Abstract
Intussusception is an important cause of small bowel obstruction in children. Non-operative reduction (NOR) is the preferable method of treatment to start with as long as there are no contraindications to its use and where facilities are available. Pneumatic reduction has become a popular therapeutic method for intussusception instead of surgery in many centers. The current study aim to evaluate the success rate of ultrasound guided pneumatic reduction of intussusception and verifying the factors affecting its efficacy as initial experience in Baghdad. A prospective study of 56 eligible patients with confirmed intussusception managed over the period of eighteen months from March 2016 to September 2017 in Baghdad. The procedure was performed under ultrasound guidance after adequate resuscitation. Those patients with unsuccessful first attempt of pneumatic reduction were subjected to second and third attempts before surgical intervention performed. a total 39 male and 17 female were found suitable for pneumatic reduction under ultrasound guide. Successful reduction by air insufflation was achieved in 44 patients (78.5%), whereas the procedure was failed in the remaining 12 patients (21.4%). There were only two out of 44 patients (4.5%) with successful reduction developed early recurrence of intussusception. One patient (2.27%) developed intestinal perforation. Pneumatic reduction of intussusception under ultrasound guidance is a quick, safe, simple, with a high success rate, radiation-sparing effect. Success rate is highly affected by the duration of symptoms and location of mass. The procedure is not devoid of recurrence risk and possibility of developing pneumoperitoneum.
Highlights
Intussusception is the most frequent cause of bowel obstruction in infants and toddlers and probably the second most common cause of acute abdominal pain after constipation in these age groups [1, 2]
The aim is to evaluate the success rate of ultrasound guided pneumatic reduction of intussusception and verifying the factors affecting its efficacy as initial experience in Baghdad
Among total 74 patients with intussusception managed during the study period, non-operative reduction by mean of air insufflation was attempted in 56 (75.6%) Patients as initial line of treatment
Summary
Intussusception is the most frequent cause of bowel obstruction in infants and toddlers and probably the second most common cause of acute abdominal pain after constipation in these age groups [1, 2]. The treatment of intussusception is an emergency, by either non-operative or operative method. Non-operative reduction (NOR) is the preferable method of treatment to start with as long as there are no contraindications to its use and where facilities are available [3]. The logical step after failure of non-operative approach is surgery. The choice between the two methods (operative and non-operative) depends on the general condition of the patient, the duration of illness and the availability of skilled radiological service [4]. The currently used techniques for non-operative reduction of intussusception include pneumatic or hydrostatic pressure enemas under fluoroscopic or sonographic guidance [1] with the advantages of decreased morbidity, cost, and length of hospitalization [2].
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