Clinical, imaging and surgical outcomes of secondary intussusceptions in children: a retrospective analysis based on the benign and malignant pathologic lead points.

Background: Timely identification of intussusception secondary to pathological lead points (PLPs) is challenging for surgeons. This study aimed to comprehensively evaluate the differences between benign and malignant PLPs in a clinical context. Methods: We reviewed 75 patients with secondary intussusception confirmed by surgical pathology between January 2012 and December 2023. Based on their PLPs, patients were categorized into benign and malignant groups, and we compared clinical features, imaging studies, and intraoperative characteristics between the two groups. Results: Of the 75 patients, 62 had benign PLPs (most commonly Meckel's diverticulum, 50%) and 13 had malignant PLPs (predominantly lymphoma, 92.3%). Malignant PLPs were associated with a longer duration of illness, higher intussusception frequency, and closer proximity to the ileocecal region (P<0.05). Small bowel-large bowel intussusception was the most common type in both the benign (51.7%) and malignant (61.5%) group, with the most frequent subtype being ileo-ileal (36.7%) in the benign group and ileo-colic (50%) in the malignant group, respectively. Conclusions: In secondary intussusception, malignant PLPs have a longer duration of illness, occur more frequently, and are closer to the ileocecal region. Ultrasound and computed tomography (CT) may complement each other in identifying some PLPs, which is crucial for timely and accurate diagnosis and treatment.