Clinical characteristics and predictors for the presence of pediatric intussusception secondary to pathological lead points

Clinical characteristics and predictors for the presence of pediatric intussusception secondary to pathological lead points | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical characteristics and predictors for the presence of pediatric intussusception secondary to pathological lead points Yuan-Yang Yu, Fang-Bin Shao, Yi-Xuan Wei, Ya-Ting Xu, Mu-Kun Guan, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7546950/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: Analyze the clinical characteristics and identify independent predictors of intussusception secondary to pathological lead points (PLPs). Methods: Children admitted with intussusception between 2010 and 2025 were retrospectively enrolled after surgery and divided into two groups: the PLPs group and the non-PLPs group and tested for differences in demography, symptomatology, auxiliary examinations, surgical results and pathological results. Results: A total of 575 cases of intussusception were included in the final analysis of which 183 had PLPs and 392 were idiopathic. The types of PLPs included lymphadenitis/lymphoid hyperplasia, Meckel's diverticulum, intestinal duplication malformations, polyps, tumors, appendicitis, ectopic gastric mucosa, ectopic pancreas, enterocyst, allergic purpura, parasite, ileocecal ulceration. Multivariable analysis revealed that older age (OR=1.020; 95%CI, 1.008-1.032; p<0.001), hematochezia (OR=0.540; 95% CI, 0.315-0.927; p=0.026), abdominal pain (OR=2.122; 95%CI, 1.092-4.123; p=0.028), recurrence (OR=4.430; 95% CI, 2.265-8.664; p<0.001), intestinal necrosis (OR=4.441; 95%CI, 2.730-7.224; p<0.001), and exp(PCT) (OR=16.077; 95%CI, 3.749-69.942; p<0.001) were independent predictors of PLPs. Conclusions: Lymphadenitis/lymphoid hyperplasia is the most common PLP of intussusception. Older age, hematochezia, abdominal pain, recurrence intussusception, intestinal necrosis and thrombocytocrit are independent predictors of PLPs. Pediatric Intussusception Pathological lead points Predictors Figures Figure 1 1 Introduction Intussusception is one of the most prevalent causes of acute abdominal diseases and the leading cause of acute bowel obstruction in children with peak incidence between 3–12 months of age [ 1 ]. The gross majority of cases are idiopathic, while the minority are secondary to pathological lead points (PLPs). Previous studies have shown that the incidence of PLPs was approximately 2.2–15% [ 2 , 3 ]. For children suspected of having PLPs, a conservative reduction often fails. Even if the intussusception is reduced in subsequent conservative treatments, the children may still be prone to complications such as recurrence due to the underlying PLPs. Therefore, it’s necessary to identify PLPs in time and make effective interventions or regular follow-ups. However, the clinical presentations of PLPs closely resemble those of primary intussusception [ 3 ], and the diagnostic yield of abdominal ultrasound is relatively limited with only 61.4% of positive cases definitively indicating the presence of a predisposing factor [ 4 ]. Sometimes, the PLPs are only discovered during the intraoperative reduction [ 5 ]. Hence, the diagnosis of PLPs is challenging. While previous studies have analyzed the clinical characteristics of secondary intussusception (SI), most were limited by small sample sizes and a primary focus on symptomatology. The study aims to analyze the clinical manifestations, auxiliary examinations and surgical outcomes between secondary and idiopathic intussusception, as well as to improve the diagnosis and treatment of PLPs. To provide a more comprehensive assessment, we expanded the dataset, incorporated additional variables, and evaluated predictors for SI to enhance diagnostic and therapeutic decision-making. 2 Methods 2.1 Patients Pediatric patients highly suspected of having intussusception in outpatient clinic, as confirmed by ultrasonography and clinical manifestations received a follow-up air or saline enema to verify it after obtaining informed consent. Patients were hospitalized if two enema reduction attempts failed, if there was suspicion of intestinal necrosis or presence of PLPs, or with hemodynamic instability despite adequate resuscitation. Hospitalized children diagnosed with intussusception between 1 January 2010 and 31 May 2025 were retrospectively examined after surgery. Exclusion criteria were as follows: (1) cases with incomplete medical records; (2) comorbid conditions affecting coagulation such as warfarin or heparin use, liver disease, nephrotic syndrome, and/or other coagulopathies. Emergency surgical reduction was performed after obtaining informed consent in children with failed enema reduction. Exploratory laparotomy and laparoscopy were primary surgical approaches. Following successful nonoperative reduction, a subset of the patients chose endoscopy in suspicion of having PLPs. The preliminary diagnosis of PLPs was made by the surgeon on the basis of intraoperative gross examinations, while definitive confirmation relied on histopathological evaluation. According to the pathological assessments, the enrolled patients were categorized into two groups: the PLPs group (confirmed PLPs) and the non-PLPs group (idiopathic intussusception). The study was approved by the Ethics Committees of The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University. The informed consent was waived due to the nature of retrospective study and anonymous patients. 2.2 Variables The medical records of enrolled patients were collected including demography (age, gender, duration of symptoms) ,clinical characteristics (hematochezia, fever, abdominal pain, diarrhea, vomitus, intermittent crying, recurrence, intestinal necrosis, classification of intussusception, etc.), laboratory parameters [C-reaction protein (CRP), white blood cells (WBCs), red blood cells (RBCs), hemoglobin (HB), hematocrit (HCT), mean corpuscular volume (MCV), red cell distribution width-CV (RDW-CV), platelets (PLTs), mean platelet volume (MPV), platelet distribution width (PDW), thrombocytocrit (PCT), neutrophil counts, lymphocyte counts, basophil counts, monocyte counts, eosinophil counts, D-dimer, prothrombin time (PT), prothrombin time-INR (PT-INR), activated partial thromboplastin time (APTT), plasma fibrinogen, thrombin time (TT)], ultrasonographic features (ascites, intestinal dilation, enlarged lymph nodes), pneumatic or hydrostatic reduction records, pathological findings, and surgical records (surgical findings and surgical approaches). Duration of symptoms was defined as the time from beginning of symptoms to the time of hospitalization. Fever was defined as a tympanic temperature above 37.5℃ at presentation. Recurrence was defined as the reappearance of typical clinical symptoms following successful reduction, with ultrasonographic confirmation of intussusception. The total number of intussusception episodes and interval between the last occurrence and the current admission were recorded. Final diagnosis of intestinal necrosis was confirmed by postoperative histopathological examination. 2.3 Statistical analysis The data in this study was analyzed by SPSS version 22.0 (IBM, Armonk, New York). There was no missing data in the final analysis. Univariate and multivariate analysis was conducted by SPSS to estimate the correlation between all the predictors and the main binary classification results. Discrete variables were expressed as counts (ratio) and continuous variables as means ± standard deviation (SD) or median with interquartile range (25th-75th percentiles) (IQR) depending on normality. The normal distribution of continuous variables was compared by Student’s t-test, non-normal distribution variables as Mann–Whitney U test and the qualitative data as Pearson’s Chi-square or Fisher’s exact tests. Then based on clinic and univariable analysis, the meaningful variables (p < 0.15) were selected into multivariable logistical regression predicting model with calculated odds ratios (ORs) and 95% confidence interval (95%CI) via forward stepwise regression based on maximum likelihood estimation. A p-value < 0.05 was considered statistically significant. 3 Results From January 2010 to May 2025, a total of 8,659 children were performed non-operative reduction after being diagnosed in the outpatient department. Among these, 7,769 (89.7%) pediatric patients successfully managed non-surgical treatment and were discharged after observation while the remaining 890 pediatric patients required admission to the Department of Pediatric Surgery. According to consistent inclusion and exclusion criteria, we excluded 126 cases with incomplete medical records and 189 cases managed solely through hospitalization without surgical intervention, leaving 575 cases being enrolled in the final retrospective analysis. Postoperative histopathological examination confirmed PLPs in 183 cases (31.82%), comprising the PLPs group, while the remaining 392 cases (68.17%) were assigned to the non-PLPs group. 3.1 Distribution of the types of PLPs in pediatric intussusception For children who failed non-surgical reduction or had contraindications for conservative treatment, surgery was performed. During the surgery, lymph nodes observed significantly enlarged were removed for pathological examination. Ultimately, 62 cases (33.88%) showed reactive intestinal/mesenteric lymph nodes hyperplasia according to the pathological results as 13 cases indicated lymphoma. Other types of PLPs were as shown in Table 1 . The average age of the patients suffered from intestinal tumors was higher than other PLPs. Among the 19 intestinal tumors, all except one which involved both the ileum and colon were located solely in the ileum. Among Meckel's diverticulum, histopathological analysis revealed the following associated abnormalities: ectopic pancreas (n = 6), ectopic gastric mucosa (n = 6), combined gastric and pancreatic heterotopia (n = 6), lymphoid hyperplasia (n = 2), and appendicitis (n = 1). Among cases of intestinal duplication, 11 exhibited isolated duplication, while the remaining cases demonstrated concurrent pathological findings: ectopic gastric mucosa (n = 6), ectopic pancreas (n = 3), coexisting ectopic pancreas and gastric mucosa (n = 1), and lymphoid hyperplasia (n = 1). Table 1 Distribution of the types of PLPs in pediatric intussusception Variables PLPs n = 183 Age (month) Polyps 23 (12.57) 61.78 (11.40-153.40) Meckel’s diverticulum 38 (20.77) 42.25 (2.43–166.80) Lymphoid hyperplasia 62 (33.88) 19.99 (1.77–90.27) Duplication 22 (12.02) 40.08 (2.23–128.30) Tumors 19 (10.38) 76.81 (0.07–174.70) Lymphoma 13 (7.10) 91.99 (36.67–175.70) Burkitt lymphoma 9 (4.92) 42.79 (36.67-174.67) Diffuse large B-cell lymphoma 2 (1.09) 93.04 (85.07–101.00) MALT 1 (0.55) 67.30 Follicular lymphoma 1 (0.55) 123.93 hamartomas 3 (1.64) 79.60 (5.30-124.17) myofibroblastoma 1 (0.55) 0.07 Wilms tumor 1 (0.55) 11.40 IMT 1 (0.55) 13.30 Appendicitis 18 (9.84) 16.07 (2.87–109.80) Enterocyst 3 (1.64) 4.52 (1.80–7.23) Henoch-Schönlein purpura 1 (0.55) 44.87 Parasite 1 (0.55) 70.50 Heterotopic gastric mucosa 22 (12.02) 48.94 (2.43–166.80) Ectopic pancreas 17 (9.29) 64.09 (2.43–166.80) Ileocecal ulceration 1 (0.55) 87.77 Values are presented as counts (%). Age (month) were described as mean (min-max);MALT, mucosa-associated lymphoid tissue lymphoma; IMT, inflammatory myofibroblastic tumor; PLPs, Pathological lead points. 