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  1. Case Definitions/

Open Syndrome Acute Intussusception in infants

Authors: Vietnam Ministry of Health

Location: Vietnam

Purpose #

Case definition for acute intussusception in infants

The definition #

Level 1 of diagnostic certainty Surgical criteria: The demonstration of invagination of the intestine at surgery; and/or Radiological criteria: The demonstration of invagination of the intestine by either air or liquid contrast enema; or The demonstration of an intra-abdominal mass by abdominal ultrasound with specific characteristic featuresb that is proven to be reduced by hydrostatic enema on post-reduction ultrasound; and/or Autopsy criteria: The demonstration of invagination of the intestine. Level 2 of diagnostic certainty Clinical criteria: Two major criteria (see table for major and minor criteria for diagnosis below); or One major criterionc and three minor criteria (see table for major and minor criteria for diagnosis below). Level 3 of diagnostic certainty Clinical criteria: Four or more minor criteria (see minor criteria for diagnosis below). Any level of diagnostic certainty In the absence of surgical criteria with the definitive demonstration of an alternative cause of bowel obstruction or intestinal infarction at surgery (e.g., volvulus or congenital pyloric stenosis). Major and minor criteria used in the case definition for the diagnosis of intussusception Major criteria

  1. Evidence of intestinal obstruction: 2. Features of intestinal invagination 3. Evidence of intestinal vascular i. History of bile-stained vomiting; One or more of the following: compromise or venous congestion: and either i. abdominal mass; i. Passage of blood per rectum; ii. Examination findings of acute ii. rectal mass; or abdominal distension and abnormal iii. intestinal prolapse; or absent bowel sounds; iv. plain abdominal radiograph showing a ii. Passage of a stool containing “red currant jelly” material; or visible intussusceptum or soft tissue mass; or iii. Plain abdominal radiograph showing v. abdominal ultrasound showing a visible iii. Blood detected on rectal fluid levels and dilated bowel loops. intussusceptum or soft tissue mass; examination. vi. abdominal CT scan showing a visible intussusceptum or soft tissue mass. Minor criteria i. Predisposing factors: age <1 year and male sex; ii. Abdominal pain; iii. Vomiting;d v. Pallor;e vi. Hypovolemic shock; vii. Plain abdominal radiograph showing an abnormal but non-specific iv. Lethargy;e bowel gas pattern.

Machine-readable definition #

The definition is available in JSON format following the Open Syndrome v1.0 specification:

