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Aetiology of Intussusception in Children

1962; BMJ; Volume: 2; Issue: 5306 Linguagem: Inglês

10.1136/bmj.2.5306.692

0959-8138

E G Knox, S Court, P. S. Gardner,

Parvovirus B19 Infection Studies

The aetiology of is still not fully understood, but two main theories have been advanced, the dietary and the infective. The dietary theory was derived partly from the age distribution of the disease, with its maximum incidence about the time of weaning, and partly from the clinical impression that affected infants were unusually fat and presumably very well fed. The possible role of infection was supported by the frequent history of mild respiratory or alimentary symptoms preceding the abrupt onset of pain and vomiting, and the almost constant finding at operation of large mesenteric lymph nodes. These show the histological changes of inflammation, and the known association of -with typhoid suggested that some unidentified infection of the lymph nodes and of Peyer's patches might be involved. The receat finding of adenoviruses in both mesenteric glands and intestinal contents reinforces the infective hypothesis and suggests that virus infection may well play an important part (Gardner, 1961; Ross and Potter, 1961'; Zachary and Potter, 1961). The dietary and infective theories are not contradictory. The disease intussusception is defined in mechanical terms, is treated by mechanical means, and in certain children has an obvious mechanical cause, and it seemed to us that a general hypothesis of its patbogenesis might also be made in mechanical and hydrodynamic terms. Consequently it was unlikely that any specific cause would be found which is both necessary and sufficient, which is always present before the disease,. ai4 which, when present, is always followed by the disease. Rather we should expect a group of interacting factors any of which might alter the mechanics of the intestine through the effects of excessive fluid-flow rates, obstruction, narrowing, or by inducing abnormal segmental contractions. We have shown (Court and Knox, 1959) that is almost three times as frequent in Newcastle as in Birmingham; (MacMahon, 1955X, and subsequent estimates from Edinburgh, Sheffield, and Aberdeen (Smith, 1960; Steyn and Kyle, 1961; Ross and Potter, 1961) suggest that the Newcastle figure is abnormally high. Bearing in mind the general similarity of climate and living conditions in these different communities, it seemed that an explanation for these differences of incidence might be found in differing habits of infant care. as in feeding methods or the use of purgatives, rather than from different infection rates. However. we did not on these grounds prejudge the issue of infection as a factor in the aetiology even if it seemed unlikely that it would alone explain the reg.'onal variations, and we decided to investigate simultaneously feeding and drug administration in children with and the frequency of recent symptoms suggesting infection in the affected children or in members of their households, and to search for viruses. The present study is concerned mainly with the clinical and epidemiological data. This emphasis is deliberate because we feel that the virus studies demand a different form of presentation, and these will be published later when completed. However, the possible relationships between the two kinds of evidence are considered at the end of this paper.