Abstract
Background: enema reduction of the intussusception under US guide is widely used as a useful alternative to surgical management. This procedure is simple with no radiational effect , less complication rate with good outcome and the parents can stay with their child during the whole procedure. Aim of study : We tried to present our experience in HRIUSG by the use of normal saline enema and to evaluate its safety, outcome and to identify the risk variables for enema failure. Methodology : From the 1st of June 2016 to 1st of January 2017, we received about 45 children at children welfare hospital (medical city complex) that confirmed sonographically to have intussusception. Five patients were excluded from the study because of contraindications (peritonitis, perforation and shock). 40 children were developed enema reduction under sonographic guide. Results : From 40 children underwent HRIUSG their age presentation range from 3 months to 32 month, 67.4 % had respiratory infection while 32.6 % had gastroenteritis. We had a successful rate about 79 % with a median of 1 trial and only 3 patients (9.3 %) developed recurrence within 1st 24 hr. from the 9 patients underwent surgery we had 8 patients had manual reduction and one patient underwent resection of the bowel. Only 3 patients had PLP. 1 patient ( 2.3% ) was reported to have complication ( perforation over sewn ). Age , gender , duration of symptoms not significantly affect the outcome P value < 0.05 while bleeding with stool, initial mass in the left colon and rectum , presence of free fluid and more trial numbers were a bad prognostic factors for enema failure . Conclusion: 1. HRIUSG is simple, safe, less costly, practical, less messy ,no radiational exposure with a low complication rate 2. Age, gender, Duration of symptoms did not affect the outcome significantly. 3. Although bleeding with stool, left colon intussusception mass and free peritoneal fluid is a risk factor for failure of HRIUSG but they are not absolute contraindication. 4. The better scenario for enema reduction success is a patient presented with symptoms < 24 hr. with no bleeding stool and a mass in the cecum and ascending colon with no free peritoneal fluid. Keywords: saline enema; reduction; intussusception ; ultrasound guide . DOI: 10.7176/JHMN/73-04 Publication date: April 30 th 2020
Highlights
Intussusception is the most frequent cause of bowel obstruction in infants and toddlers
The better scenario for enema reduction success is a patient presented with symptoms < 24 hr. with no bleeding stool and a mass in the cecum and ascending colon with no free peritoneal fluid
Intussusception was accurately described by John Hunter in 1793, Hippocrates recommended that treatment of "ileus" consist of connecting a bellows to the anus and inflating the bowel with air if hydrostatic reduction, possibly with the use of oil, failed
Summary
Intussusception is the most frequent cause of bowel obstruction in infants and toddlers. It is an acquired invagination of the proximal bowel (intussusceptum) into the distal bowel (intussuscipiens). It was first described in 1674 by Paul Barbette of Amsterdam, defined by Treves in 1899, and operated on successfully in 1873 by John Hutchinson.. In 1959 the use of air reduction was first reported, and, more recently, thousands of patients in China have been treated successfully this way, The word intussusception is derived from the Latin words intus (within) and suscipere (to receive). The inner and middle cylinders are the invaginated bowel (intussusceptum), and the outer cylinder is the recipient of the invaginated bowel (intussuscipiens).
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