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Kabeer A, Thomas R, John S, Thomas J, Davis D. The Changing Face of Childhood Intussusception: A Refinement in the Technique of Saline Reduction and Outcome. J Indian Assoc Pediatr Surg 2024; 29:19-22. [PMID: 38405251 PMCID: PMC10883185 DOI: 10.4103/jiaps.jiaps_154_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 02/27/2024] Open
Abstract
Aims Intussusception is a common pediatric surgical emergency and an indicator for primary healthcare. We report our experience with childhood intussusception at a tertiary care hospital in the private sector in Central Kerala and add our refinement to the technique of hydrostatic saline reduction which had more desirable outcome. Settings and Design Children presenting with the diagnosis of intussusception which were managed in our department of pediatric surgery at a private hospital in Kerala, India. Subjects and Methods Eighty children, up to 15 years of age, (43 boys, 37 girls) confirmed to have intussusception on ultrasound and managed in our institution from October 2016 to July 2020 with hydrostatic saline reduction. Sixty-two (77%) of them were aged 3 months to 3 years (numbers <10 to be written in words); the age of idiopathic intussusception. Statistical Analysis Used SPSS V25. Association between variables using Chi square test and independent t test. Results A total of 80 children met the criteria out of that (n = 79) had successful nonoperative reduction. Hydrostatic saline enema 73, One Barium and five air enema. A child presented in shock was taken up for laparotomy and reduced operatively. Six recurred within 24 h (7% early recurrence) and a second attempt at nonoperative reduction succeeded in all six of them. (numbers <10 in words). Eleven children (14%) had a late recurrence, the attempt at saline hydrostatic reduction was successful in only 3 (27%) and 8 went on to have surgery. Six were successfully reduced operatively and 2 had resection anastomosis. Conclusions After excluding those who need surgery on clinical grounds, we report a 98.7% success with nonoperative reduction for the first instance of intussusception, a 24 h recurrence of 7%, with successful repeat reductions in all. With the refinement in the technique, we could achieve a desirable outcome. At the first presentation, surgery was indicated in 1 of the 80 children. We report a late recurrence rate of 14%, with a 27% success rate for nonoperative reduction. No pathological lead points were identified even in this group. All the children had an uneventful and a faster recovery. In our series, we had 97.5% follow-up rate.
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Affiliation(s)
- Ahamed Kabeer
- Department of Paediatric Surgery, Rajagiri Hospital, Aluva, Kerala, India
| | - Reju Thomas
- Department of Paediatric Surgery, KIMS, Thiruvananthapuram, Kerala, India
| | - Susan John
- Department of Clinical Epidemiology, Rajagiri Hospital, Aluva, Kerala, India
| | - John Thomas
- Department of Paediatric Surgery, Rajagiri Hospital, Aluva, Kerala, India
| | - Dixi Davis
- Department of Paediatric Surgery, Rajagiri Hospital, Aluva, Kerala, India
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Tan SK, Tan CW, Hassan J, Nallusamy MA, Boo JA, Puspanathan P. Sphacelation with auto-anastomosis of the intestine: a rare outcome of intussusception in a child—a case report. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00103-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Intussusception is the telescoping of a proximal segment of the bowel into a distal segment. It can be idiopathic or pathological. Children commonly present with colicky abdominal pain, vomiting, a palpable abdominal mass, and bloody stools. Our case describes the unusual presentation of bowel sphacelation with auto-anastomosis in a child with intussusception and its clinical progression.
Case presentation
A 3-year-old boy with underlying stage IV rhabdomyosarcoma of the left orbit presented with high-grade fever and diarrhea for 1 day. He was treated for neutropenic sepsis in view of low absolute neutrophil count and recent history of chemotherapy. During his admission, he developed abdominal distension, high bilious aspirates, and diarrhea with bloody stools. Abdominal X-ray showed dilated bowel loops. Impression was septic ileus with coagulopathy. He was treated with blood transfusion and bowel rest. On the 6th day of illness, he passed out a tubular structure per rectum which was confirmed to be a segment of gangrenous bowel by histopathological examination. A diagnosis of intussusception with bowel sphacelation was made. He was treated conservatively, and his obstruction was resolved. He was discharged well with no abdominal symptoms during follow-up.
