OBJECTIVE:To investigate the predictive value of gastrointestinal decompression volume and its temporal trend for surgical intervention in children with postoperative adhesive small bowel obstruction (ASBO). METHODS:This retrospective study included 131 children with postoperative ASBO who initially received conservative treatment from January 2015 to December 2024. Based on treatment outcomes, patients were categorized into a successful conservative treatment group (CT, n = 80) and a surgical treatment group (ST, n = 51). Clinical data were collected, with emphasis on daily gastrointestinal decompression volume and its changes during conservative treatment. To account for weight differences, the unit weight gastrointestinal decompression volume (mL/kg) was adopted as the main variable. Generalized estimating equations (GEEs) were used to analyze dynamic trends. Predictive performance was evaluated using univariate binary logistic regression and receiver operating characteristic (ROC) curve analyses. RESULTS:From Day 1, GEE analysis showed a significant interaction between time and group (p = 0.049). The CT group showed a rapid decrease in unit weight gastrointestinal decompression volume (p < 0.001), whereas the ST group exhibited a slower decline. The ST group had significantly higher volumes than the CT group from Days 1-3. Decompression volumes on Days 1 and 2 were identified as significant predictors of surgery. Area under the curve values for predicting surgical need were 0.705 and 0.718 on Days 1 and 2, and the corresponding optimal cutoff values were 11.5 and 13.9 mL/kg, respectively. CONCLUSION:Unit weight gastrointestinal decompression volume and its trajectory may serve as useful predictors of the need for surgical treatment in pediatric postoperative ASBO.

Necrotizing enterocolitis (NEC) is a severe neonatal disease marked by intestinal injury, and epithelial damage has been linked to ferroptosis. This study aimed to determine the protective effect of Ferrostatin-1 (Fer-1), a ferroptosis inhibitor, on NEC-associated intestinal injury. NEC was induced in mouse pups via formula feeding, hypoxia, and lipopolysaccharide exposure. Fer-1 (5 mg/kg) was administered intraperitoneally on postnatal days 6 and 8. Intestinal tissues were analyzed for morphological injury, epithelial proliferation (Ki67), ferroptosis markers (Gpx4 and Tfr1), and lipid peroxidation (4-HNE). Human NEC intestinal organoids derived from surgical samples were treated with Fer-1 (2 µM) for 48 h. Levels of ferrous ion (FerroOrange), lipid peroxide (BODIPY), and reactive oxygen species (DCFDA) were measured. Fer-1 significantly reduced NEC-induced epithelial injury in mice, leading to improved intestinal morphology and increased epithelial proliferation, as indicated by elevated Ki67 expression. The protective effect was associated with reduced ferroptosis, demonstrated by upregulated Gpx4 expression and decreased levels of Tfr1 and 4-HNE. Similarly, in human NEC organoids, Fer-1 significantly reduced the accumulation of ferrous ions, lipid peroxides, and ROS. Fer-1 effectively protects against NEC-induced intestinal injury by inhibiting ferroptosis and reducing oxidative stress. These findings highlight its potential as a novel therapeutic strategy for managing intestinal damage in NEC.

BACKGROUND:Understanding the expression of non-coding RNA in the liver during embryonic development provides important insights into liver diseases. Therefore, we investigated circular RNA (circRNA) roles in human liver development, an unexplored research domain. METHODS:Using high-throughput sequencing and bioinformatics, we analysed foetal liver samples across developmental stages (7-20 weeks post-conception). Differentially expressed (DE) genes were identified and subjected to enrichment analysis using Gene Ontology (GO), Kyoto Encyclopaedia of Genes and Genomes (KEGG), and Disease Ontology (DO). Modular analysis was performed using the Search Tool for Retrieval of Interacting Genes (STRING), followed by construction of a protein-protein interaction (PPI) network using Cytoscape software. The key genes were screened using Molecular Complex Detection (MCODE). The mRNA levels of hub genes were validated using quantitative reverse transcription polymerase chain reaction (qRT-PCR). RESULTS:There were 645 DE circRNAs and 5,145 DE mRNAs between human livers at the three growth stages (HB, EH, and LH). It was found that the activity of circRNAs was boosted remarkably in the hepatoblastic stage. Enrichment analysis found they mainly involved in nervous system regulation of liver function, embryonic organ development and digestive system development. In addition, DE circRNAs were primarily involved in the PI3K-AKT, MAPK and calcium pathways, potentially contributing to adult liver diseases. Notably, only hsa_circ_001471 and novel_circ_017382 were simultaneously identified at all stages and were persistently downregulated. A co-expression regulatory network involving these circRNAs was established. Three hub genes (LGR5, FOXL1 and RSPO3) were identified from the PPI network of 167 genes and may play key roles in human liver development. The RT-qPCR validation results were in agreement with the sequencing data. CONCLUSIONS:Our findings provide the first insights into the roles and regulatory networks of circRNAs in human liver development, laying the groundwork for further investigations of molecular and signalling networks.

