Efficacy of fluoroscopy-guided hydrostatic reduction of acute ileocolic intussusception in children-one center experience
Keywords:
Children, Intussusception, Fluoroscopy, Hydrostatic reductionAbstract
Abstract
Background: Intussusception is one of the common causes of acute abdomen in children with male preponderance. Most of the cases are idiopathic in origin. Abdominal ultrasound is the modality of choice to diagnose this condition. Reduction either by hydrostatic or pneumatic technique, is the first modality of the therapeutic approach, while failed cases necessitate surgical intervention.
Methods: In this retrospective study, 31 patients underwent fluoroscopy-guided hydrostatic reduction of ileocolic intussusception, between May 2017 to January 2023. The data of all patients, consisting of age, sex, and presenting complaint, were retrieved from the hospital's electronic database record. At presentation, all patients were adequately resuscitated, and all basic investigations were achieved. The preliminary diagnosis of intussusception, based on history and examination, was confirmed by abdominal ultrasound, in all patients. The hydrostatic reduction was attempted in all cases lacking signs and symptoms of peritonitis and shock, irrespective of the duration of symptoms. Patients with successful reduction were observed overnight and discharged the next day. Surgical intervention was performed in failed/incomplete reduction cases.
Results: Among 31 children (up to 5 years of age), 23 (74.20%) were male and 8 (25.80%) were female (male to female ratio: 2.8:1). In our study 58.06% cases presented within the first 24 hours of onset of symptoms, followed by 32.25% and 9.68% between 24-48 hours and 48-96 hours respectively. A high success rate (83.33%) was observed in patients who presented within 24 hours, followed by patients who presented between 24-48 hours (50%) and 48-96 hours (33.33%). Overall, hydrostatic reduction was successful in 67.74% of cases. Ten patients (32.26%) needed surgical intervention.
Conclusion: Fluoroscopy-guided hydrostatic reduction of intussusception is an effective therapeutic modality that avoids surgery and anesthesia-related risks. Early presenting patients showed a high success rate which signifies the importance of quick diagnosis. We suggest that if there is no contraindication, all cases, regardless of duration, should be attempted for hydrostatic reduction as late-presenting patients can also benefit from this modality
Downloads
Metrics
References
Yang H, Wang G, Ding Y, Li Y, Sun B, Yue M, Wang J. Effectiveness and safety of ultrasound-guided hydrostatic reduction for children with acute intussusception. Science Progress 2021; 104(3): 1–10. DOI: 10.1177/00368504211040911.
Mensah Y, Glover AH, Etwire V, Appeadu WM, Twum M. Ultrasound guided hydrostatic reduction of intussusception in children at korle bu teaching hospital: an initial experience. China Medical Journal 2011; 45(3): 128-131.
Tagbo BN, Ezomike UO, Odetunde OA, Edelu BO, Eke BC, Amadi OF, Okeke IB, Ani O, Chukwubuike CM, Mwenda JM, Ekenze SO. Intussusception in children under five years of age in Enugu, Nigeria. Pan African Medical Journal. 2021;39(1):9. Doi: 10.11604/pamj.supp.2021. 39.1.20811.
Kevin Emeka Chukwubuike et al. Hydrostatic reduction of intussusception in children: a single centre experience. Pan African Medical Journal. 2020;36(263). 10.11604/pamj.2020.36.263.21380.
Grace DPS, Patrick PR, Edward JY, Lee. Practical Imaging Strategies for Intussusception in Children. AJR 2020; 215:1449–1463. Doi.org/10.2214/AJR.19.22445.
Ogundoyin OO, Atalabi OM, Lawal TA, Olulana DI. Experience with sonogram-guided hydrostatic reduction of intussusception in children in south-west Nigeria. Journal of the West African College of surgeons. 2013; 3(2): 76-88.
Kobborg M, Knudsen KBK, Ifaoui IBR, Rasmussen L, Qvist N, Ellebæk MB. Early diagnosis and treatment for intussusception in children is mandatory. Dan Med J 2021;68(3): A09200680.
Martore ML, Kornblith AE, Kohn MA, Gottlieb M. Diagnostic Accuracy of Point-of-Care Ultrasound for Intussusception in Children Presenting to the Emergency Department: A Systematic Review and Meta-analysis. Western Journal of Emergency Medicine. 2020; 21(4): 1008-1016. DOI: 10.5811/westjem.2020.4.46241.
Khorana J, Singhavejsakul J, Ukarapol N, Laohapensang M, Wakhanrittee J, Patumanond J. Enema reduction of intussusception: the success rate of hydrostatic and pneumatic reduction. Therapeutics and Clinical Risk Management. 2015;11: 1837-1842.
Ito Y, Kusakawa I, Murata Y, Ukiyama E, Kawase H, Kamagata S, Ueno S, Osamura T, Kubo M, Yoshida M. Japanese guidelines for the management of intussusception in children, 2011. Pediatrics International. 2012; 54:948–958. Doi: 10.1111/j.1442-200X.2012.03622.
Doo JW, Kim SC. Sedative reduction method for children with intussusception. Medicine 2020; 99:5(e18956). http://dx.doi.org/10.1097/MD.0000000000018956.
Vujović D, Lukač M, Sretenović A, Krstajić T, Ljubić V, Antunović SS. Indications for Repeated Enema Reduction of Intussusception in Children. Srp Arh 2014;142(5-6):320-324. DOI: 10.2298/SARH1406320V.
Turner D, Rickwood AMK, Brereton RJ. Intussusception in older children. Archives of Disease in Childhood 1980; 55:544-546.
Van den Ende ED, Allema JH, Hazebroek FWJ, Breslau PJ. Success with hydrostatic reduction of intussusception in relation to duration of symptoms. Arch Dis Child 2005; 90:1071–1072. Doi:10.1136/adc.2004.066332.
Eraki ME. A comparison of hydrostatic reduction in children with intussusception versus surgery: Single-centre experience. Afr J Paediatr Surg 2017; 14:61-4. DOI: 10.4103/ajps.AJPS_102_16.
The INCLEN Intussusception Surveillance Network Study Group BMC Pediatrics. Prospective surveillance for intussusception in Indian children aged under two years at nineteen tertiary care hospitals. 2020; 20:413. https://doi.org/10.1186/s12887-020-02293-5.
Xiaolong X, Yang W, Qi W, Yiyang Z, Bo X. Risk factors for failure of hydrostatic reduction of intussusception in pediatric patients. Medicine 2019; 98:1(e13826). Doi.org/10.1097/MD.0000000000013826
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Dr. Muhammad Afzal Sipra
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
