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

Abstract

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.