Ultrasound guided hydrostatic reduction of intussusception in children by saline enema: our experience

Abstract

Background Intussusception is a common cause of acute intestinal obstruction with potentially serious complications. The treatment of choice is an attempt at initial non-operative treatment.Aim The purpose of the study was to evaluate the effi cacy of the technique of hydrostatic reduction of intussusception using saline enema and ultrasound being practiced in our institute; the secondary goal was to identify patient subset in which it is more successful. Material and MethodsThe case records of all patients treated for intussusception in our institute from 1st January 2000 to 30th June 2007 were retrospectively analyzed to collect information. All patients with ultrasound diagnosed intussusception that were not having signs of shock or peritonitis were treated with normal saline enema under ultrasound guidance. Failure of three such attempts was an indication for operation. Result and ConclusionsWe found that this technique is easy, safe and extremely effective in treating intussusception in children. The success rate was 81.37% (83 out of 102 cases) and mortality rate was 1.2%. Ileoileocolic type of intussusception failed enema reduction more often (statistically signifi cant; P value = 0.0032) while older patients (statistically signifi cant, P value = 0.001) had higher success rates with the technique. Patients who had colocolic type of intussusception (P value = 0.29) and patients who present early (P value = 0.262) appear to have higher success rates but this was not statistically signifi cant.

Ultrasound Guided Reduction of Intussusception with Saline and Evaluating the Factors Affecting the Success of the Procedure

“…Although previous studies have indicated that age can be an effective factor for the success of the procedure, the hypotheses proposed by these studies remain controversial. Karadag et al, Fallon et al, Khorana et al and Nayak et al suggested that age is an effective factor for the success of the procedure, whereas our study and 5 other studies found that age has no effect on the success of the procedure (15,19,23,25). Fallon also postulated that the success rate in patients aged below 1 year is relatively lower since these children may be reluctant to undertake the aggressive intervention performed by the radiologist (19).…”

“…A number of factors have been shown to affect the success of reduction with enema (Table 2) (15)(16)(17)(18)(19)(20). These factors include age, gender, history of vomiting, rectal bleeding, and abdominal pain, mesenteric lymphadenopathy, length of the invaginated segment measured on USG, presence of free abdominal fluid on USG, bowel wall thickness, duration of symptoms, sedation, lethargy, localization of the intussusception, severe dehydration, small bowel obstruction, rectal prolapse of the invaginated segment, airfluid level on radiography, distension, diarrhea, constipation and also number of reduction attempts ( Table 3).…”

An Easy, Safe and Effective Method for the Treatment of Intussusception: Ultrasound-Guided Hydrostatic Reduction

“…Literatürde ultrason eşliğinde hidrostatik redüksiyon yapılan olgularda başarı oranının %80 üzeri olduğu bildirilmiştir. [1,6,8,12] Çalışmamızda başarı oranını %84.6 olarak saptadık.…”

Hydrostatic Reduction Supported With External Manuel Reduction In Treatment Of Intussusception: A New Technical Synthesis

“…Intussusception, which is defined as telescopic insertion of proximal bowel segment into distal bowel segment, can be cured completely with surgical intervention. However, this treatment increases morbidity and mortality rates (4)(5)(6)(7)(8)(9). Therefore, global first-line treatments for intussusception include ultrasound-guided hydrostatic reduction (USGHR) or fluoroscopyguided air-enema reductions (1)(2)(3)(4)(5)(6)(7)(8)(9).…”

“…However, this treatment increases morbidity and mortality rates (4)(5)(6)(7)(8)(9). Therefore, global first-line treatments for intussusception include ultrasound-guided hydrostatic reduction (USGHR) or fluoroscopyguided air-enema reductions (1)(2)(3)(4)(5)(6)(7)(8)(9). There are various non-surgical techniques described in intussusception treatment such as air or liquid enemas, oral or topical treatments as well as manual manipulation of rectum (12,13).…”