3.2 Demographic and clinical features of non-PLPs group and PLPs group Table 2 summarized the demographic and clinical features of the two groups. There exited no difference between two groups in duration of symptoms and male-to-female ratio. The median age of the PLPs group was 20.83 months which was statistically significant older than the non-PLPs group (median age: 7.35month). Vomitus was the most prevalent presenting symptom (n = 504, 87.65%), followed by hematochezia (n = 402, 69.91%), intermittent crying (n = 366, 63.65%) in all the 575 enrolled cases. The incidence of hematochezia, fever, vomitus and intermittent crying were significantly higher in the non-PLPs group compared to the PLPs group (312 versus 90, 180 versus 55, 364 versus 140, 292 versus 74, respectively; all p < 0.001). Conversely, symptoms including abdominal pain, recurrence and intestinal necrosis were more frequently in the PLPs group than in the non-PLPs group (48 versus 92, 21 versus 67, 73 versus 64, respectively; all p < 0.001). Surgical evaluation identified six types of intussusceptions according to anatomic localization: ileocolic (n = 255, 44.35%), ileocecal (n = 120, 20.86%), compound/complex (n = 97, 16.87%), small intestinal (n = 89, 15.48%), colic-colic (n = 5, 0.87%), multiple (n = 3, 0.52%). Table 2 Demographic and clinical features of non-PLPs group and PLPs group Variables Non-PLPs N = 392 PLPs n = 183 P-value Demographics Age (month), median (IQR) 7.35 (5.10-10.13) 20.83 (7.17–61.63) < 0.001 < 12 months, n (%) 318 (81.12) 71 (38.80) =12months, n (%) 74 (18.88) 112 (61.20) Gender (male/female), (ratio) 266/126 (2.1:1) 117/66 (1.7:1) 0.353 Duration of symptoms (h), median (IQR) 20 (12–36) 20 (12–40) 0.736 History, n (%) Hematochezia 312 (79.59) 90 (49.18) < 0.001 Fever 180 (45.92) 55 (30.05) < 0.001 Abdominal pain 48 (12.24) 92 (50.27) < 0.001 Diarrhea 57 (14.54) 25 (13.66) 0.779 Vomitus 364 (92.86) 140 (76.50) < 0.001 Intermittent crying 292 (74.5) 74 (40.4) < 0.001 triad of intussusception 21 (5.36) 17 (9.29) 0.077 Recurrence 21 (5.36) 67 (36.61) < 0.001 Intestinal necrosis 73 (18.62) 64 (34.97) < 0.001 Classification of intussusception, n (%) < 0.001 Ileo-colic 184 (46.94) 71 (38.80) Ileo-cecal 82 (20.92) 38 (20.77) Compound/complex 78 (19.90) 19 (10.38) Multiple 1 (0.26) 2 (1.09) Small intestinal 41 (10.46) 48 (26.23) Colic-colic 2 (0.51) 3 (1.64) PLPs, Pathological lead points. IQR, interquartile range (25th-75th percentiles). Additionally, in 88 cases of recurrence, 45 cases had one recurrence, 21 cases had two recurrences, 9 cases had three recurrences, and 13 cases had more than three recurrences. 40 cases had a recurrence within 24 hours, 11 cases within 72 hours, and 37 cases after 72 hours (Table 3 ). Obvious difference of recurrence was seen between two groups. Table 3 Recurrence episodes and interval of non-PLPs group and PLPs group Recurrence Non-PLPs n = 392 PLPs n = 183 Episodes 1 15 30 2 2 19 3 2 7 > 3 2 11 Time interval 72h 14 23 Values are presented as counts (%). PLPs, Pathological lead points. 3.3 Hematological and sonographic investigation of non-PLPs group and PLPs group Comparison results of laboratory parameters between the two groups were listed in Table 4 . There were several variables that showed significant differences, such as CRP, HB, HCT, MCV, MPV, PCT, basophil counts, eosinophil counts, TT. Platelet indices were main variables. Ascites and enlarged lymph nodes existed difference between groups, and SI seems prone to generate ascites and stimulate lymph node enlargement. Table 4 Hematological and sonographic investigation of non-PLPs group and PLPs group Variables Non-PLPs n = 392 PLPs n = 183 P-value CRP 9.00 (5.00-18.23) 6.00 (2.00-15.01) < 0.001 WBCs 11.85 (9.30–15.20) 11.72 (8.8-15.26) 0.673 RBCs 4.41 (4.05–4.73) 4.47 (4.14–4.80) 0.067 HB 114.00 (106.25–122.00) 120.00 (108.00-128.00) < 0.001 HCT 0.34 (0.33–0.37) 0.36 (0.33–0.38) < 0.001 MCV 78.95 (75.60–81.60) 80.10 (76.60–83.00) 0.002 RDW-CV 13.00 (12.30-13.88) 13.00 (12.30–13.90) 0.531 PLTs 376.00 (309.00-460.50) 394.00 (295.00-479.00) 0.289 MPV 7.80 (7.30–8.60) 8.30 (7.60-9.00) < 0.001 PDW 15.60 (15.02–15.90) 15.50 (15.10–15.80) 0.311 PCT 0.30 (0.24–0.37) 0.32 (0.26–0.39) 0.006 Exp (PCT) 1.23 ± 0.30 1.14 ± 0.33 < 0.001 Neutrophil counts 8.18 (5.56–10.92) 7.80 (5.27–11.40) 0.892 Lymphocyte counts 2.79 (1.90–3.78) 2.59 (1.77–3.69) 0.163 Monocyte counts 0.67 (0.39–1.09) 0.62 (0.38–1.13) 0.581 Basophil counts 0.03 (0.01–0.05) 0.02 (0.01–0.04) 0.004 Eosinophil counts 0.03 (0.01–0.06) 0.04 (0.01–0.12) 0.018 D-dimer 1.22 (0.61–2.47) 1.03 (0.41–2.31) 0.067 PT 13.70 (13.20–14.30) 13.80 (13.10–14.30) 0.464 PT-INR 1.05 (1.00-1.12) 1.07 (1.00-1.13) 0.061 APTT 38.50 (34.93–42.20) 37.80 (34.60–40.90) 0.077 TT 15.30 (14.50–16.00) 15.50 (14.80–16.30) 0.005 Fibrinogen 3.18 (2.65–3.73) 3.20 (2.72–3.75) 0.863 Ultrasound, n (%) ascites 161 (41.07) 92 (50.27) 0.038 Intestinal dilation 79 (20.15) 42 (22.95) 0.443 Enlarged lymph nodes 26 (6.63) 32 (17.49) < 0.001 Continuous variables were expressed as means ± standard deviation (SD) or median with interquartile range (25th-75th percentiles) depending on normality. Exp (PCT) was described as mean ± SD. CRP, C-reaction protein; WBCs, white blood cells; RBCs, red blood cells; HB, hemoglobin; HCT, hematocrit; MCV, mean corpuscular volume; RDW-CV, red cell distribution width-CV; PLTs, platelets; MPV, mean platelet volume; PDW, platelet distribution width; PCT, thrombocytocrit; PT, prothrombin time; PT-INR, prothrombin time-INR; APTT, activated partial thromboplastin time; TT, thrombin time. 3.4 Univariate and multivariate analysis on the predictors of non-PLPs group and PLPs group Univariate analysis was conducted and 17 variables were the significant factors as shown in Table 5 . Based on clinical and statistical evaluation, we included the 17 variables into multivariable analysis and six variables including age, hematochezia, abdominal pain, recurrence, intestinal necrosis, and PCT were independent predictors (Fig. 1 ) . Table 5 Univariate on the demographics and clinical characteristics of the predictors of non-PLPs group and PLPs group Variables Univariate analysis OR [95% CI] P-value Age (month) 1.040 [1.030–1.050] < 0.001 Hematochezia 0.248 [0.170–0.363] < 0.001 Abdominal pain 7.245 [4.768–11.011] < 0.001 Intermittent crying 0.232 [0.160–0.337] < 0.001 Vomitus 0.250 [0.150–0.419] < 0.001 Recurrence 9.966 [5.847–16.986] < 0.001 Intestinal necrosis 2.350 [1.581–3.493] < 0.001 Fever 0.506 [0.348–0.735] < 0.001 Ascites 1.451 [1.019–2.064] 0.039 Enlarged lymph nodes 2.983 [1.719–5.176] < 0.001 CRP 0.993 [0.985–1.002] 0.135 HB 1.024 [1.010–1.038] 0.001 HCT 11481.139 [102.31-12888402.900] < 0.001 PLT 1.002 [1.001–1.003] 0.150 MCV 1.042 [1.008–1.077] 0.014 MPV 1.436 [1.208–1.707] < 0.001 Exp (PCT) 2.767 [1.585–4.830] < 0.001 Eosinophil counts 18.186 [3.212-102.956] 0.001 Basophil counts 0.068 [0.002–3.053] 0.166 TT 1.001 [0.946–1.060] 0.972 PLPs, pathological lead points. CRP, C-reaction protein; HB, hemoglobin; HCT, hematocrit; PLTs, platelets; MCV, mean corpuscular volume; MPV, mean platelet volume; PCT, thrombocytocrit; TT, thrombin time. 4 Discussion Intussusception is one of the most clinically relevant cause of intestinal obstruction in infant and children. Approximately 90% of cases are idiopathic with favorable outcomes and no identifiable etiology [ 3 , 6 ]. However, a subset of intussusception cases (2.2–15%) are secondary to PLPs [ 1 ], with the incidence rising to 20–25% in older children [ 7 ] and increasing with age [ 8 ]. Unlike idiopathic cases, nearly all SI requires surgical intervention due to the high failure rate of enema reduction and the need to exclude malignant PLPs actively [ 1 , 9 ]. Among 575 pediatric patients with intussusception undergoing surgery in our study, the incidence of PLPs (31.82%) which was higher than that reported in previous studies, a difference likely attributable to the substantial number of cases involving lymph nodes hyperplasia. These observations, supported by previous studies [ 8 , 10 , 11 ], suggested that hyperplasia of intestinal lymphoid tissue constituted a significant etiological factor in intussusception. Mesenteric lymph nodes can not only induce intussusception but be trapped within the mesentery, leading to a lower non-operative reduction success rate (46.4% vs. 81.1%) and higher recurrence rate [ 12 , 13 ]. Although most instances involved reactive lymph nodes hyperplasia without metastasis signs, intestinal tumors still merit great attention [ 5 ]. Lymphoma was the most common intestinal tumor in our study and almost occurred in the ileum, which was consistent with the research reported by Wang et al. [ 4 ]. Apart from these, the most common gastrointestinal malformations in our study were Meckel's diverticulum and intestinal duplication which were asymptomatic in more than 90% people but common as PLPs in intussusception [ 8 ] and both may harbor ectopic pancreas and gastric mucosa. In our study cohort of 60 cases of Meckel’s diverticulum and duplication, 32cases were found with other types of PLPs concurrently present. These findings suggest that intussusception may arise from multiple synchronous PLPs, contributing to increased clinical complexity. The difficulty in identifying the leading point among multiple PLPs makes a combined management approach recommended [ 14 ]. The presence of concurrent anomalies can obscure typical symptomatology, potentially delaying diagnosis and leading to adverse clinical outcomes [ 8 , 14 – 16 ]. Intussusception recurrence is an intractable matter of concern for both family and surgeons. While most patients maintain durable remission after successful reduction [ 4 , 17 ], a distinct subset experiences recurrent episodes. Our institutional data indicated a significantly higher recurrence rate in the PLPs group compared to the non-PLPs group (36.61% versus 5.36%, p < 0.001) and recurrence was identified as a strong predictor, which were consistent with previous findings reported by Daneman et al. [ 18 ], whose 17-year longitudinal study established PLPs as strongly associated with recurrence, particularly in cases with multiple episodes (p < 0.01). Specifically, SI demonstrated both higher recurrence rates and greater temporal clustering of events, aligning with existing literature [ 9 , 18 , 19 ]. The clinical significance of this association was further quantified by Zhang et al. [ 20 ] in their analysis of 624 pediatric cases, identifying PLPs as an independent predictor of in-hospital recurrence (OR = 14.40, 95%CI: 4.34–47.80, p < 0.001). Notably, certain PLP subtypes (e.g., intestinal tumors) may manifest solely as recurrent intussusception during initial presentations [ 4 ]. These findings collectively underscore the imperative for comprehensive diagnostic evaluation following any recurrence to exclude PLPs and mitigate severe complications [ 21 ]. During the clinical assessment process, the clinical presentation of SI often mimics idiopathic cases making differentiation difficult. Abdominal pain, vomitus, and hematochezia are the classic triad symptoms of intussusception with the reported incidence of 33% [ 22 ] while it accounted for only 6.61% in our study. Vomiting is the most prevalent symptom and more common in non-PLPs group. Regarding