BACKGROUND:Non-operative treatment (NOT) has gained widespread acceptance as the initial therapy for pediatric patients with appendiceal abscess. The subsequent management methods encompass interval appendectomy (IA) and active observation (AO). The aim of the study is to compare the IA and AO alternatives after successful NOT of pediatric appendiceal abscess. METHODS:Systematic literature research of PubMed was performed for relevant studies published. Variables as length of hospital stay (LOS), recurrence rate, complication rate, cost, operative time were analyzed. RESULTS:Six articles were selected, including 396 patients with successful NOT of appendiceal abscess. 145 patients were in IA group while 251 patients were in AO group. There was no statistically significant difference in complication rate and cost was observed between IA and AO with recurrence group, while IA resulted in a shorter LOS and operative time. Moreover, the incidence rate of recurrence in AO was reported as 2.4%∼34.2%. The pooled estimate of the risk of recurrence was 9.9% (CI:4.8-20.6). CONCLUSION:Following successful NOT of pediatric appendiceal abscess, the choice of management options is still controversial. More well-designed randomized controlled trials are needed to discover optimal treatment strategy.

BACKGROUND:Ethylene thiourea (ETU), the primary metabolite of the ethylene bisdithiocarbamate (EBDC) class of fungicides, has several harmful health effects. Anorectal malformations (ARMs), which can be induced by ETU in rats, are congenital conditions in humans that often lead to postoperative defecation dysfunction despite advances in surgical methods. Spinal defecation center dysplasia has been observed during intrauterine development. However, the underlying pathological mechanisms remain unclear. METHODS:The potential molecular mechanisms were investigated using bioinformatics, RNA stability, RNA immunoprecipitation (RIP) assay, chromatin immunoprecipitation (ChIP)-quantitative real-time polymerase chain reaction (ChIP-qPCR), and dual-luciferase reporter assays in HEK 293 T cells. Western blotting and qRT-PCR were used to explore the biological functions of the indicators in HEK 293 T cells and samples from ETU-induced ARM fetal rat models. Transamniotic microinjection was performed in fetal rat models with ARM. RESULTS:Abnormally elevated microRNA (miR)-205 levels were observed in fetal rats with ARMs, and miR-205 inhibited LCOR expression by binding to its 3'-UTR. Subsequently, TAL1 was identified through bioinformatic analysis as an upstream transcriptional regulator of miR-205. TAL1 positively regulates miR-205 transcription by binding directly to a novel AGATAAG motif in the miR-205 promoter. In addition, TAL1 upregulation was demonstrated to be stabilized by IGF2BP1 in an m6A-dependent manner. Mechanistically, IGF2BP1 serves as a reader for m6A-modified TAL1 through its RRM1-2 domain directly binding with TAL1 and modification at 1549 adenosine within the m6A motif "GGACU" of TAL1. Functionally, IGF2BP1-stabilized TAL1 promotes lipid accumulation by activating the miR-205-LCOR axis. Notably, intra-amniotic microinjection of LCOR restored excessive lipogenesis in rat embryos with ARMs. CONCLUSIONS:These findings indicate that the novel IGF2BP1/TAL1/miR-205/LCOR axis leads to lipid accumulation. Additionally, intra-amniotic injection of LCOR helps restore abnormal lipid metabolism in the lumbosacral defecation center of rats with ETU-induced ARMs during embryogenesis.

This study aimed to evaluate the characteristics of congenital lung malformations (CLMs) in patients from infancy to adulthood, and to determine the optimal timing for thoracoscopic surgery. All patients with CLMs who underwent thoracoscopic surgery between 2017 and 2023 were retrospectively reviewed. The patients were divided into five age groups: 1–6 months, 6–12 months, 1–4 years, 4–16 years, and >16 years. Clinical characteristics and surgical outcomes were compared and analyzed for variance among the age groups. A total of 173 patients with CLM were included. Thirteen (7.5 Conclusion: Thoracoscopic surgery for CLMs is safe and feasible at all ages. Age < 4 years may predict uneventful surgical outcomes due to fewer operative adhesions.