{
   "category": "suspected",
   "definition_type": "case_definition",
   "description": "Case definition for acute intussusception in infants",
   "human_readable_definition": "Level 1 of diagnostic certainty\nSurgical criteria:\nThe demonstration of invagination of the intestine at surgery;\nand/or\nRadiological criteria:\nThe demonstration of invagination of the intestine by either air or liquid contrast enema;\nor\nThe demonstration of an intra-abdominal mass by abdominal ultrasound with specific characteristic featuresb that is proven to be reduced by\nhydrostatic enema on post-reduction ultrasound;\nand/or\nAutopsy criteria:\nThe demonstration of invagination of the intestine.\nLevel 2 of diagnostic certainty\nClinical criteria:\nTwo major criteria (see table for major and minor criteria for diagnosis below);\nor\nOne major criterionc and three minor criteria (see table for major and minor criteria for diagnosis below).\nLevel 3 of diagnostic certainty\nClinical criteria:\nFour or more minor criteria (see minor criteria for diagnosis below).\nAny level of diagnostic certainty\nIn the absence of surgical criteria with the definitive demonstration of an alternative cause of bowel obstruction or intestinal infarction at surgery\n(e.g., volvulus or congenital pyloric stenosis).\nMajor and minor criteria used in the case definition for the diagnosis of intussusception\nMajor criteria\n1. Evidence of intestinal obstruction: 2. Features of intestinal invagination 3. Evidence of intestinal vascular\ni. History of bile-stained vomiting; One or more of the following: compromise or venous congestion:\nand either i. abdominal mass; i. Passage of blood per rectum;\nii. Examination findings of acute ii. rectal mass; or\nabdominal distension and abnormal iii. intestinal prolapse; or absent bowel sounds; iv. plain abdominal radiograph showing a ii. Passage of a stool containing\n“red currant jelly” material;\nor visible intussusceptum or soft tissue mass; or\niii. Plain abdominal radiograph showing v. abdominal ultrasound showing a visible iii. Blood detected on rectal\nfluid levels and dilated bowel loops.\nintussusceptum or soft tissue mass; examination.\nvi. abdominal CT scan showing a visible\nintussusceptum or soft tissue mass.\nMinor criteria\ni. Predisposing factors: age \u003c1 year and male sex; ii. Abdominal pain; iii. Vomiting;d v. Pallor;e\nvi. Hypovolemic shock;\nvii. Plain abdominal radiograph showing an abnormal but non-specific\niv. Lethargy;e bowel gas pattern.",
   "inclusion_criteria": [
     {
       "logical_operator": "OR",
       "type": "criterion",
       "values": [
         {
           "logical_operator": "AT_LEAST",
           "logical_operator_arguments": [
             2
           ],
           "type": "criterion",
           "values": [
             {
               "logical_operator": "AND",
               "name": "Evidence of intestinal obstruction",
               "type": "criterion",
               "values": [
                 {
                   "name": "bile-stained vomiting",
                   "type": "symptom"
                 },
                 {
                   "logical_operator": "OR",
                   "type": "criterion",
                   "values": [
                     {
                       "name": "examination findings of acute abdominal distension and abnormal or absent bowel sounds",
                       "type": "symptom"
                     },
                     {
                       "name": "fluid levels and dilated bowel loops on plain abdominal radiograph",
                       "type": "symptom"
                     }
                   ]
                 }
               ]
             },
             {
               "logical_operator": "AT_LEAST",
               "logical_operator_arguments": [
                 1
               ],
               "name": "Features of intestinal invagination",
               "type": "criterion",
               "values": [
                 {
                   "name": "abdominal mass",
                   "type": "symptom"
                 },
                 {
                   "name": "rectal mass",
                   "type": "symptom"
                 },
                 {
                   "name": "intestinal prolapse",
                   "type": "symptom"
                 },
                 {
                   "name": "plain abdominal radiograph showing a visible intussusceptum or soft tissue mass",
                   "type": "diagnostic_test"
                 },
                 {
                   "name": "abdominal ultrasound showing a visible intussusceptum or soft tissue mass",
                   "type": "diagnostic_test"
                 },
                 {
                   "name": "abdominal CT scan showing a visible intussusceptum or soft tissue mass",
                   "type": "diagnostic_test"
                 }
               ]
             },
             {
               "logical_operator": "OR",
               "name": "Evidence of intestinal vascular compromise",
               "type": "criterion",
               "values": [
                 {
                   "name": "blood per rectum",
                   "type": "symptom"
                 },
                 {
                   "name": "stool containing red currant jelly material",
                   "type": "symptom"
                 },
                 {
                   "name": "blood on rectal examination",
                   "type": "symptom"
                 }
               ]
             }
           ]
         },
         {
           "logical_operator": "AND",
           "type": "criterion",
           "values": [
             {
               "logical_operator": "AT_LEAST",
               "logical_operator_arguments": [
                 1
               ],
               "type": "criterion",
               "values": [
                 {
                   "logical_operator": "AND",
                   "name": "Evidence of intestinal obstruction",
                   "type": "criterion",
                   "values": [
                     {
                       "name": "bile-stained vomiting",