the vomiting rates, it was possible that the patients in the non-PLPs group were mostly younger than 1 year with poorer ability to control the vomiting reflex [ 23 ]. The presence of bloody and mucoid stools, indicative of impaired intestinal circulation, typically manifested later in the course of intussusception. In our study, this finding emerged as a negative risk factor, potentially attributable to patient age and intussusception subtypes. Younger infants, whose intestinal barrier function remains underdeveloped, may exhibit heightened susceptibility to mucosal injury. Notably, the non-PLPs group demonstrated a higher proportion of complex/compound intussusception cases, which could contribute to more severe intestinal ischemia due to tighter invagination and compromised vascular supply [ 24 ]. Acer-Demir et al. [ 25 ] conducted age-stratified analyses of intussusception patients, categorizing them into subgroups (younger versus older than 1 year, and younger versus older than 2 year), and their findings revealed that patients under 1 year old exhibited a significantly higher incidence of hematochezia and longer intussusceptum segments compared to the older. As the intestinal mucosa suffers from prolonged damage and ischemia, intestinal necrosis can occur as a serious clinical consequence of intussusception requiring intestinal resection. However, hematochezia was not the independent risk factor for intestinal necrosis and was unreliable for predicting intestinal necrosis in children with intussusception according to our previous studies [ 26 , 27 ]. In our current study, we came to the conclusion that intestinal necrosis was an independent risk factor for PLPs. In pediatric intussusception with intestinal necrosis, it’s even more necessary to be vigilant about the presence of PLPs, and even more careful exploration should be conducted during the operation to avoid missed diagnosis and prevent more severe clinical consequences. Besides, abdominal pain appears to be age-related, while many older children complain only abdominal pain without other symptoms [ 23 , 28 , 29 ]. We found abdominal pain was an independent risk factor for predicting PLPs which was probably related with that most of the primary intussusception patients were too younger to verbally complain about their symptoms and abdominal pain may be underreported [ 23 ]. In Wang’s research [ 4 ] about 31 cases of pediatric intussusception secondary to small bowel tumors, only three presented the typical triad, while the majority presented with recurrent abdominal pain. As such, for the older children complained with abdominal pain, especially intermittent pain, intussusception can’t be excluded even if the child doesn’t have hematochezia or emesis [ 30 ]. Generally, age is an important factor of intussusception. In our study, age was an independent risk factor of PLPs. The median age of children in the PLPs group was significantly higher than that in the non-PLPs group (20.83 months, IQR 7.17–61.63 versus 8.63 months, IQR 5.68–21.70; p < 0.001). Age-stratified analysis further confirmed that children older than 12 months demonstrated a significantly higher prevalence of PLPs. These findings are consistent with previous reports [ 2 , 5 , 7 , 9 ] suggesting that intussusception in older pediatric patients warrants heightened clinical suspicion for underlying PLPs. Consequently, comprehensive diagnostic evaluation should be prioritized in this age group to identify potential PLPs. Although there were significant different in age and symptoms between the two groups, none of them can reliably distinguish PLPs in individual cases [ 31 ]. Further examinations are urgently needed. Our analysis revealed significant differences in multiple laboratory parameters upon univariate assessment. Notably, PCT emerged as an independent predictor for PLPs. MPV, PCT, and PLT represent key platelet indices, collectively suggesting the potential utility of platelet-derived biomarkers in predicting SI. Current investigations are systematically evaluating the clinical relevance of these hematological parameters. Platelet indices demonstrate significant clinical variability across multiple pathological conditions, including inflammatory bowel disease [ 32 ], cholecystitis [ 33 – 35 ], purpura [ 36 ], neoplastic disorders [ 37 , 38 ], appendicitis [ 39 , 40 ], etc. Emerging evidence supported their potential diagnostic utility in gastrointestinal diseases. Tang et al. [ 41 ] identified PCT as a promising biomarker for active Crohn's disease, particularly in patients with low CRP level. Furthermore, Chen et al. [ 42 ] established that a platelet-to-lymphocyte ratio (PLR) > 113.32 (OR = 0.210, p < 0.001) served as independent predictors for colorectal polyps’ histology. In our study, there existed difference between PLR and SI after univariate analysis (p 0.05). Li et al. [ 36 ] established a significant correlation between decreased MPV and severe gastrointestinal involvement in pediatric Henoch-Schönlein purpura cases (p < 0.05). Intriguingly, our data demonstrated an inverse MPV pattern, with significantly higher values observed in the PLPs group versus the non-PLPs group. This discrepancy may stem from fundamental differences in study populations. Existing literature had predominantly focused on single-disease cohort, whereas our study encompassed a heterogeneous spectrum of PLPs, including several rare etiologies. This methodological distinction underscores the necessity for large-scale, multicenter studies to validate platelet indices as biomarkers across diverse intussusception subtypes. Primarily, the retrospective design inherently limits data verification, as the accuracy of medical records could not be systematically validated. Additionally, the relatively small sample size, particularly for certain rare PLP subtypes, may affect the statistical power and external validity of our findings. These methodological constraints underscore the necessity for future prospective, multicenter studies with larger cohorts to enhance the generalizability of conclusions regarding PLP-associated intussusception. 5 Conclusion In conclusion, lymphadenitis/lymphoid hyperplasia is the most common PLPs in intussusception. Some children may have multiple PLPs which urgently in need of more attention. Older age, abdominal pain, bloody stool, intestinal necrosis, recurrence intussusception and PCT are independent predictors of PLPs. Declarations Conflict of interest: The authors declare that they have no conflict of interest. Ethical approval: The study had approval from the Ethics Committees of The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical. The study was conducted in accordance with the Declaration of Helsinki. Informed consent: As this was a retrospective study, all analyses were based on clinical data only. And all enrolled patients were anonymised. Therefore, the informed consent was waived. Funding: National Natural Science Foundation of China, Grant/Award Numbers: 81903235; Natural Science Foundation of Zhejiang Province, Grant/Award Numbers: LQ21H110001. Author Contribution Y.Y.: Supervision; writing original draft; writing review and editing. F. S.: Data curation; investigation; methodology. Y.W.: Formal analysis; project administration. Y. X.: writing original draft; writing-review and editing. M.G.: Investigation; methodology. Z.R.: Writing original draft and editing. H.H.: visualization; writing original draft; writing-review and editing. X.H.: Conceptualization; methodology; project administration; resources; supervision. Acknowledgement We would like to express our gratitude to Department of Pediatric Surgery colleagues for their help with data collection. Data Availability No datasets were generated or analyzed during the current study. References Fiegel H, Gfroerer S, Rolle U (2016) Systematic review shows that pathological lead points are important and frequent in intussusception and are not limited to infants. Acta Paediatr Suppl 105:1275–1279. https://doi.org/10.1111/apa.13567 Wong CWY, Jin S, Chen J, Tam PKH, Wong KKY (2016) Predictors for bowel resection and the presence of a pathological lead point for operated childhood intussusception: A multi-center study. 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Brit J Surg 79:867–876. https://doi.org/10.1002/bjs.1800790906 Rubinstein JC, Liu L, Caty MG, Christison-Lagay ER (2015) Pathologic leadpoint is uncommon in ileo-colic intussusception regardless of age. J Pediatr Surg 50:1665–1667. https://doi.org/10.1016/j.jpedsurg.2015.03.048 Milbrandt K, Sigalet D (2008) Intussusception associated with a Meckel's diverticulum and a duplication cyst. J Pediatr Surg 43:e21–23. https://doi.org/10.1016/j.jpedsurg.2008.09.005 Bussell HR, Kroiss S, Tharakan SJ, Meuli M, Moehrlen U (2019) Intussusception in children: lessons learned from intestinal lymphoma as a rare lead-point. Pediatr Surg Int 35:879–885. https://doi.org/10.1007/s00383-019-04488-z Yan QT, Xu LD, Chao J, Zhang ZM, Wang H (2022) Characteristics of intestinal-related lymphoid hyperplasia in children and its correlation with intussusception of children. BMC Pediatr 22:641. https://doi.org/10.1186/s12887-022-03675-7 Hasegawa T, Ueda S, Tazuke Y, Monta O, Sakurai T, Takahara N, Tanaka T, Habukawa C (1998) Colonoscopic diagnosis of lymphoid hyperplasia causing recurrent intussusception: Report of a case. Surg Today 28:301–304. https://doi.org/10.1007/s005950050126 Koumanidou C, Vakaki M, Pitsoulakis G, Kakavakis K, Mirilas P (2002) Sonographic detection of lymph nodes in the intussusception of infants and young children: clinical evaluation and hydrostatic reduction. AJR Am J Roentgenol 178:445–450. https://doi.org/10.2214/ajr.178.2.1780445 .I VR (2023) Sonographic Detection of Enlarged Mesenteric Lymph Nodes in Children and its Significance. Int J Innov Sci Res Technol 8: 942–956. https://doi.org/10.7863/jum.2007.26.5.581 Kang SI, Gu MJ (2020) Synchronous ileal inflammatory fibroid polyp and Meckel's diverticulum found during laparoscopic surgery for adult intussusception. Yeungnam Univ J Med 37:226–229. https://doi.org/10.12701/yujm.2019.00388 Hakimi T, Aslamzai M, Seyar F, Hakimi Z, Halimi SA, Jawed MA (2025) Coexistence of cecal duplication cyst and Meckel's diverticulum presenting as intussusception in a malnourished child a case report with literature review. BMC Pediatr 25:479. https://doi.org/10.1186/s12887-025-05823-1 Riccardo G, Valeria B, Giulia C, Alessia C, Luisa F, Elisabetta T, Alessandro M, Isabella M, Jürgen S (2014) Heterotopic pancreas in Meckel's diverticulum in a 7-year-old child with intussusception and recurrent gastrointestinal bleeding: case report and literature review focusing on diagnostic controversies. Afr J Paediatr Surg 11:354–358. https://doi.org/10.4103/0189-6725.143172 Lai WP, Yang YJ, Cheng CN, Chen JS (2007) Clinico-pathological features of intussusception in children beyond five years old. Acta Paediatr Tw 48:267–271. https://doi.org/10.7097/APT.200710.0 Daneman A, Alton DJ, Lobo E, Gravett J, Kim P, Ein SH (1998) Patterns of recurrence of intussusception in children: a 17-year review. Pediatr Radiol 28:913–919. https://doi.org/10.1007/s002470050497 Xu. T, Duan. XF, Jiang.Bin L, Wei.Jue X, Zhi.Bao L, Guo.Gang Y (2022) Development and Validation of a Nomogram for Predicting Pathological Intussusceptions in Children Prior to Surgical Intervention. Front Pediatr 