Risk factors for short-term recurrent intussusception and reduction failure after ultrasound-guided saline enema

Shen, Gang; Zhang, Chuanguang; Li, Junfeng; Zhang, Jing; Liu, Yongdong; Guan, Zheming; Hu, Qiang

doi:10.1007/s00383-018-4340-3

Cited by 26 publications

(24 citation statements)

References 19 publications

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“…As shown in the results, a positive history of previous enema reduction did not alter the success rate of further reductions (15,16) . We suggest surgical treatment only in cases with failure of saline reduction and suspicious lead points in several episodes of recurrence.…”

Section: Discussionsupporting

confidence: 56%

Twenty Years of Experience in Management of Intussusception: Saline Enema Reduction with Ultrasound Guidance

Saied¹,

Badebarin²,

Hasanzadeh³

et al. 2021

Tcdd

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Objective: Intussusception is a common condition involving infants and toddlers in which non-operative management plays an important role. The aim of this study was to present our 20 years of experience of saline enema reduction with ultrasound guide in management of intussusception. Methods: A 20-year retrospective study was performed from January 1999 to December 2018 in Iran, Tabriz Pediatric Hospital. Candidates for inclusion in the study were children from 0 to 14 years old who were diagnosed with intussusception. Treatment option (surgical or saline enema reduction) was recorded along with primary and total success rate of saline enema reduction, early recurrence rate, surgery details and lead points. Results: A total of 1376 patients with intussusception were studied. 112 patients experienced spontaneous reduction, and 1131 patients underwent ultrasonographic guided saline enema reduction. The primary attempt was successful in 76.8% of the patients (874 cases); however, in 8.4% of the patients (74 cases) recurrence was recorded during 48 hours after reduction. 264 patients were referred for second and or third reductions. The overall success rate of enema reduction was 79.9%. The mean age of the children with successful reduction was lower than the failed group (1.27±1.27 versus 1.63±1.05 years old; p=0.001). The success rate was significantly lower in patients with signs of currant jelly stool and palpable mass (p<0.001). 364 patients (26.5%) underwent surgery treatment. Leading points were recognized in 64 patients, and Meckel's diverticulum (63.24%) was the most common pathologic leading point. Conclusion:Ultrasound-guided saline enema reduction is a feasible method and is suggested as an efficient and safe method for non-operative management of intussusception. Its success rate is high and could be increased further by proper case selection and repeated reduction attempts even in recurrent cases.

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Section: Discussionsupporting

confidence: 56%

Twenty Years of Experience in Management of Intussusception: Saline Enema Reduction with Ultrasound Guidance

Saied¹,

Badebarin²,

Hasanzadeh³

et al. 2021

Tcdd

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“…24 Similarly, Shen et al showed that infection played a small role in recurrence. 25 The recurrence of intussusception is relatively common. 26 The recurrence is higher with hydrostatic and pneumatic reduction (10-15%) and lower with operative reduction (1-3%).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Findings to Predict Risk of Recurrence in Pediatric Intussusception After Air Enema Reduction

Zhang

Shao

Wei

et al. 2021

J of Ultrasound Medicine

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Objectives Intussusception is one of the most common abdominal emergencies in early children. Intussusception recurs in 8–20% of children after successful nonoperative reduction. The aim of this study was to explore the ultrasound findings to predict risk of recurrence in pediatric intussusception after air enema reduction. Methods A total of 336 intussusception children were followed up for 1 year after received successful air enema reduction. They were divided into the recurrent group and the non‐recurrent group. The differences of clinical characteristics, ultrasonic features, and laboratory tests were analyzed by univariate analyses and the Cox proportional hazard model. Results Sixty‐five children with recurrent intussusception were identified. There were statistically significances in the diameter of the mass, in the presence or absence of enlarged lymph nodes out of the sleeve, and in the sleeve between recurrent and non‐recurrent groups (P < .05). Other ultrasonic features, clinical characteristics, and blood parameters had no differences (P > .05). Multivariate Cox proportional hazard model showed that the diameter of the mass and abdominal lymph nodes may be the risk factors of intussusception recurrence (HR = 1.395, 95% CI: 1.045~1.863 and HR = 2.078, 95% CI: 1.118~3.865, P < .05). The cut‐off value of mass diameter was 2.55 cm, above which recurrence is more likely. Conclusions Intussusception recurrence was prone with greater mass diameter (>2.55 cm) and enlarged abdominal lymph nodes. Although these ultrasound findings for recurrence do not necessarily reduce the rate of recurrence, it can predict the recurrent possibility, and help the emergency physicians to be more vigilant in these children and better counsel parents upon discharge.

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“…Therefore, identifying the conditions that increase the risk of a poor outcome (e.g., recurrence or difficult-to-relieve cases) is important. Previous studies have described the risk factors for recurrent intussusception, including age, presence of pathological leading points, and symptom duration [5][6][7][8]. However, the association between specific laboratory findings and outcomes has not been investigated.…”

Section: Introductionmentioning

confidence: 99%

Lactic acid level as an outcome predictor in pediatric patients with intussusception in the emergency department

et al. 2020

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Background: Intussusception decreases blood flow to the bowel, and tissue hypoperfusion results in increased lactic acid levels. We aimed to determine whether lactic acid levels are associated with pediatric intussusception outcomes. Methods: The electronic medical records of our emergency department pediatric patients diagnosed with intussusception, between January 2015 and October 2018, were reviewed. An outcome was considered poor when intussusception recurred within 48 h of reduction or when surgical reduction was required due to air enema failure. Results: A total of 249 patients were included in the study, including 39 who experienced intussusception recurrence and 11 who required surgical reductions; hence, 50 patients were included in the poor outcome group. The poor and good outcome groups showed significant differences in their respective blood gas analyses for pH (7.39 vs. 7.41, P = .001), lactic acid (1.70 vs. 1.30 mmol/L, P < .001), and bicarbonate (20.70 vs. 21.80 mmol/L, P = .036). Multivariable logistic regression analyses showed that pH and lactic acid levels were the two factors significantly associated with poor outcomes. When the lactic acid level cutoff values were ≥ 1.5, ≥2.0, ≥2.5, and ≥ 3.0 mmol/L, the positive predictive values for poor outcomes were 30.0, 34.6, 50.0, and 88.9%, respectively. Conclusion: Lactic acid levels affect outcomes in pediatric patients with intussusception; higher lactic acid levels are associated with higher positive predictive values for poor outcomes.

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Risk factors for short-term recurrent intussusception and reduction failure after ultrasound-guided saline enema

Abstract: The overall success rate of ultrasound-guided saline enemas was 97.2%, and the pathologic intussusception rate was 1.6%. Age above 2 years and the absence of fever were risk factors for short-term recurrence, and pathologic intussusception was a risk factor for the failure of reduction.

Cited by 26 publications

References 19 publications

Twenty Years of Experience in Management of Intussusception: Saline Enema Reduction with Ultrasound Guidance

Twenty Years of Experience in Management of Intussusception: Saline Enema Reduction with Ultrasound Guidance

Ultrasound Findings to Predict Risk of Recurrence in Pediatric Intussusception After Air Enema Reduction

Lactic acid level as an outcome predictor in pediatric patients with intussusception in the emergency department

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