                       "type": "symptom"
                     },
                     {
                       "logical_operator": "OR",
                       "type": "criterion",
                       "values": [
                         {
                           "name": "examination findings of acute abdominal distension and abnormal or absent bowel sounds",
                           "type": "symptom"
                         },
                         {
                           "name": "fluid levels and dilated bowel loops on plain abdominal radiograph",
                           "type": "symptom"
                         }
                       ]
                     }
                   ]
                 },
                 {
                   "logical_operator": "AT_LEAST",
                   "logical_operator_arguments": [
                     1
                   ],
                   "name": "Features of intestinal invagination",
                   "type": "criterion",
                   "values": [
                     {
                       "name": "abdominal mass",
                       "type": "symptom"
                     },
                     {
                       "name": "rectal mass",
                       "type": "symptom"
                     },
                     {
                       "name": "intestinal prolapse",
                       "type": "symptom"
                     },
                     {
                       "name": "plain abdominal radiograph showing a visible intussusceptum or soft tissue mass",
                       "type": "diagnostic_test"
                     },
                     {
                       "name": "abdominal ultrasound showing a visible intussusceptum or soft tissue mass",
                       "type": "diagnostic_test"
                     },
                     {
                       "name": "abdominal CT scan showing a visible intussusceptum or soft tissue mass",
                       "type": "diagnostic_test"
                     }
                   ]
                 },
                 {
                   "logical_operator": "OR",
                   "name": "Evidence of intestinal vascular compromise",
                   "type": "criterion",
                   "values": [
                     {
                       "name": "blood per rectum",
                       "type": "symptom"
                     },
                     {
                       "name": "stool containing red currant jelly material",
                       "type": "symptom"
                     },
                     {
                       "name": "blood on rectal examination",
                       "type": "symptom"
                     }
                   ]
                 }
               ]
             },
             {
               "logical_operator": "AT_LEAST",
               "logical_operator_arguments": [
                 3
               ],
               "name": "Evidence of intestinal vascular compromise",
               "type": "criterion",
               "values": [
                 {
                   "logical_operator": "AND",
                   "name": "Predisposing factors: age \u003c1 year and male sex",
                   "type": "criterion",
                   "values": [
                     {
                       "attribute": "age",
                       "name": "Less than one year old",
                       "operator": "\u003c=",
                       "type": "demographic_criteria",
                       "unit": "years",
                       "value": 1
                     },
                     {
                       "attribute": "gender",
                       "name": "Male gender",
                       "operator": "==",
                       "type": "demographic_criteria",
                       "value": "male"
                     }
                   ]
                 },
                 {
                   "name": "abdominal pain",
                   "type": "symptom"
                 },
                 {
                   "name": "vomiting",
                   "type": "symptom"
                 },
                 {
                   "name": "lethargy",
                   "type": "symptom"
                 },
                 {
                   "name": "pallor",
                   "type": "symptom"
                 },
                 {
                   "name": "hypovolemic shock",
                   "type": "symptom"
                 },
                 {
                   "name": "Plain abdominal radiograph showing an abnormal but non-specific bowel gas pattern",
                   "type": "diagnostic_test",
                   "value": "abnormal but non-specific bowel gas pattern"
                 }
               ]
             }
           ]
         }
       ]
     }
   ],
   "keywords": [
     "Intussusception",
     "Asia"
   ],
   "language": "English",
   "location": "Vietnam",
   "open_syndrome_version": "1.0.0",
   "organization": "Vietnam Ministry of Health",
   "published_at": "2025-01-29T12:00:00Z",
   "published_by": [
     "Open Syndrome Initiative"
   ],
   "published_in": "https://opensyndrome.org",
   "references": [
     {
       "citation": "Validation of clinical case definition of acute intussusception in infants in Viet Nam and Australia",
       "url": "https://iris.who.int/handle/10665/269695"
     }
   ],
   "scope": "specific",
   "status": "draft",
   "target_public_health_threats": [
     "Intussusception"
   ],
   "title": "Open Syndrome Acute Intussusception in infants",
   "version": "1.0.0"
 }

Using the Definition #

Healthcare organizations can implement this definition through:

  • Direct integration with surveillance systems
  • API endpoints for real-time validation
  • Manual case verification processes

Next Steps #

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  • Clinical feedback on the definition criteria
  • Technical feedback on the implementation format
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  • Reports of implementation experiences

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