secondary intussusception accounted for 3.7% of total cases. PLP types showed distinct age and sex distributions and differences in selected clinical and therapeutic features. Meckel diverticulum and duplication predominated in males < 2 years, polyps in females aged 2 to 6 years, and lymphoma/HSP in children ≥ 6 years. The PLP group showed significantly lower enema success (52.0% vs 90.9%, P < .001), higher necrosis (10.8%), and recurrence rates (45.9%) versus idiopathic cases. Ultrasound demonstrated varying diagnostic accuracy: higher for Meckel diverticulum/polyps but limited for lymphoma/HSP. Each PLP type exhibited distinct intussusception patterns, recurrence modes, and treatment requirements. Pediatric secondary intussusception has identifiable etiologies, and PLP types were associated with differences in onset age, imaging features, and clinical pathways. High suspicion for PLPs is warranted in recurrent cases, older children, and those with atypical imaging. While ultrasound provides valuable PLP detection, its limitations suggest the need for a multiparameter predictive model to enable precise preoperative identification and personalized treatment optimization.