Conclusion
Intussusception is a common cause of small bowel obstruction in children. A high index of suspicion of intussusception should be maintained in children presenting with vomiting and bloody stools complemented by ultrasound to avoid missing this diagnosis. Sphacelation of the intussuscepted bowel with auto-anastomosis is a rare presentation of intussusception with a favorable outcome.
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Karakuş OZ, Sabuncu S, Ulusoy O, Sarioglu FC, Güleryüz H, Ateş O, Hakgüder G, Olguner M, Akgür FM. Ultrasound-guided hydrostatic enema reduction of intussusception and confirmation with single abdominal radiograph in children. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:451-455. [PMID: 33782988 DOI: 10.1002/jcu.23012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE To detect false-positive reduction results after ultrasound (US)-guided hydrostatic intussusception reduction, we have incorporated water-soluble contrast material to the enema fluid and confirmed the reduction with a single abdominal radiograph. We present the results of the combined imaging method for the reduction of intussusception in children. MATERIALS AND METHODS The records of the patients who were treated for intussusception were analyzed retrospectively. Patients were divided into two groups: a US-guided reduction group and a US-guided reduction plus radiographic control group. The patient characteristics, symptoms, treatment methods, outcomes, and complications and follow-up were analyzed. RESULTS A total of 164 intussusception episodes were treated in 153 patients. Hydrostatic reduction of intussusception was performed in 59 patients in the US-guided group and in 94 patients in the US-guided plus radiographic control group. Recurrence rate in the US-guided group was 15.7%, vs 3.5% in the US-guided plus radiography group (P = .029). In the US-guided plus radiographic control group, 5 (5.3%) false positive reductions under US guidance were determined by abdominal radiography. CONCLUSION In order to decrease false positive reduction rate and early recurrence, US-guided intussusception reduction can be performed with saline plus water-soluble contrast material and confirmation of reduction obtained with a single direct abdominal radiograph.
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Affiliation(s)
- Osman Z Karakuş
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Serra Sabuncu
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Oktay Ulusoy
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Fatma Ceren Sarioglu
- Division of Pediatric Radiology, Department of Radiology, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Handan Güleryüz
- Division of Pediatric Radiology, Department of Radiology, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Oğuz Ateş
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Gülce Hakgüder
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Mustafa Olguner
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Feza M Akgür
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
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Abstract
OBJECTIVE. Intussusception is the most common cause of intestinal obstruction in young children. Radiology has a key role in its diagnosis and treatment. This systematic review summarizes the currently available evidence for best practices in radiologic management of pediatric intussusception. CONCLUSION. High diagnostic accuracy and lack of ionizing radiation make ultrasound (US) the preferred imaging modality for diagnosing intussusception. For intussusception reduction, fluoroscopy-guided pneumatic enema and US-guided hydrostatic enema are equally dependable and safe techniques. The areas that warrant further research in this field include the efficacy and safety of the US-guided pneumatic enema, potential benefits of sedation and general anesthesia for the reduction procedure, and the optimal management of intussusceptions potentially involving pathologic lead points.
