Pathological lead points in surgically treated pediatric ileocolic intussusception: A 17-year single-center cohort study

Abstract Purpose: Pathological lead points (PLPs) are an important cause of pediatric intussusception, but their clinical characteristics and associated factors remain incompletely characterized in surgically treated children. This study aimed to describe the etiologies of PLPs and compare demographic, clinical, laboratory, operative, and postoperative characteristics between children with and without PLPs undergoing surgery for ileocolic intussusception. Methods: This retrospective single-center cohort study included 83 children who underwent surgery for ileocolic intussusception at a tertiary pediatric surgical center. Results: PLPs were identified in 15.7%. Meckel’s diverticulum (MD) was the most common lesion (9/13, 69.2%). Patients with PLPs were older (median, 82.0 vs. 17.5 months), had a longer symptom duration before presentation (51.0 vs. 17.0 hours), and had higher leukocyte counts (17.1 vs. 11.7 × 10⁹/L). Bowel resection was performed in all 13 children with PLPs and in 12/70 children without PLPs (17.1%). In the primary multivariable model, increasing age was consistently associated with PLP status (adjusted odds ratio [OR] per month, 1.06; 95% confidence interval [CI], 1.02–1.11; p < 0.001). Higher leukocyte count was also associated with PLP status (adjusted OR, 1.21; 95% CI, 1.01–1.52; p = 0.034), although this association was less stable in the influence-based sensitivity analysis. Conclusions: Among children undergoing surgery for ileocolic intussusception, PLPs were identified in 15.7%, most commonly MD. Older age was the most consistent factor associated with PLP status. These exploratory findings characterize a selected surgical population and should not be used to guide the choice between operative and nonoperative management.