Evaluation of the role of dexamethasone in decreasing early recurrence of intussusception: Using ultrasound-guided saline enema for reduction

Abstract

Aim: Intussusception is the most common abdominal emergency during early childhood. The current initial management by contrast enema or pneumatic reduction under fluoroscopy carries the risk of radiation. In case of recurrence, the repeated attempts for another reduction will also increase this risk, in addition to other risks of operative reduction, if needed. The aim of this study was to evaluate the effectiveness of ultrasound-guided saline enema reduction (USGSER) in the diagnosis and treatment of intussusception, and to assess the value of using dexamethasone injection in preventing or minimizing the frequency of recurrence. Patients and methods: The study included 75 cases with intussusception presented from August 2006 until July 2010 to Assiut University Children's Hospital. They were randomly classified into two groups: group A (GA; 40 cases) received three doses of i.m. dexamethasone, once before starting reduction and every 8 h thereafter; group B (GB; 35 cases) did not receive dexamethasone. The success, failure and recurrence rates after USGSER in the two groups were reported. Results: Ultrasonography was diagnostic in all cases. Successful USGSER was obtained in 33 of 40 cases in GA, and in 27 of 35 cases in GB. The recurrence of intussusception was encountered in one case of GA, and in five cases of GB postreduction; all were treated successfully by USGSER. Failure of USGSER with subsequent laparotomy occurred in 15 cases; (7 from GA, and 8 from GB) where manual reduction could be obtained in nine cases, while resection anastomosis was necessary in six cases. Conclusion: USGSER is a safe, easy and cost-effective modality of treatment for intussusceptions, without the risk of radiation. Dexamethasone might help in decreasing the frequency of recurrence.