BACKGROUND:Pediatric liver tumors are predominantly primary malignant tumors, and complete tumor resection with sufficient preservation of liver tissue is crucial for improving prognosis. However, due to the delicate anatomical structure of the pediatric liver and the relatively large size of the tumors, especially in difficult cases, the surgical challenges are substantial. While precision liver surgery are widely applied in clinical practice, pediatric cases require more customized approaches. The application of three-dimensional (3D) visualization technology is crucial for enhancing surgical accuracy, allowing for precise preoperative planning and intraoperative guidance. METHODS:This consensus was collaboratively developed by 36 experts from eight countries, using the Glaser's state-of-the-art method to review and refine the draft. RESULTS:The final consensus resulted in 15 international multidisciplinary consensus recommendations on clinical application of 3D visualization in precision surgery for pediatric liver tumors. CONCLUSION:This consensus will standardize the application of 3D visualization technology in precision surgery for pediatric liver tumors to improve outcomes and reduce risks.

Nonsyndromic cleft lip with palate (nsCLP) is a common birth defect disease. Current diagnostic methods comprise fetal ultrasound images, which are mainly limited by fetal position and technician skills. We aimed to identify reliable maternal serum lipid biomarkers to diagnose nsCLP. Eight-feature selection methods were used to assess the dysregulated lipids from untargeted lipidomics in a discovery cohort. The robust rank aggregation algorithm was applied on these selected lipids. The data were subsequently processed using 7 classification models to retrieve a panel of 35 candidate lipid biomarkers. Potential lipid biomarkers were evaluated using targeted lipidomics in a validation cohort. Seven classification models and multivariate analyses were constructed to identify the lipid biomarkers for nsCLP. The diagnostic model achieved high performance with 3 lipids in determining nsCLP. A panel of 3 lipid biomarkers showed great potential for nsCLP diagnosis. FA (20:4) and LPC (18:0) were also significantly downregulated in early serum samples from the nsCLP group in the additional validation cohort. We demonstrate the applicability and robustness of a machine-learning algorithm to analyze lipidomic data for efficient and reliable biomarker screening.

Anorectal malformation (ARM), a common congenital anomaly of the digestive tract, is a result of insufficient elongation of the urorectal septum. The cytoplasmic protein Receptor of Activated C-Kinase 1 (Rack1) is involved in embryonic neural development; however, its role in embryonic digestive tract development and ARM formation is unexplored. Our study explored the hindgut development and cell death mechanisms in ARM-affected rats using spatial transcriptome analysis. We induced ARM in rats by administering ethylenethiourea via gavage on gestational day (GD) 10. On GDs 14-16, embryos from both normal and ARM groups underwent spatial transcriptome sequencing, which identified key genes and signalling pathways. Rack1 exhibited significant interactions among differentially expressed genes on GDs 15 and 16. Reduced Rack1 expression in the ARM-affected hindgut, verified by Rack1 silencing in intestinal epithelial cells, led to increased P38 phosphorylation and activation of the MAPK signalling pathway. The suppression of this pathway downregulated Nqo1 and Gpx4 expression, resulting in elevated intracellular levels of ferrous ions, reactive oxygen species (ROS) and lipid peroxides. Downregulation of Gpx4 expression in the ARM hindgut, coupled with Rack1 co-localisation and consistent mitochondrial morphology, indicated ferroptosis. In summary, Rack1, acting as a hub gene, modulates ferrous ions, lipid peroxides, and ROS via the P38-MAPK/Nqo1/Gpx4 axis. This modulation induces ferroptosis in intestinal epithelial cells, potentially influencing hindgut development during ARM onset.

Background: The first robotic surgery in children and adult happened in more or less that same time but the development in children subsequently lagged behind especially for complicated operations such as robotic- assisted hepaticojejunostomy for choledochal cyst (RHCC). In order to achieve a high standard for this operation, expert consensus was developed among Chinese experts with ample experience in RHCC. Methods: Thirty experts from twenty-six institutions experts participated in the consensus meeting. A Screening Committee was established to performed a comprehsenive literature review on RHCC. A few specific topics have been proposed based on the review but only topics which were agreed upon were discussed during the meeting using Delphi Rounds. Lastly, formulated recommendations were proposed by the Committee and finalized in the expert consensus meeting. Results: After initial screening and discussion, nine topics were selected for discusssion. Eight recommendation statements were formulated. All recommendations reached more than 80 % consensus among experts at the final Delphi Round. Conclusions: The consensus statementson RHCC in children were based on available international literatures and experience from Chinese experts. These statements helpto standardize the surgical techniques and prevent surgical complications during RHCC.

