Radiographic signs predictive of success of hydrostatic reduction of intussusception

Abstract

Outcome of hydrostatic reduction of intussusception (HRI) was analyzed according to specific radiographic signs to improve success. At our institution, a pediatric surgical team performs HRI using a standardized protocol. We reviewed 266 consecutive HRI performed from 1998 to 2008 according to patient demographics, symptomatology, parameters of inflammation (peak WBC, peak CRP), position of the tip of the intussuscepted bowel and an intussusception bowel ratio (IBR). Of the 266 cases, 250 (94%) were successful (group A) and 16 (6%) failed (group B). Average age was significantly higher in group A than in group B (14.9 +/- 12.4 vs. 8.33 +/- 3.93 months) (P < 0.01). Duration of symptoms was significantly shorter in group A than in group B (15.0 +/- 12.5 vs. 25.0 +/- 9.7 h) (P < 0.05). The position of the tip was ascending colon (Ac): A = 34 (14%), B = 1 (6%); right transverse colon (RTc): A = 112 (45%), B = 1 (6%); left transverse colon (LTc): A = 84 (34%), B = 12 (75%); descending colon (Dc): A = 15 (6%), B = 0 (%); and sigmoid colon (Sc): A = 5 (2%), B = 2 (13%). The tip was located in LTc, Dc and Sc significantly more often in group B (14/16, 88%) than group A (104/250, 42%) (P < 0.01). IBR for group B (1.68 +/- 0.47) was significantly larger than group A (1.13 +/- 0.28) (P < 0.01). Differences in parameters of inflammation were not significant. We found that the position of the tip and IBR are predictive of success of HRI. Having a dedicated team perform HRI using a standardized protocol with consideration of IBR and the position of the tip eliminates bias, fosters reliability and ensures reproducibility, while at the same time it allows patients with inappropriate data to be spared potentially dangerous attempted HRI.