10:877358. https://doi.org/10.3389/fped.2022.877358 Zhang J, Dong Q, Su XX, Long JS (2023) Factors associated with in-hospital recurrence of intestinal intussusception in children. BMC Pediatr 23:428. https://doi.org/10.1186/s12887-023-04267-9 Cho MJ, Nam CW, Choi SH, Hwang EH (2020) Management of recurrent ileocolic intussusception. J Pediatr Surg 55:2150–2153. https://doi.org/10.1016/j.jpedsurg.2019.09.039 Simon NM, Joseph J, Philip RR, Sukumaran TU, Philip R (2019) Intussusception: Single Center Experience of 10 Years. Indian Pediatr 56:29–32. https://doi.org/10.1007/s13312-019-1462-1 Aoki Y, Iguchi A, Kitazawa K, Kobayashi H, Senda M, Honda A (2021) Differences in Clinical Findings Based on the Duration of Symptoms and Age of Children With Ileocolic Intussusception: A Single-Institution Survey in Rural Japan. Pediater Emerg Care 37:537–542. https://doi.org/10.1097/pec.0000000000001750 Hu JJ, Liu MQ, Yu XB, Xia QZ, Wang K, Guo SK, Chen XM (2019) Clinical Characteristics of Intussusception with Surgical Reduction: a Single-Center Experience with 568 Cases. J Gastrointest Surg 23:2255–2262. https://doi.org/10.1007/s11605-019-04178-0 Acer-Demir T, Güney LH, Fakioğlu, E,Gültekingil A (2023) Comparison of Clinical Features of Intussusception in Terms of Age and Duration of Symptoms. Pediater Emerg Care 39:841–847. https://doi.org/10.1097/pec.0000000000003061 Yu YY, Zhang JJ, Xu YT, Lin ZX, Guo SK, Li ZR, Huang HY, Huang XZ (2024) Developing and validating a nomogram for early predicting the need for intestinal resection in pediatric intussusception. Front Pediatr 12:1409046. https://doi.org/10.3389/fped.2024.1409046 Huang HY, Lin XK, Guo SK, Bao XZ, Lin ZX, Li ZR, Huang XZ (2021) Haemostatic indexes for predicting intestinal necrosis in children with intussusception. ANZ J Surg 91:1485–1490. https://doi.org/10.1111/ans.16854 Li Y, Zhou Q, Liu C, Sun C, Sun H, Li X, Zhang L (2023) Epidemiology, clinical characteristics, and treatment of children with acute intussusception: a case series. BMC Pediatr 23:143. https://doi.org/10.1186/s12887-023-03961-y Vandewalle RJ, Bagwell AK, Shields JR, Burns RC, Brown BP, Landman MP (2019) Radiographic and Clinical Factors in Pediatric Patients With Surgical Small-bowel Intussusception. J Surg Res 233:167–172. https://doi.org/10.1016/j.jss.2018.08.002 Lin XK, Xia QZ, Huang XZ, Han YJ, He GR, Zheng N (2017) Clinical characteristics of intussusception secondary to pathologic lead points in children: a single-center experience with 65 cases. Pediatr Surg Int 33:793–797. https://doi.org/10.1007/s00383-017-4101-8 Lioubashevsky N, Hiller N, Rozovsky K, Segev L, Simanovsky N (2013) Ileocolic versus small-bowel intussusception in children: can US enable reliable differentiation? Radiology 269:266–271. https://doi.org/10.1148/radiol.13122639 Huang J, Lu J, Jiang FY, Song TJ (2023) Platelet/Albumin ratio and plateletcrit levels are potential new biomarkers for assessing endoscopic inflammatory bowel disease severity. BMC Gastroenterol 23:393. https://doi.org/10.1186/s12876-023-03043-4 Özdemir S, Altunok I, Özkan A, İslam MM, Algın A, Eroğlu SE, Aksel G (2024) Relationship between platelet indices in acute cholecystitis: A case-control study. Rev Gastroenterol Mex (Engl Ed) 89:232–236. https://doi.org/10.1016/j.rgmxen.2023.04.012 Sayit AT, Gunbey PH, Terzi Y (2015) Is the Mean Platelet Volume in Patients with Acute Cholecystitis an Inflammatory Marker? J Clin Diagn Res 9:TC05–07. https://doi.org/10.7860/jcdr/2015/12028.6061 Kucuk S, Mızrak S (2021) Diagnostic Value of Inflammatory Factors in Patients with Gallbladder Cancer, Dysplasia, and Cholecystitis. Cancer Control 28:–. https://doi.org/10.1177/10732748211033746 Li BW, Ren Q, Ling JZ, Tao ZB, Yang XM, Li YN (2021) Clinical relevance of neutrophil-to-lymphocyte ratio and mean platelet volume in pediatric Henoch-Schonlein Purpura: a meta-analysis. Bioengineered 12:286–295. https://doi.org/10.1080/21655979.2020.1865607 Karateke A, Kaplanoglu M, Baloglu A (2015) Relations of Platelet Indices with Endometrial Hyperplasia and Endometrial Cancer. Asian Pac J Cancer Prev 16:4905–4908. https://doi.org/10.7314/apjcp.2015.16.12.4905 Tao YX, Zhou Y, Chen HZ, Qin Y, He XH, Liu P, Zhou SY, Yang JL, Zhou LQ, Zhang CG, Yang S, Gui L, Shi YK (2022) Prognostic role of red blood cell distribution width and platelet/lymphocyte ratio in early-stage classical Hodgkin lymphoma. Future Oncol 18:1817–1827. https://doi.org/10.2217/fon-2021-1398 Pogorzelska K, Krętowska A, Krawczuk-Rybak M, Sawicka-Żukowska M (2020) Characteristics of platelet indices and their prognostic significance in selected medical condition - a systematic review. Adv Med Sci 65:310–315. https://doi.org/10.1016/j.advms.2020.05.002 Budak YU, Polat M, Huysal K (2016) The use of platelet indices, plateletcrit, mean platelet volume and platelet distribution width in emergency non-traumatic abdominal surgery: a systematic review. Biochem Med (Zagreb) 26:178–193. https://doi.org/10.11613/bm.2016.020 Tang J, Gao X, Zhi M, Zhou HM, Zhang M, Chen HW, Yang QF, Liang ZZ (2015) Plateletcrit: a sensitive biomarker for evaluating disease activity in Crohn's disease with low hs-CRP. J Dig Dis 16:118–124. https://doi.org/10.1111/1751-2980.12225 Chen R, Wang L, Zhao Q, Li Z, Chen M, Lian G, Zhang J (2021) Platelet-to-lymphocyte ratio and C-reactive protein as markers for colorectal polyp histological type. BMC Cancer 21:556. https://doi.org/10.1186/s12885-021-08221-9 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7546950","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":512140635,"identity":"e23c7e46-a365-4bc1-8829-a495b5abcda8","order_by":0,"name":"Yuan-Yang Yu","email":"","orcid":"","institution":"The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yuan-Yang","middleName":"","lastName":"Yu","suffix":""},{"id":512140636,"identity":"9cd1ac52-07af-46f1-945f-41376e0d3676","order_by":1,"name":"Fang-Bin 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20:08:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7546950/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7546950/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91816943,"identity":"b903463c-b62a-41a3-86eb-df0dfdaacc03","added_by":"auto","created_at":"2025-09-22 06:53:04","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":73186,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7546950/v1/84e18ddf2a6ac69ab372d1c4.docx"},{"id":91816990,"identity":"dee39d25-850d-4f18-b837-f5b430475623","added_by":"auto","created_at":"2025-09-22 06:53:16","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":20654,"visible":true,"origin":"","legend":"","description":"","filename":"Table4.docx","url":"https://assets-eu.researchsquare.com/files/rs-7546950/v1/e6f955b11060dd729c458140.docx"},{"id":91487472,"identity":"d8a43913-0efa-4835-aab7-8d9a169e1d02","added_by":"auto","created_at":"2025-09-17 05:02:46","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":78150,"visible":true,"origin":"","legend":"\u003cp\u003eMultivariate analysis and forest plot of independent risk factors. PCT, thrombocytocrit; LCI, lower confidence interval; UCI, upper confidence interval. • Odds ratio (OR); —95%CI\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7546950/v1/a6066c7c44dfcb1f23714c17.jpg"},{"id":102858320,"identity":"9c3623c8-a553-4593-92f0-abc0a03f164c","added_by":"auto","created_at":"2026-02-17 15:39:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1008833,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7546950/v1/5309838d-0564-4672-bb96-5b5c84615ddc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical characteristics and predictors for the presence of pediatric intussusception secondary to pathological lead points","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eIntussusception is one of the most prevalent causes of acute abdominal diseases and the leading cause of acute bowel obstruction in children with peak incidence between 3\u0026ndash;12 months of age [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The gross majority of cases are idiopathic, while the minority are secondary to pathological lead points (PLPs). Previous studies have shown that the incidence of PLPs was approximately 2.2\u0026ndash;15% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. For children suspected of having PLPs, a conservative reduction often fails. Even if the intussusception is reduced in subsequent conservative treatments, the children may still be prone to complications such as recurrence due to the underlying PLPs. Therefore, it\u0026rsquo;s necessary to identify PLPs in time and make effective interventions or regular follow-ups. However, the clinical presentations of PLPs closely resemble those of primary intussusception [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and the diagnostic yield of abdominal ultrasound is relatively limited with only 61.4% of positive cases definitively indicating the presence of a predisposing factor [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Sometimes, the PLPs are only discovered during the intraoperative reduction [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Hence, the diagnosis of PLPs is challenging.\u003c/p\u003e\u003cp\u003eWhile previous studies have analyzed the clinical characteristics of secondary intussusception (SI), most were limited by small sample sizes and a primary focus on symptomatology. The study aims to analyze the clinical manifestations, auxiliary examinations and surgical outcomes between secondary and idiopathic intussusception, as well as to improve the diagnosis and treatment of PLPs. To provide a more comprehensive assessment, we expanded the dataset, incorporated additional variables, and evaluated predictors for SI to enhance diagnostic and therapeutic decision-making.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Patients\u003c/h2\u003e\u003cp\u003ePediatric patients highly suspected of having intussusception in outpatient clinic, as confirmed by ultrasonography and clinical manifestations received a follow-up air or saline enema to verify it after obtaining informed consent. Patients were hospitalized if two enema reduction attempts failed, if there was suspicion of intestinal necrosis or presence of PLPs, or with hemodynamic instability despite adequate resuscitation. Hospitalized children diagnosed with intussusception between 1 January 2010 and 31 May 2025 were retrospectively examined after surgery. Exclusion criteria were as follows: (1) cases with incomplete medical records; (2) comorbid conditions affecting coagulation such as warfarin or heparin use, liver disease, nephrotic syndrome, and/or other coagulopathies.\u003c/p\u003e\u003cp\u003eEmergency surgical reduction was performed after obtaining informed consent in children with failed enema reduction. Exploratory laparotomy and laparoscopy were primary surgical approaches. Following successful nonoperative reduction, a subset of the patients chose endoscopy in suspicion of having PLPs. The preliminary diagnosis of PLPs was made by the surgeon on the basis of intraoperative gross examinations, while definitive confirmation relied on histopathological evaluation. According to the pathological assessments, the enrolled patients were categorized into two groups: the PLPs group (confirmed PLPs) and the non-PLPs group (idiopathic intussusception).