Intussusception is the invagination of one segment of intestine into an adjacent distal segment. The process can produce venous and lymphatic congestion, bowel-wall edema, progressive obstruction, arterial compromise, and, if untreated, bowel necrosis and perforation. It is one of the important causes of acute abdominal emergency in infants and young children. The disease is particularly common during infancy and early childhood, with a peak incidence reported in the first two years of life. Most pediatric cases are idiopathic, although lymphoid hyperplasia and pathological lead points such as Meckel diverticulum, duplication cysts, polyps, and tumors may be identified in a minority of patients.¹–³ Clinical presentation is variable. Intermittent abdominal pain, episodic crying or irritability in infants, vomiting, lethargy, abdominal mass, and rectal bleeding may occur, but the complete classical triad is present in only a minority of children. This variability can delay diagnosis.⁴–⁶ Ultrasonography is widely used as the first-line imaging modality because it can demonstrate characteristic concentric-ring or target appearances and can also provide information about bowel-wall perfusion, free fluid, and the response to reduction. Systematic reviews have reported high diagnostic accuracy for ultrasonography in children with suspected intussusception.⁷,⁸ For clinically stable children without evidence of perforation, peritonitis, or shock, image-guided enema reduction is the standard non-operative treatment. Pneumatic reduction has demonstrated high success rates and is at least as safe as liquid contrast reduction in large comparative analyses.⁹ Delayed repeat enema may successfully reduce a proportion of initially incompletely reduced intussusceptions and can decrease the need for operative intervention in selected stable patients.¹⁰,¹¹ Surgery is indicated when non-operative reduction is contraindicated or unsuccessful, or when there is perforation, peritonitis, bowel necrosis, or another condition requiring operative management.⁵,¹² The present study was undertaken to describe the demographic profile, clinical presentation, anatomical distribution, management pathways, recurrence, and complications of pediatric intussusception treated at a tertiary-care pediatric surgery centre in Jaipur. The source document contains a cohort of 100 children and provides detailed descriptive data on age, sex, presentation time, associated factors, symptoms, intussusception type, treatment, and outcomes.

2.1 Study design and setting This was a prospective observational cohort study conducted in the Department of Pediatric Surgery, at SMS medical college Jaipur Rajasthan, india. The source document describes the study as including 100 children and gives the study period as January 2023 to June 2024 in the abstract. A separate section of the source document states January 2023 to June 2023; this discrepancy should be verified against the institutional study protocol and ethics records before journal submission. 2.2 Participants Children aged 0–10 years with a diagnosis of acute intussusception were eligible. The stated exclusion criteria were: (1) concomitant acute surgical abdominal conditions, (2) previous abdominal surgery, and (3) missing data. 2.3 Diagnosis and data collection All children were diagnosed using abdominal ultrasonography. The source document records the target-ring/concentric-circle appearance on transverse imaging and the sleeve sign on longitudinal imaging. Demographic and clinical variables included sex, age, month of onset, time from symptom onset to hospital presentation, possible associated factors, symptoms, intussusception depth, anatomical type, treatment, recurrence, and postoperative complications. 2.4 Statistical analysis The source document states that SPSS version 19.0 (IBM, Armonk, NY, USA) was used. Continuous variables were intended to be expressed as mean ± standard deviation and categorical variables as number and percentage. The original manuscript mentions Student's t-test and chi-square testing, but no comparative hypothesis requiring these tests is clearly reported in the presented results. Therefore, the revised manuscript presents the available data primarily as descriptive statistics. Before submission, the authors should provide the original analysis dataset if inferential statistics are to be retained.

A total of 100 children with acute intussusception were included in the study. The demographic and presentation characteristics are summarized below. Variable N % Male 75 75 Female 25 25 Age 1–6 months 4 4 Age 6–12 months 15 15 Age 12–24 months 30 30 Age 24–36 months 20 20 Age 36–48 months 15 15 Age >48 months 16 16 Presentation within 12 h 30 30 Presentation 12–24 h 50 50 Presentation 24–48 h 15 15 Presentation >48 h 5 5 The study population was predominantly male (75%). The largest age group was 12–24 months (30%), followed by 24–36 months (20%). Fifty percent of children reached hospital 12–24 hours after symptom onset, while 30% presented within 12 hours. Month of presentation N % January 10 10 February 13 13 March 20 20 April 25 25 May 20 20 June 12 12 Presentation occurred throughout the reported months, with the highest monthly proportion in April (25%). The study data therefore suggest a peak in April within the observed period, but the cohort is not sufficient to establish a seasonal pattern. Associated factor / history N % Diarrhea 10 10 Recent vaccination 15 15 Recent infection 10 10 History of cold/cough 5 5 No identified factor 65 65 Clinical feature N % Abdominal pain / paroxysmal crying 86 86 Vomiting 50 50 Upper respiratory tract symptoms 10 10 Classical triad 10 10 Abdominal pain or paroxysmal crying was the most frequently documented clinical feature (86%), followed by vomiting (50%). The classical triad of abdominal pain, bloody stool, and palpable abdominal mass was reported in 10% of children. Type of intussusception N % Jejuno-ileal 1 1 Ileo-ileal 10 10 Ileo-colic 80 80 Colo-colic 9 9 Ileo-colic intussusception was the predominant anatomical type, accounting for 80% of the cohort. The reported mean intussusception depth was 4.0 ± 1.2 cm, with a range of 1.0–9.0 cm and a median of 3.9 cm. Reported treatment category N % Conservative management 70 70 Enema reduction 15 15 Manual reduction 10 10 Surgical repair 5 5 The source narrative states that 15% underwent enema reduction; children not reduced by the initial enema underwent repeat air enema, and five cases were described as failures that were subsequently successfully reduced surgically. Because the treatment table and narrative appear to describe treatment stages differently, these figures should be verified against the original case records before submission. The revised manuscript does not reinterpret these data beyond what is explicitly reported. Outcome / complication N % Recurrence within one year 2 2 Wound infection among surgical cases 2 Not calculable from supplied denominator Paralytic ileus among surgical cases 1 Not calculable from supplied denominator Reported reoperation 1 1 Two children experienced recurrence within one year. Among surgically treated children, two developed wound infection and one developed paralytic ileus; the latter was managed conservatively. The source table also records one reoperation.