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Tanger R, Singh AP, Gupta AK, Barolia DK, Shukla AK. Nonavailability of Ultrasound: Try Stethoscope in Pneumatic Reduction. J Indian Assoc Pediatr Surg 2020; 25:76-79. [PMID: 32139984 PMCID: PMC7020676 DOI: 10.4103/jiaps.jiaps_129_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/03/2018] [Accepted: 10/26/2019] [Indexed: 11/04/2022] Open
Abstract
Aim and Objective This study aimed to finding alternative ways for centers with nonavailability of ultrasonography or fluoroscopy for nonoperative pneumatic reduction of intussusceptions. Materials and Methods A total of 48 cases of intussusceptions were included in the study in-between October 2016 and March 2018. We tried stethoscope-guided pneumatic reduction using locally assembled equipment. The intraluminal pressure was monitored and maintained below 100 mmHg. A total of two attempts of 3 min each were allowed. We compared our results with the control group who have been performing laparotomy for every case of intussusception. Results There were 35 males and 13 females in our study. The average age of the patients was 7.5 months. Intussusceptions were reduced in 38 (80%) patients but could not be reduced in 10 (20%) patients. Majority of the intussusceptions had symptoms of at least 2 days. There were no complications such as perforation in our study. Conclusion Stethoscope-guided pneumatic reduction seems to be a feasible and alternative effective method for the treatment of intussusceptions in children where availability of ultrasonography and skilled radiologist with overburden of work is a great issue.
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Affiliation(s)
- Ramesh Tanger
- Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India
| | - Aditya Pratap Singh
- Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India
| | - Arun Kumar Gupta
- Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India
| | | | - Arvind Kumar Shukla
- Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India
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Beger B, Duz E, Kizilyildiz BS, Akdeniz H, Melek M, Agengin K, Avci V, Sonmez B. A new enema for treatment of intussusception with hydrostatic reduction: Olive oil. Afr J Paediatr Surg 2019; 16:14-16. [PMID: 32952134 PMCID: PMC7759078 DOI: 10.4103/ajps.ajps_83_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Intussusception is routinely treated using ultrasound-guided hydrostatic reduction (USGHR) with normal saline in our paediatric surgery department. With this study, olive oil was added to normal saline in ultrasound-guided reduction of intussusception. MATERIALS AND METHODS Forty patients who were diagnosed and treated for intussusception in Van Yuzuncu Yıl University Faculty of Medicine Pediatric Surgery Department from March 2017 to May 2017 were included in the study. During this retrospective study, randomly chosen 20 patients that treated with USGHR using normal saline were marked as Group 1. Moreover, 20 patients that treated with USGHR using a mixture of olive oil and saline (10% olive oil 90% normal saline) were marked as Group 2. Patients' age, gender, symptoms, treatment techniques, complications and hospitalisation periods were retrospectively noted. RESULTS Forty patients were included in the study. In Group 1, 14 patients were treated in the first session, 4 patients were treated in the second session and 2 patients required laparotomy. Mean reduction time in this group was 15 min mean fluid volume used in each reduction was 80 ml/kg and mean hospitalisation period was 38 h. In Group 2, 19 patients were treated in the first session, and only 1 patient required a second session. Mean reduction time was 12 min, used fluid volume was 58 ml/kg for each reduction and hospitalisation period was 24 h. CONCLUSION The average volume of fluid used for reduction, average reduction time, numbers of recurrent reductions and hospitalisation were less when a mixture of olive oil and normal saline were used in comparison with when normal saline was used alone to reduction the intussusception under ultrasound guidance. Using olive oil mixed with normal saline as a new enema fluid is likely to increase the success rate of ultrasound-guided reduction of intussusception.