\u003c/p\u003e\u003cp\u003eThe study was approved by the Ethics Committees of The Second Affiliated Hospital and Yuying Children\u0026rsquo;s Hospital of Wenzhou Medical University. The informed consent was waived due to the nature of retrospective study and anonymous patients.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Variables\u003c/h2\u003e\u003cp\u003eThe medical records of enrolled patients were collected including demography (age, gender, duration of symptoms) ,clinical characteristics (hematochezia, fever, abdominal pain, diarrhea, vomitus, intermittent crying, recurrence, intestinal necrosis, classification of intussusception, etc.), laboratory parameters [C-reaction protein (CRP), white blood cells (WBCs), red blood cells (RBCs), hemoglobin (HB), hematocrit (HCT), mean corpuscular volume (MCV), red cell distribution width-CV (RDW-CV), platelets (PLTs), mean platelet volume (MPV), platelet distribution width (PDW), thrombocytocrit (PCT), neutrophil counts, lymphocyte counts, basophil counts, monocyte counts, eosinophil counts, D-dimer, prothrombin time (PT), prothrombin time-INR (PT-INR), activated partial thromboplastin time (APTT), plasma fibrinogen, thrombin time (TT)], ultrasonographic features (ascites, intestinal dilation, enlarged lymph nodes), pneumatic or hydrostatic reduction records, pathological findings, and surgical records (surgical findings and surgical approaches). Duration of symptoms was defined as the time from beginning of symptoms to the time of hospitalization. Fever was defined as a tympanic temperature above 37.5℃ at presentation. Recurrence was defined as the reappearance of typical clinical symptoms following successful reduction, with ultrasonographic confirmation of intussusception. The total number of intussusception episodes and interval between the last occurrence and the current admission were recorded. Final diagnosis of intestinal necrosis was confirmed by postoperative histopathological examination.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Statistical analysis\u003c/h2\u003e\u003cp\u003eThe data in this study was analyzed by SPSS version 22.0 (IBM, Armonk, New York). There was no missing data in the final analysis. Univariate and multivariate analysis was conducted by SPSS to estimate the correlation between all the predictors and the main binary classification results. Discrete variables were expressed as counts (ratio) and continuous variables as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) or median with interquartile range (25th-75th percentiles) (IQR) depending on normality. The normal distribution of continuous variables was compared by Student\u0026rsquo;s t-test, non-normal distribution variables as Mann\u0026ndash;Whitney U test and the qualitative data as Pearson\u0026rsquo;s Chi-square or Fisher\u0026rsquo;s exact tests. Then based on clinic and univariable analysis, the meaningful variables (p\u0026thinsp;\u0026lt;\u0026thinsp;0.15) were selected into multivariable logistical regression predicting model with calculated odds ratios (ORs) and 95% confidence interval (95%CI) via forward stepwise regression based on maximum likelihood estimation. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"3 Results","content":"\u003cp\u003eFrom January 2010 to May 2025, a total of 8,659 children were performed non-operative reduction after being diagnosed in the outpatient department. Among these, 7,769 (89.7%) pediatric patients successfully managed non-surgical treatment and were discharged after observation while the remaining 890 pediatric patients required admission to the Department of Pediatric Surgery. According to consistent inclusion and exclusion criteria, we excluded 126 cases with incomplete medical records and 189 cases managed solely through hospitalization without surgical intervention, leaving 575 cases being enrolled in the final retrospective analysis. Postoperative histopathological examination confirmed PLPs in 183 cases (31.82%), comprising the PLPs group, while the remaining 392 cases (68.17%) were assigned to the non-PLPs group.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Distribution of the types of PLPs in pediatric intussusception\u003c/h2\u003e\u003cp\u003eFor children who failed non-surgical reduction or had contraindications for conservative treatment, surgery was performed. During the surgery, lymph nodes observed significantly enlarged were removed for pathological examination. Ultimately, 62 cases (33.88%) showed reactive intestinal/mesenteric lymph nodes hyperplasia according to the pathological results as 13 cases indicated lymphoma. Other types of PLPs were as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The average age of the patients suffered from intestinal tumors was higher than other PLPs. Among the 19 intestinal tumors, all except one which involved both the ileum and colon were located solely in the ileum. Among Meckel's diverticulum, histopathological analysis revealed the following associated abnormalities: ectopic pancreas (n\u0026thinsp;=\u0026thinsp;6), ectopic gastric mucosa (n\u0026thinsp;=\u0026thinsp;6), combined gastric and pancreatic heterotopia (n\u0026thinsp;=\u0026thinsp;6), lymphoid hyperplasia (n\u0026thinsp;=\u0026thinsp;2), and appendicitis (n\u0026thinsp;=\u0026thinsp;1). Among cases of intestinal duplication, 11 exhibited isolated duplication, while the remaining cases demonstrated concurrent pathological findings: ectopic gastric mucosa (n\u0026thinsp;=\u0026thinsp;6), ectopic pancreas (n\u0026thinsp;=\u0026thinsp;3), coexisting ectopic pancreas and gastric mucosa (n\u0026thinsp;=\u0026thinsp;1), and lymphoid hyperplasia (n\u0026thinsp;=\u0026thinsp;1).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of the types of PLPs in pediatric intussusception\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePLPs\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;183\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAge (month)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePolyps\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (12.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61.78 (11.40-153.40)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeckel\u0026rsquo;s diverticulum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38 (20.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42.25 (2.43\u0026ndash;166.80)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymphoid hyperplasia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62 (33.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.99 (1.77\u0026ndash;90.27)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuplication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (12.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40.08 (2.23\u0026ndash;128.30)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (10.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76.81 (0.07\u0026ndash;174.70)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymphoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (7.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91.99 (36.67\u0026ndash;175.70)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBurkitt lymphoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (4.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42.79 (36.67-174.67)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiffuse large B-cell lymphoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93.04 (85.07\u0026ndash;101.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMALT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFollicular lymphoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e123.93\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ehamartomas\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (1.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79.60 (5.30-124.17)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emyofibroblastoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWilms tumor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIMT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAppendicitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (9.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.07 (2.87\u0026ndash;109.80)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnterocyst\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (1.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.52 (1.80\u0026ndash;7.23)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHenoch-Sch\u0026ouml;nlein purpura\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParasite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeterotopic gastric mucosa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (12.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48.94 (2.43\u0026ndash;166.80)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEctopic pancreas\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (9.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64.09 (2.43\u0026ndash;166.80)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIleocecal ulceration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e87.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eValues are presented as counts (%). Age (month) were described as mean (min-max);MALT, mucosa-associated lymphoid tissue lymphoma; IMT, inflammatory myofibroblastic tumor; PLPs, Pathological lead points.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Demographic and clinical features of non-PLPs group and PLPs group\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarized the demographic and clinical features of the two groups. There exited no difference between two groups in duration of symptoms and male-to-female ratio. The median age of the PLPs group was 20.83 months which was statistically significant older than the non-PLPs group (median age: 7.35month). Vomitus was the most prevalent presenting symptom (n\u0026thinsp;=\u0026thinsp;504, 87.65%), followed by hematochezia (n\u0026thinsp;=\u0026thinsp;402, 69.91%), intermittent crying (n\u0026thinsp;=\u0026thinsp;366, 63.65%) in all the 575 enrolled cases. The incidence of hematochezia, fever, vomitus and intermittent crying were significantly higher in the non-PLPs group compared to the PLPs group (312 versus 90, 180 versus 55, 364 versus 140, 292 versus 74, respectively; all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Conversely, symptoms including abdominal pain, recurrence and intestinal necrosis were more frequently in the PLPs group than in the non-PLPs group (48 versus 92, 21 versus 67, 73 versus 64, respectively; all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Surgical evaluation identified six types of intussusceptions according to anatomic localization: ileocolic (n\u0026thinsp;=\u0026thinsp;255, 44.35%), ileocecal (n\u0026thinsp;=\u0026thinsp;120, 20.86%), compound/complex (n\u0026thinsp;=\u0026thinsp;97, 16.87%), small intestinal (n\u0026thinsp;=\u0026thinsp;89, 15.48%), colic-colic (n\u0026thinsp;=\u0026thinsp;5, 0.87%), multiple (n\u0026thinsp;=\u0026thinsp;3, 0.52%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic and clinical features of non-PLPs group and PLPs group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-PLPs\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;392\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePLPs\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;183\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDemographics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (month), median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.35 (5.10-10.