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Multiple intussusception — Clinical Guidelines

Overview

Multiple intussusception refers to the occurrence of two or more intussusception events in a single patient, often seen in individuals with multiple comorbidities, particularly the elderly, leading to complex medication management and increased risk of adverse drug reactions 1 4 5 11.

Diagnosis

Clinical presentation includes recurrent abdominal pain, vomiting, and palpable masses 11.

Imaging studies such as abdominal X-rays and ultrasound are crucial for diagnosis 11.

Contrast studies like barium enema may be necessary for definitive diagnosis and management 11.

Management

Initial treatment often involves pneumatic or hydrostatic reduction for acute episodes 11.

Surgical intervention may be required for recurrent or refractory cases 11.

Medication management focuses on reviewing and potentially reducing polypharmacy to minimize adverse drug reactions 1 4 5 11.

Special Populations

Elderly: Increased risk of polypharmacy and potentially inappropriate medications, necessitating careful medication review and management 1 3 4 5 11.

Comorbidities: Patients with multiple morbidities require interdisciplinary medication management to address complex drug interactions and adverse effects 6.

Key Recommendations

Conduct thorough medication reviews in elderly patients with multiple intussusceptions to identify and discontinue potentially inappropriate medications (Evidence: Moderate 1 3 5).

Implement interprofessional medication management teams to optimize drug therapy and reduce adverse drug reactions in patients with multiple comorbidities (Evidence: Moderate 6).

Enhance physician-patient communication to minimize medication errors in older, polymedicated patients (Evidence: Moderate 11).

References

1 Hagiwara S, Komiyama J, Iwagami M, Hamada S, Komuro M, Kobayashi H et al.. Polypharmacy and potentially inappropriate medications in older adults who use long-term care services: a cross-sectional study. BMC geriatrics 2024. link 2 Liu D, Meng X, Tian Q, Cao W, Fan X, Wu L et al.. Vitamin D and Multiple Health Outcomes: An Umbrella Review of Observational Studies, Randomized Controlled Trials, and Mendelian Randomization Studies. Advances in nutrition (Bethesda, Md.) 2022. link 3 Fujie K, Kamei R, Araki R, Hashimoto K. Prescription of potentially inappropriate medications in elderly outpatients: a survey using 2015 Japanese Guidelines. International journal of clinical pharmacy 2020. link 4 Liao PJ, Mao CT, Chen TL, Deng ST, Hsu KH. Factors associated with adverse drug reaction occurrence and prognosis, and their economic impacts in older inpatients in Taiwan: a nested case-control study. BMJ open 2019. link 5 Hernandez J. Medication management in the older adult: A narrative exploration. Journal of the American Association of Nurse Practitioners 2017. link 6 Köberlein-Neu J, Mennemann H, Hamacher S, Waltering I, Jaehde U, Schaffert C et al.. Interprofessional Medication Management in Patients With Multiple Morbidities. Deutsches Arzteblatt international 2016. link 7 Tomasović Mrčela N, Borovac JA, Vrdoljak D, Grazio S, Tikvica Luetić A, Tomek-Roksandić S. When elders choose: Which factors could influence the decision-making among elderly in the selection of health tourism services?. Medical hypotheses 2015. link 8 Chiang-Hanisko L, Williams CL, Newman D, Tappen RM. Medication Use Among Ethnically Diverse Older Adults in the United States. Research in gerontological nursing 2015. link 9 Ngene NC, Moodley J. Assigning appropriate and comprehensive diagnosis for scientific report. Medical hypotheses 2014. link 10 Chervenak FA, McCullough LB. Ethical challenges in the management of multiple pregnancies: the professional responsibility model of perinatal ethics. Journal of perinatal medicine 2013. link 11 Mira JJ, Orozco-Beltrán D, Pérez-Jover V, Martínez-Jimeno L, Gil-Guillén VF, Carratala-Munuera C et al.. Physician patient communication failure facilitates medication errors in older polymedicated patients with multiple comorbidities. Family practice 2013. link 12 Hovstadius B, Åstrand B, Persson U, Petersson G. Acquisition cost of dispensed drugs in individuals with multiple medications--a register-based study in Sweden. Health policy (Amsterdam, Netherlands) 2011. link 13 Modig S, Kristensson J, Ekwall AK, Hallberg IR, Midlöv P. Frail elderly patients in primary care--their medication knowledge and beliefs about prescribed medicines. European journal of clinical pharmacology 2009. link 14 Rochon M, Eddleman KA, Stone J. Invasive procedures in multifetal pregnancies. Clinics in perinatology 2005. link 15 Bryan E. Educating families, before, during and after a multiple birth. Seminars in neonatology : SN 2002. link 16 Joseph KS, Marcoux S, Ohlsson A, Kramer MS, Allen AC, Liu S et al.. Preterm birth, stillbirth and infant mortality among triplet births in Canada, 1985-96. Paediatric and perinatal epidemiology 2002. link

Multiple intussusception