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Affiliation(s)
- Burhan Beger
- Department of Pediatric Surgery, Van Yuzunciyil University, Van, Turkey
| | - Ebuzer Duz
- Department of Pediatric Surgery, Van Yuzunciyil University, Van, Turkey
| | | | - Huseyin Akdeniz
- Department of Radiology, Van Yuzunciyil University, Van, Turkey
| | - Mehmet Melek
- Department of Pediatric Surgery, Van Yuzunciyil University, Van, Turkey
| | - Kemal Agengin
- Department of Pediatric Surgery, Van Yuzunciyil University, Van, Turkey
| | - Veli Avci
- Department of Pediatric Surgery, Van Yuzunciyil University, Van, Turkey
| | - Bulent Sonmez
- Department of Pediatry, Van Lokman Hekim Hospital, Van, Turkey
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Karadağ ÇA, Abbasoğlu L, Sever N, Kalyoncu MK, Yıldız A, Akın M, Candan M, Dokucu Aİ. Ultrasound-guided hydrostatic reduction of intussusception with saline: Safe and effective. J Pediatr Surg 2015; 50:1563-5. [PMID: 25863544 DOI: 10.1016/j.jpedsurg.2015.03.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/01/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The study was undertaken to assess the efficacy of ultrasound-guided saline enema in reducing intussusception and to determine the role of age and duration of symptoms on this event. METHODS The case records of patients who were treated for intussusception at our institutions over the past 10 years were retrospectively analyzed. A total of 419 patients were treated for intussusception and 375 of them were included into the study. Patients were excluded if they had symptoms and signs of acute abdominal disease and required surgery as an initial treatment. RESULTS Hydrostatic reduction was successful in 313 of the 375 patients (83.46%). The procedure-related complication rate was nil. There were 29 episodes of recurrences in 23 patients, and recurrence rates did not differ between patients who responded to hydrostatic reduction and those who required surgery. Younger age [median (range); 11 months (3-108 months) vs. 20 months (1-180 months); p<0.05], rectal bleeding (p<0.01) and long duration of symptoms [mean (range); 1.95 days (1-7 days) vs. 1.44 days (1-10 days); p<0.01] were significantly associated with failed hydrostatic reduction. CONCLUSION Ultrasound-guided hydrostatic reduction is an easy, safe and effective method for the treatment of intussusception in the absence of acute abdominal findings.
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Affiliation(s)
- Çetin Ali Karadağ
- Şişli Hamidiye Etfal Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey.
| | - Latif Abbasoğlu
- Acıbadem University Faculty of Medicine, Department of Pediatric Surgery, Istanbul, Turkey
| | - Nihat Sever
- Şişli Hamidiye Etfal Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey
| | - Meltem Kaba Kalyoncu
- Şişli Hamidiye Etfal Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey
| | - Abdullah Yıldız
- Şişli Hamidiye Etfal Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey
| | - Melih Akın
- Şişli Hamidiye Etfal Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey
| | - Mustafa Candan
- Acıbadem Kadıköy Hospital, Department of Pediatric Surgery Istanbul, Turkey
| | - Ali İhsan Dokucu
- Şişli Hamidiye Etfal Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey
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Nayak D, Jagdish S. Ultrasound guided hydrostatic reduction of intussusception in children by saline enema: our experience. Indian J Surg 2008; 70:8-13. [PMID: 23133008 DOI: 10.1007/s12262-008-0002-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Accepted: 02/04/2008] [Indexed: 11/26/2022] Open
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 efficacy 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 METHODS The 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 CONCLUSIONS We 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 significant; P value = 0.0032) while older patients (statistically significant, 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 significant.
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Affiliation(s)
- Debashish Nayak
- Pediatric Surgery Unit Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, 605 006 India
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Abstract
PURPOSE To assess the feasibility and effectiveness of ultrasonography (US)-guided pneumatic reduction of intussusception in children. MATERIALS AND METHODS The study group consisted of 49 consecutive patients (aged 2 months to 7 years; 36 boys, 13 girls) who underwent 52 reductions of intussusception during 9 months. Intussusception was diagnosed in all patients with the known US criteria, and all patients underwent a US-guided pneumatic reduction attempt wholly within the US examination room. A pressure of 60 mm Hg was maintained for 30 seconds, with US guidance. The procedure was considered to be successful when US showed the disappearance of the intussusceptum and the edematous terminal ileum with an abrupt transition into the normal proximal ileum. When the intussusception was not reduced, the procedure was repeated, with pressure increased to 120 mm Hg. RESULTS The overall success rate of US-guided pneumatic reduction was 92% (48 of 52 reductions), with no immediate recurrence. Of the two patients who had intussusceptions that were irreducible, one had residual ileoileal intussusception at surgery, and the other had an ileal polyp as a lead point. Perforation occurred in two (4%) of 52 cases; one patient underwent right hemicolectomy due to bowel necrosis and had a pinpoint perforation in the normal proximal transverse colon, and the other underwent manual reduction of ileoileocolic intussusception, with microperforation in the proximal transverse colon. CONCLUSION US-guided pneumatic reduction seems to be a feasible and effective method for the treatment of intussusception in children because of its radiation-sparing effect and high success rate.