Abstract Purpose To compare the clinical characteristics, surgical management and prognosis of mesenteric lymphatic malformations (ML) and omental lymphatic malformations (OL) in children. Methods This retrospective study included 148 ML patients and 53 OL patients who underwent surgical treatment at two centers between January 2016 and December 2022. Details about the patients’ clinical characteristics, cyst characteristics, preoperative complications, surgical methods, and prognosis were retrieved and compared. Results No significant differences in sex ratio, prenatal diagnosis, or age of diagnosis were noted between ML and OL patients. Vomiting was more common in ML patients than in OL patients (46.6% vs. 22.6%, P = 0.002), but OL patients were more likely to be misdiagnosed (35.8% vs. 18.9%, P = 0.012). The size of the cysts in OL patients was significantly larger than that in ML patients (14.0 [4.0–30.0] vs. 10.0 [2.0–50.0] cm, P<0.001), and cysts with turbid fluid were more common in OL patients (38.0% vs. 20.6%, P<0.001). More OL patients than ML patients had preoperative hemorrhage or infection of cysts (41.5% vs. 31.8%, P<0.016). Cyst excision was performed in 137 (92.6%) ML patients and 51 (96.2%) OL patients, and the incidence of postoperative complications was lower (12.6% vs. 4.2%, P = 0.165) among OL patients. The main postoperative complications included adhesive ileus and recurrence of cysts. Additionally, more OL patients than ML patients were treated with laparoscopic surgery (69.8% vs. 39.2%, P<0.001). Conclusions There were differences in clinical characteristics, cyst characteristics and preoperative complications between ML and OL patients. Cyst excision was the most common surgical method that was used to treat both ML and OL patients, and laparoscopic surgery could be a feasible surgical approach for treating OL patients with a good prognosis. Trial registration Retrospectively registered.

Anorectal malformations (ARMs) are congenital diseases that lead to postoperative fecal incontinence, constipation, and soiling, despite improvements in surgery; however, their pathological mechanisms remain unclear. Here, we report the role of microRNA-141-3p in maintaining homeostasis between apoptosis and autophagy in the lumbosacral defecation center of fetal rats with ARMs. Elevated microRNA-141-3p expression inhibited YIN-YANG-1 expression by binding its 30 UTR, and repressed autophagy and triggered apoptosis simultaneously. Then, adenylate cyclase 3 was screened to be the downstream target gene of YIN-YANG-1 by chromatin immunoprecipitation sequencing experiments, and Yin Yang 1 could positively activate the transcription of adenylate cyclase 3 by directly interacting with the motif GAGATGG and ATGG in its promoter. Intraamniotic microinjection of adeno-rno-microRNA-141-3psponge-GFP in fetal rats with ARMs on embryonic day 15 restored apoptosis-autophagy homeostasis. These findings reveal that microRNA-141-3p upregulation impaired homeostasis between apoptosis and autophagy by inhibiting the YINYANG-1/adenylate cyclase 3 axis, and that intraamniotic injection of anti-microRNA-141-3p helped maintain homeostasis in the lumbosacral defecation center of ARMs during embryogenesis.

Understanding non-coding RNA expression in the liver during embryogenesis holds key insights into liver disease occurrences. Therefore, we investigated circular RNA (circRNA) roles in human liver development, an unexplored research domain. Employing high-throughput sequencing and bioinformatics technology, we analyzed fetal liver samples across developmental stages (7–20 post-conception weeks). Our findings revealed significant differential expression of 645 circRNAs and 5,145 messenger RNAs during human liver development. Notably, hsa_circ_001471 and novel_circ_017382 were persistently downregulated. Gene Ontology assessments implicated nervous system regulation of liver function, embryonic organ development, and digestive system development. Kyoto Encyclopedia of Genes and Genomes implicated PI3K-AKT, MAPK, and calcium pathways, potentially contributing to adult liver disease. A competitive endogenous RNA modulatory network of hsa_circ_001471 and novel_circ_017382 was established, and RT-qPCR validated RNA sequencing results. Our findings provide insights into circRNA roles and regulatory networks in human liver development, offering a foundation for further molecular and signaling network investigations.