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.83 (7.17\u0026ndash;61.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;12 months, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e318 (81.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71 (38.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026gt;=12months, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74 (18.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e112 (61.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender (male/female), (ratio)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e266/126 (2.1:1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e117/66 (1.7:1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.353\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of symptoms (h), median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (12\u0026ndash;36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (12\u0026ndash;40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.736\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHematochezia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e312 (79.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90 (49.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e180 (45.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55 (30.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbdominal pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48 (12.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92 (50.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiarrhea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57 (14.54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (13.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.779\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVomitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e364 (92.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e140 (76.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntermittent crying\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e292 (74.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74 (40.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003etriad of intussusception\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (5.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (9.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.077\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRecurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (5.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67 (36.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntestinal necrosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (18.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64 (34.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClassification of intussusception, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIleo-colic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e184 (46.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71 (38.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIleo-cecal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82 (20.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38 (20.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompound/complex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78 (19.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (10.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultiple\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmall intestinal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (10.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48 (26.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eColic-colic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (0.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (1.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003ePLPs, Pathological lead points. IQR, interquartile range (25th-75th percentiles).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAdditionally, in 88 cases of recurrence, 45 cases had one recurrence, 21 cases had two recurrences, 9 cases had three recurrences, and 13 cases had more than three recurrences. 40 cases had a recurrence within 24 hours, 11 cases within 72 hours, and 37 cases after 72 hours (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Obvious difference of recurrence was seen between two groups.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRecurrence episodes and interval of non-PLPs group and PLPs group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRecurrence\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-PLPs\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;392\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePLPs\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;183\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEpisodes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime interval\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;24h\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24h-72h\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;72h\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eValues are presented as counts (%). PLPs, Pathological lead points.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Hematological and sonographic investigation of non-PLPs group and PLPs group\u003c/h2\u003e\u003cp\u003eComparison results of laboratory parameters between the two groups were listed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. There were several variables that showed significant differences, such as CRP, HB, HCT, MCV, MPV, PCT, basophil counts, eosinophil counts, TT. Platelet indices were main variables. Ascites and enlarged lymph nodes existed difference between groups, and SI seems prone to generate ascites and stimulate lymph node enlargement.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHematological and sonographic investigation of non-PLPs group and PLPs group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-PLPs\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;392\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePLPs\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;183\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.00 (5.00-18.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.00 (2.00-15.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWBCs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.85 (9.30\u0026ndash;15.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.72 (8.8-15.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.673\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRBCs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.41 (4.05\u0026ndash;4.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.47 (4.14\u0026ndash;4.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e114.00 (106.25\u0026ndash;122.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e120.00 (108.00-128.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.34 (0.33\u0026ndash;0.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.36 (0.33\u0026ndash;0.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMCV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78.95 (75.60\u0026ndash;81.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80.10 (76.60\u0026ndash;83.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRDW-CV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.00 (12.30-13.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.00 (12.30\u0026ndash;13.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.531\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePLTs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e376.00 (309.00-460.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e394.00 (295.00-479.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.289\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMPV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.80 (7.30\u0026ndash;8.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.30 (7.60-9.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePDW\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.60 (15.02\u0026ndash;15.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.50 (15.10\u0026ndash;15.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.311\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.30 (0.24\u0026ndash;0.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.32 (0.26\u0026ndash;0.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExp (PCT)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeutrophil counts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.18 (5.56\u0026ndash;10.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.80 (5.27\u0026ndash;11.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.892\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymphocyte counts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.79 (1.90\u0026ndash;3.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.59 (1.77\u0026ndash;3.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.163\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMonocyte counts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.67 (0.39\u0026ndash;1.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.62 (0.38\u0026ndash;1.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.581\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasophil counts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.03 (0.01\u0026ndash;0.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.02 (0.01\u0026ndash;0.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEosinophil counts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.03 (0.01\u0026ndash;0.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.04 (0.01\u0026ndash;0.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.018\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD-dimer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.22 (0.61\u0026ndash;2.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.03 (0.41\u0026ndash;2.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.70 (13.20\u0026ndash;14.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.80 (13.10\u0026ndash;14.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.464\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePT-INR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.05 (1.00-1.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.07 (1.00-1.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.061\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAPTT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.50 (34.93\u0026ndash;42.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.80 (34.60\u0026ndash;40.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.077\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.30 (14.50\u0026ndash;16.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.50 (14.80\u0026ndash;16.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFibrinogen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.18 (2.65\u0026ndash;3.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.20 (2.72\u0026ndash;3.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.863\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUltrasound, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eascites\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e161 (41.