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Affiliation(s)
- C H Yoon
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-ku, Seoul 138-736, South Korea.
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Abstract
PURPOSE A prospective study was conducted comparing air reduction, barium reduction under fluoroscopy, and saline reduction under ultrasound guidance for diagnosis and treatment of intussusception involved in 147 patients. METHODS Fifty children received air reduction (AR group), 50 received barium enema reduction (BE group) and 47 received saline reduction under ultrasound guidance (US group). Nonoperative management was attempted if there was a history of less than 48 hours; absence of general or abdominal signs of toxicity, peritonism, or peritonitis, and reasonable blood electrolyte levels (K, 3 to 5 mmol/L; Na, 130 to 150 mmol/L). RESULTS Group AR had successful outcome in 45 of 50 children (90%); BE had successful outcome in 35 of 50 children (70%), and US had successful outcome in 32 of 47 children (67%). This 20% to 23% success rate difference between air reduction and the other two techniques (BE and US) was statistically significant (P = .01). There was no significant difference between BE and US saline (P > or = .05). There were no perforations encountered in AR patients, three perforations in BE patients, and two perforations in US patients. There was no mortality. CONCLUSIONS Air reduction seems to be associated with fewer complications and the highest success rate. Proper selection of patients is crucial to achieve a high success rate and to minimise complications.
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Affiliation(s)
- A T Hadidi
- Department of Paediatric Surgery, Cairo University, Egypt
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Chan KL, Saing H, Peh WC, Mya GH, Cheng W, Khong PL, Lam C, Lam WW, Leong LL, Low LC. Childhood intussusception: ultrasound-guided Hartmann's solution hydrostatic reduction or barium enema reduction? J Pediatr Surg 1997; 32:3-6. [PMID: 9021555 DOI: 10.1016/s0022-3468(97)90079-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A comparison was made of the efficacy of ultrasound guided Hartmann's solution hydrostatic reduction on 23 patients (US group) with the same number of consecutive patients in whom hydrostatic reduction was done by barium enema (BE group) under fluoroscopy for childhood intussusception. The US group was diagnosed by ultrasound scan and reduction was attempted under the guidance of ultrasonography with Hartmann's solution at 100 mm Hg pressure. Excluded were patients older than 12 years, patients in shock, patients with peritonitis, bowel perforation, and gross abdominal distension as well as recurrent intussusception of more than three episodes. There were three patients excluded in this group. The diagnosis of intussusception and complete reduction were confirmed by gastrografin enema. This US group had three recurrences (3 of 26, 11.5%), one lead point (1 of 23, 4.4%), and 19 successful reductions (19 of 26, 73%). Incidentally, there were also three patients excluded in this period of barium enema reduction. There was only one recurrence (1 of 24, 4.2%), one leadpoint (1 of 23, 4.4%), and 12 successful reductions (12 of 24, 50%) in these 23 BE patients. The success rates for the ileo-colic intussusceptions with Hartmann's solution reduction and barium enema reduction were 91% (19 of 21) and 55% (12 of 22), respectively (P = .00865). There was no complication in either group, and the accuracy of diagnosing a complete reduction was 100% in both forms of reduction. Hence, ultrasound-guided hydrostatic reduction for childhood ileocolic intussusception is preferred because it is safe, accurate, has a higher success rate, and can avoid radiation exposure risk.
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Affiliation(s)
- K L Chan
- Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong
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