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

Abstract

BackgroundThe management of childhood intussusception in our sub-region is still via surgical intervention. Currently, the gold standard of treatment is non-operative reduction. We sought to assess the suitability of hydrostatic (saline) reduction of intussusception in children in our institution.Materials and methodsA prospective study was conducted between January 2016 and June 2017 in all children with ultrasound confirmed intussusception at a tertiary teaching hospital in Nigeria. All children excluding those with signs of peritonitis, bowel gangrene and intestinal prolapse were selected for ultrasound-guided hydrostatic reduction (USGHR). We allowed a maximum of three attempts at reduction.ResultsThe age range was 3 months to 48 months with a mean of 10.8 ± 9.1 months. Forty percent (N = 18) presented after 24 h of onset of symptoms. The success rate of hydrostatic reduction with saline enema was 84.4% (N = 38). Two (4.4%) perforations occurred during the procedure. Three (7.5%) patients had recurrent intussusception within six months. The duration of symptoms greater than 24 h, age and sex of patients did not influence successful reduction p > 0.05. The duration of admission between those who had successful non-operative reduction and those who subsequently had operative reduction and or resection attained statistical significant difference, p = 0.001. There was no mortality. We achieved a 68% decrease in the operative reduction of intussusception using USGHR as the primary modality of treatment.ConclusionOur study found out that USGHR is a suitable alternative for the treatment of childhood intussusception.

Hydrostatic reduction of intussusception in chidren: a single centre experience

“…In the present study, ileocolic (idiopathic) type of intussusception was the most common type. This is consistent with the observation of most series [ 7 , 14 , 23 ]. Other types of intussusception such as ileoileal, colocolic, jejunoileal, jejunojejunal can also occur in children but they are far less common than ileocolic type.…”

“…It is noteworthy that this late presentation is mostly seen in developing countries where there is lots of poverty and ignorance. The finding of abdominal pain as the most common presenting symptom of intussusception is in line with the reports of other studies [ 14 , 18 ]. However, other studies reported vomiting and abdominal mass as the most common symptoms [ 4 , 15 , 19 ].…”

“…While hydrostatic reduction of intussusception is well established in developed countries, its practice in developing countries is shaky due to late presentation, lack of facilities and appropriate expertise [ 12 , 13 ]. The male dominance recorded in the current study is consistently observed in many other reports too [ 8 , 14 , 15 ]. The mean age of our patients is similar to that Khorana et al .…”

“…The mean age of our patients is similar to that Khorana et al . but varies with that of other studies of its nature [ 4 , 8 , 10 , 14 ]. The reason for these differences is not clear but may be explained by geographical location, dietary patterns and age of weaning of the infants.…”

Treatment Outcome of Acute Intussusception in Children Under Two Years of Age: A Prospective Cohort Study

“…Thus, the confirmed diagnosis is mainly based on ultrasound findings, and a pediatric surgeon should decide whether to take the infant for an enema pneumatic reduction or close surveillance [10][11]. Besides, choosing an intervention between saline-enema and pneumatic reduction for the treatment of acute intussusception is under debate due to the varied success rate of 83%-88% [12][13][14][15]. This prospective study aims to describe the clinical manifestation and develop a conservative management protocol for acute ileocaecal intussusception in children under two years of age.…”