Ethylene thiourea (ETU), a metabolite of the fungicide ethylene bisdithiocarbamate (EBDC), has received great concern because of its harmful effects. ETU-induced anorectal malformations (ARMs) in rat models have been reported and widely used in the study of ARMs embryogenesis. Dysplasia of the lumbosacral spinal cord (LSSC), pelvic floor muscles (PFMs), and hindgut (HG) during intrauterine life affects postoperative defecation in patients with ARMs. However, the underlying toxic effects of ETU and pathological mechanisms in the three defecation-related tissues of fetuses with ARMs have not been reported. Thus, this study aimed to elucidate the molecular mechanisms involved in ARMs, with a focus on the dysregulation of miR-200b-3p and its downstream target tropomodulin 3 (TMOD3). The mRNA and protein levels of miR-200b-3p and TMOD3 in LSSC, PFMs, and HG of fetal rats with ARMs were evaluated by reverse transcription quantitative polymerase chain reaction and Western blotting (WB) on embryonic day 17 (E17). Further, a dual-luciferase reporter assay confirmed their targeting relationship. Gene silencing and overexpression of miR-200b-3p and TMOD3 were performed to verify their functions in HEK-293 T cells. Fetal rats with ARMs also received intra-amniotic microinjection of AdTMOD3 on E15, and key molecules in nuclear factor kappa (NF-kappa B) signaling and apoptosis were evaluated by WB on E21. Abnormally high levels of miR-200b-3p inhibited TMOD3 expression by binding with its 3 '-un- translated region, leading to the activation of the non-canonical NF-kappa B signaling pathway, which is critical in the maldevelopment of LSSC, PFMs, and HG in ARMs rats. Furthermore, miR-200b-3p triggered apoptosis by directly targeting TMOD3. Notably, intra-amniotic Ad-TMOD3 microinjection revealed that the upregulation of TMOD3 expression mitigates the effects of miR-200b-3p on the activation of non-canonical NF-kappa B signaling and apoptosis in fetal rat model of ARMs. A novel miR-200b-3p/TMOD3/non-canonical NF-kappa B signaling axis triggered the massive apoptosis in LSSC, PFMs, and HG of ARMs, which was restored by the intra-amniotic injection of AdTMOD3 during embryogenesis. Our results indicate the potential of TMOD3 as a treatment target to restore defecation.

Background: Anorectal malformations (ARMs) are among the most common congenital digestive tract malformations worldwide. Although there have been extensive efforts for elucidating their pathogenesis, the specific molecular mechanisms underlying ARMs remain unclear. Methods: We generated ARM Wistar rat models using ethylenethiourea. Nine pregnant rats were allocated to the ARM and control groups, respectively. Hindgut tissue was isolated from embryos collected on gestational days 14, 15, and 16, representing the key timepoints of anorectal development. High-throughput sequencing was used to identify differentially expressed genes. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed on the obtained genes. Module analysis was performed via Search Tool for the Retrieval of Interacting Genes (STRING), and a protein-protein interaction (PPI) network was constructed using Cytoscape software. Gene Set Enrichment Analysis (GSEA) was conducted to verify the enrichment of development/apoptosis/epithelium/morphogenesis/Wnt pathway-related core gene sets and identify ARM hub genes. Reverse transcription-quantitative polymerase chain reaction assay was employed to verify mRNA levels of hub genes. Results: 313 GSEA core genes form ten core gene sets were selected. Based on the 281 differentially expressed circRNAs (|Fc| > 2, FDR < 0.05), 42 PPI core genes were obtained. According to the integration of GSEA analysis and PPI network, three hub genes (Cul1, Gli3, and Osr2) highly associated with ETU-induced ARMs were identified. The qRT-PCR validation data were consistent with the sequencing results. Conclusions: These results provide a theoretical basis for the further identification of potential diagnostic and therapeutic targets in ARMs.