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92 (50.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.038\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntestinal dilation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79 (20.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42 (22.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.443\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnlarged lymph nodes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (6.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (17.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eContinuous variables were expressed as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) or median with interquartile range (25th-75th percentiles) depending on normality. Exp (PCT) was described as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. CRP, C-reaction protein; WBCs, white blood cells; RBCs, red blood cells; HB, hemoglobin; HCT, hematocrit; MCV, mean corpuscular volume; RDW-CV, red cell distribution width-CV; PLTs, platelets; MPV, mean platelet volume; PDW, platelet distribution width; PCT, thrombocytocrit; PT, prothrombin time; PT-INR, prothrombin time-INR; APTT, activated partial thromboplastin time; TT, thrombin time.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Univariate and multivariate analysis on the predictors of non-PLPs group and PLPs group\u003c/h2\u003e\u003cp\u003eUnivariate analysis was conducted and 17 variables were the significant factors as shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. Based on clinical and statistical evaluation, we included the 17 variables into multivariable analysis and six variables including age, hematochezia, abdominal pain, recurrence, intestinal necrosis, and PCT were independent predictors (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUnivariate on the demographics and clinical characteristics of the predictors of non-PLPs group and PLPs group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eUnivariate analysis\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR [95% CI]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (month)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.040 [1.030\u0026ndash;1.050]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHematochezia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.248 [0.170\u0026ndash;0.363]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbdominal pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.245 [4.768\u0026ndash;11.011]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntermittent crying\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.232 [0.160\u0026ndash;0.337]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVomitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.250 [0.150\u0026ndash;0.419]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRecurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.966 [5.847\u0026ndash;16.986]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntestinal necrosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.350 [1.581\u0026ndash;3.493]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.506 [0.348\u0026ndash;0.735]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAscites\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.451 [1.019\u0026ndash;2.064]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.039\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnlarged lymph nodes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.983 [1.719\u0026ndash;5.176]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.993 [0.985\u0026ndash;1.002]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.135\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.024 [1.010\u0026ndash;1.038]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11481.139 [102.31-12888402.900]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePLT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.002 [1.001\u0026ndash;1.003]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.150\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMCV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.042 [1.008\u0026ndash;1.077]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.014\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMPV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.436 [1.208\u0026ndash;1.707]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExp (PCT)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.767 [1.585\u0026ndash;4.830]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEosinophil counts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18.186 [3.212-102.956]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasophil counts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.068 [0.002\u0026ndash;3.053]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.166\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.001 [0.946\u0026ndash;1.060]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.972\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003ePLPs, pathological lead points. CRP, C-reaction protein; HB, hemoglobin; HCT, hematocrit; PLTs, platelets; MCV, mean corpuscular volume; MPV, mean platelet volume; PCT, thrombocytocrit; TT, thrombin time.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eIntussusception is one of the most clinically relevant cause of intestinal obstruction in infant and children. Approximately 90% of cases are idiopathic with favorable outcomes and no identifiable etiology [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, a subset of intussusception cases (2.2\u0026ndash;15%) are secondary to PLPs [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], with the incidence rising to 20\u0026ndash;25% in older children [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and increasing with age [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Unlike idiopathic cases, nearly all SI requires surgical intervention due to the high failure rate of enema reduction and the need to exclude malignant PLPs actively [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAmong 575 pediatric patients with intussusception undergoing surgery in our study, the incidence of PLPs (31.82%) which was higher than that reported in previous studies, a difference likely attributable to the substantial number of cases involving lymph nodes hyperplasia. These observations, supported by previous studies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], suggested that hyperplasia of intestinal lymphoid tissue constituted a significant etiological factor in intussusception. Mesenteric lymph nodes can not only induce intussusception but be trapped within the mesentery, leading to a lower non-operative reduction success rate (46.4% vs. 81.1%) and higher recurrence rate [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Although most instances involved reactive lymph nodes hyperplasia without metastasis signs, intestinal tumors still merit great attention [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Lymphoma was the most common intestinal tumor in our study and almost occurred in the ileum, which was consistent with the research reported by Wang et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Apart from these, the most common gastrointestinal malformations in our study were Meckel's diverticulum and intestinal duplication which were asymptomatic in more than 90% people but common as PLPs in intussusception [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and both may harbor ectopic pancreas and gastric mucosa. In our study cohort of 60 cases of Meckel\u0026rsquo;s diverticulum and duplication, 32cases were found with other types of PLPs concurrently present. These findings suggest that intussusception may arise from multiple synchronous PLPs, contributing to increased clinical complexity. The difficulty in identifying the leading point among multiple PLPs makes a combined management approach recommended [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The presence of concurrent anomalies can obscure typical symptomatology, potentially delaying diagnosis and leading to adverse clinical outcomes [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIntussusception recurrence is an intractable matter of concern for both family and surgeons. While most patients maintain durable remission after successful reduction [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], a distinct subset experiences recurrent episodes. Our institutional data indicated a significantly higher recurrence rate in the PLPs group compared to the non-PLPs group (36.61% versus 5.36%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and recurrence was identified as a strong predictor, which were consistent with previous findings reported by Daneman et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], whose 17-year longitudinal study established PLPs as strongly associated with recurrence, particularly in cases with multiple episodes (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Specifically, SI demonstrated both higher recurrence rates and greater temporal clustering of events, aligning with existing literature [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The clinical significance of this association was further quantified by Zhang et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] in their analysis of 624 pediatric cases, identifying PLPs as an independent predictor of in-hospital recurrence (OR\u0026thinsp;=\u0026thinsp;14.40, 95%CI: 4.34\u0026ndash;47.80, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Notably, certain PLP subtypes (e.g., intestinal tumors) may manifest solely as recurrent intussusception during initial presentations [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These findings collectively underscore the imperative for comprehensive diagnostic evaluation following any recurrence to exclude PLPs and mitigate severe complications [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDuring the clinical assessment process, the clinical presentation of SI often mimics idiopathic cases making differentiation difficult. Abdominal pain, vomitus, and hematochezia are the classic triad symptoms of intussusception with the reported incidence of 33% [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] while it accounted for only 6.61% in our study. Vomiting is the most prevalent symptom and more common in non-PLPs group. Regarding the vomiting rates, it was possible that the patients in the non-PLPs group were mostly younger than 1 year with poorer ability to control the vomiting reflex [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The presence of bloody and mucoid stools, indicative of impaired intestinal circulation, typically manifested later in the course of intussusception. In our study, this finding emerged as a negative risk factor, potentially attributable to patient age and intussusception subtypes. Younger infants, whose intestinal barrier function remains underdeveloped, may exhibit heightened susceptibility to mucosal injury. Notably, the non-PLPs group demonstrated a higher proportion of complex/compound intussusception cases, which could contribute to more severe intestinal ischemia due to tighter invagination and compromised vascular supply [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Acer-Demir et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] conducted age-stratified analyses of intussusception patients, categorizing them into subgroups (younger versus older than 1 year, and younger versus older than 2 year), and their findings revealed that patients under 1 year old exhibited a significantly higher incidence of hematochezia and longer intussusceptum segments compared to the older. As the intestinal mucosa suffers from prolonged damage and ischemia, intestinal necrosis can occur as a serious clinical consequence of intussusception requiring intestinal resection. However, hematochezia was not the independent risk factor for intestinal necrosis and was unreliable for predicting intestinal necrosis in children with intussusception according to our previous studies [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In our current study, we came to the conclusion that intestinal necrosis was an independent risk factor for PLPs. In pediatric intussusception with intestinal necrosis, it\u0026rsquo;s even more necessary to be vigilant about the presence of PLPs, and even more careful exploration should be conducted during the operation to avoid missed diagnosis and prevent more severe clinical consequences.