The present cohort demonstrates the typical demographic and clinical pattern of pediatric intussusception, with a predominance of boys and a concentration of cases in early childhood. In the present study, 75% of affected children were male and 30% were aged 12–24 months. The predominance of ileo-colic intussusception (80%) is also consistent with the usual anatomical pattern described in pediatric series.¹–⁵ Clinical recognition remains important because the classical triad is uncommon. In this cohort, abdominal pain or paroxysmal crying was reported in 86%, whereas only 10% had the complete triad of pain, bloody stool, and abdominal mass. This finding supports the need to maintain clinical suspicion even when rectal bleeding or a palpable mass is absent. Published studies have similarly emphasized age-related and variable presentations of intussusception.⁵,⁶ Most children in the present cohort had no documented associated etiological factor (65%). Diarrhea, recent vaccination, recent infection, and cold/cough were recorded in smaller proportions. These observations should be interpreted as clinical associations rather than proof of causation. In particular, a history of vaccination in 15% of children does not establish that vaccination caused intussusception; a controlled comparison group and temporal information would be required to assess such an association. Most pediatric intussusception remains idiopathic, while pathological lead points are identified in a minority of cases.¹–³ Ultrasonography was the diagnostic modality used in all children in this study. The target-ring/concentric-circle and sleeve appearances recorded in the source manuscript are characteristic sonographic findings. Contemporary evidence supports ultrasound as a highly accurate first-line diagnostic test for pediatric intussusception. A systematic review and meta-analysis reported pooled sensitivity and specificity of approximately 94% and 96%, respectively, while a later meta-analysis reported similarly high diagnostic performance.⁷,⁸ Non-operative reduction is the preferred treatment for stable children without contraindications. Evidence synthesized in a large meta-analysis found higher pooled reduction success with pneumatic enema than with liquid enema, without a significant difference in perforation rate.⁹ Delayed repeat enema is also supported in selected children with incomplete initial reduction who remain clinically stable.¹⁰,¹¹ These findings are relevant to the present study because the source document describes repeat air-enema attempts before proceeding to surgery in children with unsuccessful initial reduction. The reported treatment results require careful interpretation because the supplied manuscript contains an internal difference between the treatment table and the narrative description. The table lists conservative treatment (70%), enema reduction (15%), manual reduction (10%), and surgical repair (5%), while the narrative states that five of the 15 enema-treated children failed reduction and subsequently underwent surgical reduction. Consequently, the treatment categories may not represent mutually exclusive final treatment groups. This issue should be resolved from the original case records before calculating a definitive enema success rate or presenting a treatment flow diagram. Recurrence occurred in two children (2%) during one year of follow-up. Published literature generally reports a higher recurrence frequency after successful non-operative reduction, with recurrence estimates varying according to follow-up duration, technique, and patient characteristics. Meta-analytic data have reported recurrence after air enema in the mid-single-digit range, while other reviews describe broader ranges.¹²,¹³ The lower observed recurrence in the present cohort may reflect the sample size, follow-up completeness, or the treatment mix and should not be generalized without larger prospective data. Postoperative morbidity was limited in the reported cohort, with two wound infections and one episode of paralytic ileus. However, because the exact number of children undergoing operative intervention is unclear from the supplied treatment data, complication rates among surgical patients cannot be reliably calculated. Future studies should report operative indications, operative technique, bowel viability, need for resection, lead-point findings, length of stay, and complications using clearly defined denominators. 5. Strengths and Limitations Strengths of the study include prospective collection of clinical information, a defined cohort of 100 children, ultrasound-based diagnosis, and reporting of anatomical type, treatment, recurrence, and postoperative complications. The main limitations are the single-centre design, relatively small sample size, absence of a comparator group, limited information on pathological lead points and operative findings, and inconsistencies in the reported study period and treatment categorization. The study also does not provide confidence intervals or complete inferential statistical analyses, limiting the ability to draw associations beyond descriptive observations.

In this tertiary-care cohort, pediatric intussusception predominantly affected boys and children in the first few years of life, with ileo-colic intussusception representing the majority of cases. Abdominal pain or paroxysmal crying was the most common clinical manifestation, whereas the classical triad was uncommon. Ultrasonography provided the basis for diagnosis, and non-operative enema reduction was used in a subset of children, with surgery required when reduction failed or operative management was indicated. Two recurrences and three postoperative complications were reported. Larger, multicentre prospective studies with standardized treatment pathways and clearly defined outcome denominators are needed to better characterize treatment success and recurrence.

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