The discovery of N6-methyladenosine (m6A) methylation and its role in translation has led to the emergence of a new field of research. Despite accumulating evidence suggesting that m6A methylation is essential for the pathogenesis of cancers and aging diseases by influencing RNA stability, localization, transformation, and translation efficiency, its role in normal and abnormal embryonic development remains unclear. An increasing number of studies are addressing the development of the nervous and gonadal systems during embryonic development, but only few are assessing that of the immune, hematopoietic, urinary, and respiratory systems. Additionally, these studies are limited by the requirement for reliable embryonic animal models and the difficulty in collecting tissue samples of fetuses during development. Multiple studies on the function of m6A methylation have used suitable cell lines to mimic the complex biological processes of fetal development or the early postnatal phase; hence, the research is still in the primary stage. Herein, we discuss current advances in the extensive biological functions of m6A methylation in the development and maldevelopment of embryos/fetuses and conclude that m6A modification occurs extensively during fetal development. Aberrant expression of m6A regulators is probably correlated with single or multiple defects in organogenesis during the intrauterine life. This comprehensive review will enhance our understanding of the pivotal role of m6A modifications involved in fetal development and examine future research directions in embryogenesis.

Background: Management of intractable constipation is still challenging in children. Fecal impaction has been considered a common cause while retrograde colonic enema(RCE) is an effective method for this condition. Fecal microbiota transplantation(FMT) has also demonstrated great potential in many gastrointestinal diseases. However, the efficacy of RCE with FMT in childhood constipation remains unclear.Methods: A randomized, double-blind, controlled trial with 110 children who met the inclusion criteria was conducted. The subjects were randomly assigned to the FMT with RCE group or the placebo with RCE group. The duration of FMT treatment was 4 weeks, with a 12-week follow-up. The main observations were complete spontaneous bowel movements and bowel function satisfaction, and the adverse effects were assessed based on symptoms.Findings: At the end of follow-up, the effectiveness rates in the FMT with RCE and placebo with RCE groups were 43.64% and 21.82%, respectively (χ2 =11.24, P < 0.05). Compared with the end of treatment, there were eight recurrences (25.00%) in the FMT with RCE group and three recurrences (20.00%) in the placebo with RCE group( P >0.05). Among the primary outcome indicators, 27 patients (49.09%) in the FMT with RCE group and 15 patients (27.27%) in the placebo with RCE group were satisfied with defecation (χ2 =5.55, P <0.05). In total, 22 patients (40.00%) in the FMT with RCE group and 10 patients(18.18%) in the placebo with RCE group had complete spontaneous bowel movements for ≥ 3 weeks (χ2 =6.35, P <0.05). No adverse effects were found in all recruited cases.Interpretation: FMT enhances the efficacy of RCE and the use of RCE based FMT is a safe and effective method in the treatment of intractable constipation in children.Trial Registration Details: The study protocol was registered prospectively (https://clinicaltrials.gov/; registration number: NCT 05035784).Funding Information: This study was supported by the National Natural Science Foundation of China (No. 81570465, 30700917) and the General Funding Project from Department of Education of Liaoning Province (No. JC2019014).Declaration of Interests: We declare no competing interests.Ethics Approval Statement: The Ethics Committee of China Medical University (2018PS427K) approved the protocol, and written informed consent was obtained from all parents.

OBJECTIVE:Bowel perforation is a major, yet unstudied complication of ultrasound-guided hydrostatic enema reduction (UGHR). In this study, we aimed to explore the risk factors and determine the clinical characteristics of bowel perforation during UGHR for paediatric intussusception (P-UGHR). METHODS:We retrospectively analysed the medical records of patients who underwent UGHR for intussusception at our institution between January 2011 and December 2021. The patients were divided into the P-UGHR and no P-UGHR groups. Univariate and multivariate logistic regression analyses were performed to analyse the risk factors for P-UGHR, and the clinical characteristics of patients with P-UGHR were determined. RESULTS:The final analysis included 4961 intussusception episodes. We identified 15 patients [eight male (53.3%); median age, 8.73 months; age range, 3-17 months] with P-UGHR. All P-UGHR cases involved colonic perforations without necrosis distal to the intussusception mass. The perforations were located in the ascending [40% (6/15)], transverse [46.7% (7/15)] or descending colon [13.3% (2/15)]. Age ≤10.5 months [odds ratio (OR), 3.636; 90% confidence interval (CI), 1.274-10.38; P = 0.043], bloody stools (OR, 4.189; 90% CI, 1.352-12.978; P = 0.037) and symptom duration >17.5 h (OR, 0.188; 90% CI, 0.053-0.666; P = 0.03) were independent risk factors for P-UGHR. CONCLUSION:Age ≤10.5 months, bloody stools and symptom duration >17.5 h were independent risk factors for P-UGHR. Caution should be exercised during UGHR in patients aged ≤10.5 months, with bloody stools or symptom duration >17.5 h.