\u003c/p\u003e\u003cp\u003eBesides, abdominal pain appears to be age-related, while many older children complain only abdominal pain without other symptoms [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. We found abdominal pain was an independent risk factor for predicting PLPs which was probably related with that most of the primary intussusception patients were too younger to verbally complain about their symptoms and abdominal pain may be underreported [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In Wang\u0026rsquo;s research [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] about 31 cases of pediatric intussusception secondary to small bowel tumors, only three presented the typical triad, while the majority presented with recurrent abdominal pain. As such, for the older children complained with abdominal pain, especially intermittent pain, intussusception can\u0026rsquo;t be excluded even if the child doesn\u0026rsquo;t have hematochezia or emesis [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGenerally, age is an important factor of intussusception. In our study, age was an independent risk factor of PLPs. The median age of children in the PLPs group was significantly higher than that in the non-PLPs group (20.83 months, IQR 7.17\u0026ndash;61.63 versus 8.63 months, IQR 5.68\u0026ndash;21.70; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Age-stratified analysis further confirmed that children older than 12 months demonstrated a significantly higher prevalence of PLPs. These findings are consistent with previous reports [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] suggesting that intussusception in older pediatric patients warrants heightened clinical suspicion for underlying PLPs. Consequently, comprehensive diagnostic evaluation should be prioritized in this age group to identify potential PLPs.\u003c/p\u003e\u003cp\u003eAlthough there were significant different in age and symptoms between the two groups, none of them can reliably distinguish PLPs in individual cases [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Further examinations are urgently needed. Our analysis revealed significant differences in multiple laboratory parameters upon univariate assessment. Notably, PCT emerged as an independent predictor for PLPs. MPV, PCT, and PLT represent key platelet indices, collectively suggesting the potential utility of platelet-derived biomarkers in predicting SI. Current investigations are systematically evaluating the clinical relevance of these hematological parameters. Platelet indices demonstrate significant clinical variability across multiple pathological conditions, including inflammatory bowel disease [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], cholecystitis [\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], purpura [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], neoplastic disorders [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], appendicitis [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], etc. Emerging evidence supported their potential diagnostic utility in gastrointestinal diseases. Tang et al. [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] identified PCT as a promising biomarker for active Crohn's disease, particularly in patients with low CRP level. Furthermore, Chen et al. [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] established that a platelet-to-lymphocyte ratio (PLR)\u0026thinsp;\u0026gt;\u0026thinsp;113.32 (OR\u0026thinsp;=\u0026thinsp;0.210, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) served as independent predictors for colorectal polyps\u0026rsquo; histology. In our study, there existed difference between PLR and SI after univariate analysis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while association did not persist in multivariate analysis (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Li et al. [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] established a significant correlation between decreased MPV and severe gastrointestinal involvement in pediatric Henoch-Sch\u0026ouml;nlein purpura cases (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Intriguingly, our data demonstrated an inverse MPV pattern, with significantly higher values observed in the PLPs group versus the non-PLPs group. This discrepancy may stem from fundamental differences in study populations. Existing literature had predominantly focused on single-disease cohort, whereas our study encompassed a heterogeneous spectrum of PLPs, including several rare etiologies. This methodological distinction underscores the necessity for large-scale, multicenter studies to validate platelet indices as biomarkers across diverse intussusception subtypes.\u003c/p\u003e\u003cp\u003ePrimarily, the retrospective design inherently limits data verification, as the accuracy of medical records could not be systematically validated. Additionally, the relatively small sample size, particularly for certain rare PLP subtypes, may affect the statistical power and external validity of our findings. These methodological constraints underscore the necessity for future prospective, multicenter studies with larger cohorts to enhance the generalizability of conclusions regarding PLP-associated intussusception.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eIn conclusion, lymphadenitis/lymphoid hyperplasia is the most common PLPs in intussusception. Some children may have multiple PLPs which urgently in need of more attention. Older age, abdominal pain, bloody stool, intestinal necrosis, recurrence intussusception and PCT are independent predictors of PLPs.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical approval:\u003c/strong\u003e\u003cp\u003eThe study had approval from the Ethics Committees of The Second Affiliated Hospital and Yuying Children\u0026rsquo;s Hospital of Wenzhou Medical. The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eInformed consent:\u003c/strong\u003e\u003cp\u003eAs this was a retrospective study, all analyses were based on clinical data only. And all enrolled patients were anonymised. Therefore, the informed consent was waived.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eNational Natural Science Foundation of China, Grant/Award Numbers: 81903235; Natural Science Foundation of Zhejiang Province, Grant/Award Numbers: LQ21H110001.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eY.Y.: Supervision; writing original draft; writing review and editing. F. S.: Data curation; investigation; methodology. Y.W.: Formal analysis; project administration. Y. X.: writing original draft; writing-review and editing. M.G.: Investigation; methodology. Z.R.: Writing original draft and editing. H.H.: visualization; writing original draft; writing-review and editing. X.H.: Conceptualization; methodology; project administration; resources; supervision.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to express our gratitude to Department of Pediatric Surgery colleagues for their help with data collection.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eNo datasets were generated or analyzed during the current study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFiegel H, Gfroerer S, Rolle U (2016) Systematic review shows that pathological lead points are important and frequent in intussusception and are not limited to infants. 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BMC Cancer 21:556. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12885-021-08221-9\u003c/span\u003e\u003cspan address=\"10.1186/s12885-021-08221-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pediatric, Intussusception, Pathological lead points, Predictors","lastPublishedDoi":"10.21203/rs.3.rs-7546950/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7546950/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e Analyze the clinical characteristics and identify independent predictors of intussusception secondary to pathological lead points (PLPs).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Children admitted with intussusception between 2010 and 2025 were retrospectively enrolled after surgery and divided into two groups: the PLPs group and the non-PLPs group and tested for differences in demography, symptomatology, auxiliary examinations, surgical results and pathological results.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 575 cases of intussusception were included in the final analysis of which 183 had PLPs and 392 were idiopathic. The types of PLPs included lymphadenitis/lymphoid hyperplasia, Meckel's diverticulum, intestinal duplication malformations, polyps, tumors, appendicitis, ectopic gastric mucosa, ectopic pancreas, enterocyst, allergic purpura, parasite, ileocecal ulceration. Multivariable analysis revealed that older age (OR=1.020; 95%CI, 1.008-1.032; p\u0026lt;0.001), hematochezia (OR=0.540; 95% CI, 0.315-0.927; p=0.026), abdominal pain (OR=2.122; 95%CI, 1.092-4.123; p=0.028), recurrence (OR=4.430; 95% CI, 2.265-8.664; p\u0026lt;0.001), intestinal necrosis (OR=4.441; 95%CI, 2.730-7.224; p\u0026lt;0.001), and exp(PCT) (OR=16.077; 95%CI, 3.749-69.942; p\u0026lt;0.001) were independent predictors of PLPs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Lymphadenitis/lymphoid hyperplasia is the most common PLP of intussusception. Older age, hematochezia, abdominal pain, recurrence intussusception, intestinal necrosis and thrombocytocrit are independent predictors of PLPs.\u003c/p\u003e","manuscriptTitle":"Clinical characteristics and predictors for the presence of pediatric intussusception secondary to pathological lead points","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 05:02:41","doi":"10.21203/rs.3.rs-7546950/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"00845c07-7bac-474d-ad9c-2a4850abbcab","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-17T15:39:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 05:02:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7546950","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7546950","identity":"rs-7546950","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}