Ultrasound Guided Reduction of Intussusception with Saline and Evaluating the Factors Affecting the Success of the Procedure

Abstract

Background: Intussusception is a major cause of acute abdomen in childhood. Prompt diagnosis and appropriate treatment of intussusception is of prime importance for preventing morbidity and mortality. In this study, we aimed to investigate the effectivity of ultrasound (USG)-guided hydrostatic reduction of intussusception with saline and to investigate the factors affecting the success of this method. Methods: A total of 100 children with intussusception who were treated by hydrostatic reduction with saline were retrospectively reviewed. The effect of age, gender, duration of symptoms, rectal bleeding, number of reduction attempts performed, and the diameter and length of the invaginated segment measured on USG were evaluated. Results: Successful reduction was achieved in 88 (88%) patients. Mean age was 24.83 months, with 25.59 months in patients with successful reduction and 20 months in patients with failed reduction. Reduction was successful in 83.9% of the patients with a history of rectal bleeding and in 94.7% of the patients with no history of rectal bleeding (P > 0.05). Mean duration of symptoms was 2.74 days in the patients with successful reduction and 4.33 days in the patients with failed reduction. The mean diameter and length of the invaginated segments measured on USG were 3.5 cm and 5.12 cm in the patients with successful reduction and 4.27 cm and 9.23 cm in the patients with failed reduction, respectively. No significant difference was observed between the patients with successful and failed reduction in terms of rectal bleeding, vomiting, gender, age, and body weight (P > 0.05). It was also found that success rate increased as the number of reduction attempts increased and the success rate decreased as the duration of symptoms and the diameter and the length of the invaginated segment increased (P < 0.05). Conclusions:In conclusion, USG-guided reduction of intussusception with saline is a practical and safe method that yields high success rates. Repeating this method in patients with partial reduction that are clinically stable leads to a significant increase in the success of the procedure. A prolonged duration of symptoms and an increase in the size and the diameter of the invaginated segment may have adverse effects on the success of the procedure.

Shear wave elastography evaluation in predicting the success of ultrasound-guided saline enema hydrostatic reduction technique in ileocolic intussusception

“…During the sonographic and SWE evaluation, the length and the diameter of the invaginated bowel segment were measured along with stiffness through the anterior wall to predict the success of the USGSE. Concurrent with current literature, in our study, the length of intussusception was negatively correlated with the USGSE success rate (10,11); however, there was no statistically relevant association with the diameter. This may have been due to the small number of patients.…”

Clinical Features and Outcome of Saline Hydrostatic Reduction in Patients with Intussusception in a Tertiary Care Centre

“…Presence of rectal bleeding is found to reduce success rate of hydrostatic reduction. [17] Similarly, in our study, blood in stools was a significant factor for failure of USGR. Also vomiting > 48hrs duration was a significant factor contributing to failure of USGR.…”

The Use of Phosphate Enama in the Treatment of Short Segment Intususception Cases

“…A wide variety of surgical and non-surgical treatment modalities have been applied so far. Nowadays, it is usually treated with hydrostatic and pneumatic reduction (2,3). In this study, the reduction of short segment intussusception induced by phosphate enema treatment used as a practical method that was not previously identified was reported.…”

“…Today, it is usually treated with hydrostatic and pneumatic reduction (2,3). Surgical intervention is performed on patients with signs of peritonitis upon initial presentation, and in cases which hydrostatic or pneumatic reduction was not successful (2)(3)(4). Hydrostatic and pneumatic treatments are performed by pushing the invaginated intestine with air and liquid pressurization applied through the intestine lumen.…”

“…The hydrostatic pressure created by barium or saline is let to the free flow at 80-120 cm height, which is reduced by pushing the invaginated segment (Figure 1). The roles of saline and air enema in the reduction of childhood intussusception have been compared in numerous studies (3,6,7). Although both methods have been shown to be superior to another, both of them are widely used in clinical practice (6,7).…”