Abstract:Objective: To evaluate the role of pneumatic reduction in the management of intussusception in children in the setting of a sub-Saharan African nation. Design: Prospective case series. Setting: Tertiary care teaching hospital in Kumasi, Ghana. Subjects: Forty four children, aged 4 months to 13 years, 28 boys and 16 girls, were admitted with a clinical diagnosis of intussusception and confirmed by ultrasonography. Interventions: Twenty two children had air enema reduction of the intussusception attempted in the… Show more
“…We had a fairly high success rate of 67% which was higher than the 59.1% obtained in the other study in Ghana [10] but lower than the over 90% seen in studies in China and over 75% in North America. [2][3][4][5] Two factors that may have contributed to the apparently low success rate in our study were: delay in presentation to our facility (all but one of the cases that did not reduce had had the symptoms for at least 2 days) and the small numbers in our study where one patient was 5.6% of the sample.…”
Section: Discussioncontrasting
confidence: 66%
“…[1,5,6] In Ghana, nonsurgical reduction was not started until January 2004 when it was commenced at Komfo Anokye Teaching Hospital. [10] Fluoroscopic-guided pneumatic reduction of intussusception was the first nonsurgical management of intussusception in children to be popularized at Korle Bu Teaching Hospital and was started in August, 2007.…”
Section: Discussionmentioning
confidence: 99%
“…Further in KATH an anaesthetist was required to give general anaesthesia by intubating and ventilating the child while in KBTH ketamine hydrochloride was used and carefully monitored without the need for intubation or ventilation. [10] Abraham el al. [13] in 2005 described a simple and safe technique for pneumatic reduction of intussusception where they used the height and water in an enema can to generate pressure for the reduction process.…”
Section: Discussionmentioning
confidence: 99%
“…However until August 2007, it had not been used for reduction of intussusception in children at Korle Bu Teaching Hospital (KBTH), Accra, Ghana, though the procedure had been started 3.5 years earlier (January 2004) at Komfo Anokye Teaching Hospital (KATH), the second largest Tertiary Hospital in Ghana, located in Kumasi, with significant success. [10] This technique is a fairly simple, cheap, quick and safe method of intussusception reduction which needs to be promoted in Ghana and other neighbouring countries that are yet to practice it.…”
Pneumatic reduction of intussusception is a cost-effective and rapid method of management of intussusception. It however has limitations like high reported rate of bowel perforation and limited ability to identify lead points. The benefits however seem to outweigh these challenges, such as fluoroscopic-guided pneumatic reduction has a very high success rate. Fluoroscopic guided pneumatic reduction should be considered as one of the primary modes of reduction in Ghana and other neighbouring countries that are yet to practice it.
“…We had a fairly high success rate of 67% which was higher than the 59.1% obtained in the other study in Ghana [10] but lower than the over 90% seen in studies in China and over 75% in North America. [2][3][4][5] Two factors that may have contributed to the apparently low success rate in our study were: delay in presentation to our facility (all but one of the cases that did not reduce had had the symptoms for at least 2 days) and the small numbers in our study where one patient was 5.6% of the sample.…”
Section: Discussioncontrasting
confidence: 66%
“…[1,5,6] In Ghana, nonsurgical reduction was not started until January 2004 when it was commenced at Komfo Anokye Teaching Hospital. [10] Fluoroscopic-guided pneumatic reduction of intussusception was the first nonsurgical management of intussusception in children to be popularized at Korle Bu Teaching Hospital and was started in August, 2007.…”
Section: Discussionmentioning
confidence: 99%
“…Further in KATH an anaesthetist was required to give general anaesthesia by intubating and ventilating the child while in KBTH ketamine hydrochloride was used and carefully monitored without the need for intubation or ventilation. [10] Abraham el al. [13] in 2005 described a simple and safe technique for pneumatic reduction of intussusception where they used the height and water in an enema can to generate pressure for the reduction process.…”
Section: Discussionmentioning
confidence: 99%
“…However until August 2007, it had not been used for reduction of intussusception in children at Korle Bu Teaching Hospital (KBTH), Accra, Ghana, though the procedure had been started 3.5 years earlier (January 2004) at Komfo Anokye Teaching Hospital (KATH), the second largest Tertiary Hospital in Ghana, located in Kumasi, with significant success. [10] This technique is a fairly simple, cheap, quick and safe method of intussusception reduction which needs to be promoted in Ghana and other neighbouring countries that are yet to practice it.…”
Pneumatic reduction of intussusception is a cost-effective and rapid method of management of intussusception. It however has limitations like high reported rate of bowel perforation and limited ability to identify lead points. The benefits however seem to outweigh these challenges, such as fluoroscopic-guided pneumatic reduction has a very high success rate. Fluoroscopic guided pneumatic reduction should be considered as one of the primary modes of reduction in Ghana and other neighbouring countries that are yet to practice it.
“…Our work shows that patients treated successfully by enema have shorter hospital stays and a lower rate of complications than those undergoing surgery ( Table 2) [1].…”
We consider that general anaesthesia increases effective reduction pressures and could avoid many surgeries in apparently non-reducible intestinal intussusceptions.
Non-operative reduction has emerged as rst line in the management of uncomplicated intussusception. The aim of this study was to compare the outcome of saline hydrostatic reduction and pneumatic reduction of intussusception in infants.
MethodsThis is a prospective study of infants with uncomplicated intussusception con rmed by ultrasound over a period of twenty-one months from December, 2018 to August, 2020. Fifty-two (69.3%) out of seventyve infants underwent enema reduction under ultrasound guidance. The success rates, time to reduction and complication rates were assessed.
ResultsThe success rates, between the saline hydrostatic reduction group and pneumatic reduction group, were comparable [17(65.4%) versus 19(73.1%); relative risk (RR) 0.8; 95% con dence interval (CI) 0.6-1.2; p = 0.54]. The mean time to reduction was higher in the saline hydrostatic reduction group (15.4 ± 5.1 minutes versus 10.8 ± 4.1 minutes; p = 0.003). The two groups had similar complication rates; for perforation [1(3.8%) versus 0(0.0%); RR 0.9 (CI 0.9-1.0); p = 0.31] and recurrence [2(7.7%) versus 1(3.8%); RR 0.9 (CI 0.8-1.0); p = 0.55].
ConclusionSaline hydrostatic reduction and pneumatic reduction of uncomplicated intussusception under ultrasound guidance in infants might have comparable outcomes. However, pneumatic reduction may be faster.
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