Implementing ultrasound-guided hydrostatic reduction of intussusception in a low-resource country in Sub-Saharan Africa: our initial experience in Ethiopia

Abstract

The rate of operative reduction of intussusception decreased by 77% following the introduction of USGHR as the initial non-surgical intervention. Therefore, we believe USGHR should be fully implemented in our hospital, and recommend that this study serves as an example to other institutions in our country as well as in other developing countries facing similar challenges.

Sonographic guided hydrostatic saline enema reduction of childhood intussusception: a prospective study

“…Since the widespread acceptance of saline reduction under ultrasound guidance, published data indicated high success rates comparable to, or better than fluoroscopic barium or air reduction. The use of USGHR as mainstay of treatment has been slow to take place in many developing nations including Nigeria due to late presentation, misdiagnosis, either lack of or dysfunctional fluoroscopic units and lack of expertise to undertake the procedure in many hospitals [ 1 , 4 , 9 ]. The high mortality rate associated with surgical treatment in developing countries over its developed counterpart has underscored the need for more countries especially those in sub-Saharan Africa to embrace USGHR [ 4 , 15 ].…”

“…Ogundoyin et al [ 1 ] in Nigeria found a lower successful reduction rate of 55.6%. Wakjira et al [ 9 ] in a recent study were able to achieve 87.2% reduction rate. However, Sanchez et al [ 20 ] in a subset of 14 children that underwent hydrostatic reduction with saline recorded 100% success rate.…”

“…The other non-surgical methods are reduction with barium or air under fluoroscopic guidance [ 5 , 8 ]. These other non-surgical methods of reduction under fluoroscopy are either non-existent or dysfunctional in most centres in sub Saharan Africa including our hospital [ 1 , 9 ], thereby making ultrasound guided reduction of intussusception a better modality of treatment in resource poor environment. Ultrasound scanners are relatively cheap and readily available in most hospitals thereby rendering ultrasound guided hydrostatic reduction (USGHR) cost effective for patients.…”

“…In a review by Bekdash et al [ 12 ], the overall success rate of non-operative reduction of intussusception ranged from 46 to 94%, while recent studies reported that the success rate for hydrostatic reduction with saline ranges from 55.6 to 90% [ 1 , 13 , 14 ]. A much more recent study from Ethiopia found a successful reduction rate of 87.2% [ 9 ].…”

Pediatric radiology mission work: opportunities, challenges and outcomes

“…The benefits of pediatric radiology global outreach efforts are substantial, even life-saving, as recently documented. Wakjira and colleagues [19] demonstrated the effectiveness of an educational program teaching ultrasound-guided hydrostatic intussusception reduction to radiologists in Ethiopia. Prior to the education program, intussusception was treated primarily with surgery and, in the absence of access to a surgeon, was fatal.…”