Pneumatic Reduction Of Intussusception In Children At The Komfo Anokye Hospital, Kumasi, Ghana

Abstract

Objective: To evaluate the role of pneumatic reduction in the management of intussusception in children in the setting of a sub-Saharan African nation. Design: Prospective case series. Setting: Tertiary care teaching hospital in Kumasi, Ghana. Subjects: Forty four children, aged 4 months to 13 years, 28 boys and 16 girls, were admitted with a clinical diagnosis of intussusception and confirmed by ultrasonography. Interventions: Twenty two children had air enema reduction of the intussusception attempted in the operation theatre under general anaesthesia. The average pressure used for air enema reduction of the intussusceptions was 110.4 mm Hg. Main outcome measures: Success of pneumatic reduction, morbidity and mortality.Results: Overall air enema reduction of intussusception was successful in 59.1% of children who underwent this procedure. There were no deaths among children who had a successful air enema reduction of intussusception. One child (11.1 %) out of nine who had laparotomy done after a failed pneumatic reduction died. The average length of hospital stay was shorter in those with successful air enema reduction (3.8 ± 2.3 days, 95% Confidence Interval [CI] = 2.4 to 5.2) than those who had a laparotomy performed for manual reduction of the intussusception after a failed pneumatic reduction (6.7 ± 5.1 days, 95% CI = 33 to 9.9). Conclusion: Although the sample size is small, pneumatic reduction of intussusception in children without peritonitis is possible, practical, and reliable and must be tried first, preferably under general anaesthesia in our sub-region before proceeding to laparotomy in case of failure.

Pneumatic reduction of intussusception in children at Korle Bu Teaching Hospital: An initial experience

“…We had a fairly high success rate of 67% which was higher than the 59.1% obtained in the other study in Ghana [10] but lower than the over 90% seen in studies in China and over 75% in North America. [2][3][4][5] Two factors that may have contributed to the apparently low success rate in our study were: delay in presentation to our facility (all but one of the cases that did not reduce had had the symptoms for at least 2 days) and the small numbers in our study where one patient was 5.6% of the sample.…”

“…[1,5,6] In Ghana, nonsurgical reduction was not started until January 2004 when it was commenced at Komfo Anokye Teaching Hospital. [10] Fluoroscopic-guided pneumatic reduction of intussusception was the first nonsurgical management of intussusception in children to be popularized at Korle Bu Teaching Hospital and was started in August, 2007.…”

“…Further in KATH an anaesthetist was required to give general anaesthesia by intubating and ventilating the child while in KBTH ketamine hydrochloride was used and carefully monitored without the need for intubation or ventilation. [10] Abraham el al. [13] in 2005 described a simple and safe technique for pneumatic reduction of intussusception where they used the height and water in an enema can to generate pressure for the reduction process.…”

“…However until August 2007, it had not been used for reduction of intussusception in children at Korle Bu Teaching Hospital (KBTH), Accra, Ghana, though the procedure had been started 3.5 years earlier (January 2004) at Komfo Anokye Teaching Hospital (KATH), the second largest Tertiary Hospital in Ghana, located in Kumasi, with significant success. [10] This technique is a fairly simple, cheap, quick and safe method of intussusception reduction which needs to be promoted in Ghana and other neighbouring countries that are yet to practice it.…”

Rescue by pneumoenema under general anaesthesia of apparently non-reducible intestinal intussusception

“…Our work shows that patients treated successfully by enema have shorter hospital stays and a lower rate of complications than those undergoing surgery ( Table 2) [1].…”