Reduction of intussusception in infants by a pediatric surgical team: improvement in safety and outcome

Abstract

Commonly, reduction of intussusception is performed by experienced radiologists. We review the performance of a pediatric surgical team for treating intussusception according to a standard protocol and present our findings. Three hundred and seventy eight patients with signs and symptoms of intussusception we treated from 1980 to 2005 were reviewed. Hydrostatic reduction (HR) was performed using a water-soluble contrast agent under fluoroscopy unless there was a serious condition clinically. Before 1998, HR was performed exclusively by pediatric surgical trainees (period A). In 1998, a standard protocol (double-balloon tube, maximum pressure of 120 cm H2O, repeated a maximum of five times, and HR performed by a pediatric surgical trainee under the supervision of a consultant pediatric surgeon) was adopted (period B). As part of the protocol, the operating room was notified of the HR procedure and placed on call for emergency surgery. Of the 378 patients, 21 required immediate laparotomy due to serious general condition, leaving 138 during period A and 219 during period B who had HR. Patient age, sex, and duration of symptoms (period A, 14.5 +/- 7.8 h; period B, 13.1 +/- 9.9 h) were not statistically significant. Success of HR during period A was 64.5%, and significantly improved for period B at 94.5% (P < 0.01). During period B, 128 of our patients had been referred from elsewhere for failed reduction attempted by radiologists or pediatricians. We were able to perform HR successfully in 118 of these (92.2%). During period A, it was significantly less at 54.0% (P < 0.01). Bowel perforation during HR occurred in two patients during period A (1.4%) and two patients during period B (0.9%), but the latter cases were transferred immediately for emergency surgery with good outcome. Reduction of intussusception by a pediatric surgical team would appear to be significantly safer with better outcome, and is thus more efficient.

Japanese guidelines for the management of intussusception in children, 2011

“…There is no direct comparison of reduction rates between the use of barium enema and water‐soluble iodinated contrast enema under fluoroscopy, but reduction rates using barium enema in the Japanese literature are 87–95%, 73,77,78,80 which is comparable with reduction rates of water‐soluble iodinated contrast enema 61,108,109 (level 4). There have been reports of comparison of reduction rates between the use of barium and air under fluoroscopy in the foreign literature.…”

“…Traditional practice dictates a barium column of 100 cm to a maximum of 120 cm if the intussusception is static 75,109,120 (level 4). One should be cautious that the pressure is different depending on the type of liquid and its dilution, even if the height of the column is the same.…”

A child with colo-colonic intussusception due to a large colonic polyp: Case report and literature review

“…[1] At our institution, a paediatric surgical team performs hydrostatic reduction (HR) according to a standardised protocol with excellent results. [2,3] However, colocolonic intussusception (CI) is an uncommon cause of intestinal obstruction in children and because it is sometimes not easily diagnosed, [4,5] treatment can be delayed, resulting in more radical surgical intervention, such as a bowel resection, [6] being required.…”

“…At the time of admission, her body temperature was 36.4°C, heart rate was 62 beats/min, respiratory rate was 25 breaths/min, and blood pressure was 112/66 mmHg. Her abdomen was slightly distended and a palpable mass was present in the left lower abdomen without signs of peritoneal irritation.After a meniscus sign was observed, HR was attempted according to our standardised protocol [3] [ Figure 2]. The CI was reduced successfully after two trials of HR.…”

“…After a meniscus sign was observed, HR was attempted according to our standardised protocol [3] [ Figure 2]. The CI was reduced successfully after two trials of HR.…”