Air Enema Reduction Of Intussusception Research Articles

No Prophylactic Antibiotic Use for Young Children\u2019s Intussusception with Low-risk Infection after Successful Air Enema Reduction

The Chinese government has issued the policy of promulgating the clinical use of antibacterial drugs since 2011. Prophylactic antibiotic use is a challenging problem among young children with intussusception after successful air enema reduction. There were limited data regarding the clinical value of prophylactic antibiotics for intussusception with low-risk infections. A retrospective non-randomized comparative study was conducted among 188 young children with intussusception after successful air enema reduction between January 1, 2011 and December 30, 2013. Among these children, 51 received prophylactic antibiotics and 137 did not receive antibiotics. Our results showed that there were no significant differences in age, gender, weight, admission period, reduction interval, axillary temperature, leukocytes, neutrophils, lymphocytes, monocytes, mesenteric lymph nodes and complications between groups (P > 0.05). The national policy had significantly improved clinical use of antibiotic for young children with low-risk intussusception (OR < 0.001, P < 0.001). Inpatients days were longer for children used antibiotics than those who did not (median, 27.0 hours vs 21.0 hours, P = 0.003). Prophylactic antibiotics appeared to be of little value after the successful air enema reduction of intussusception in young children with low-risk infection. Policy intervention is effective for antibiotic use in China.

Surgical outcomes after failed air enema reduction of intussusception in children in a paediatric hospital in Singapore

Purpose: The aim of this study is to determine the surgical outcomes after failed air enema reduction of intussusception in children in a paediatric hospital in Singapore. Knowledge of the surgical findings in cases of failed reductions may potentially help clinicians determine which cases need further investigation should there be a secondary cause of the intussusception such as a pathological lead point.

Adding a custom made pressure release valve during air enema for intussusception: A new technique.

Background:Non-surgical reduction remains the first line treatment of choice for intussusception. The major complication of air enema reduction is bowel perforation. The authors developed a custom made pressure release valve to be added to portable insufflation devices, delivering air at pressures accepted as safe for effective reduction of intussusception in children under fluoroscopic guidance. The aim of this study was to develop a custom made pressure release valve that is suitable for the insufflation devices used for air enema reduction of intussusception and to put this valve into regular clinical practice.Materials and Methods:An adjustable, custom made pressure release valve was assembled by the authors using readily available components. The valve was coupled to a simple air enema insufflation device. The device was used for the trial of reduction of intussusception in a prospective study that included 132 patients.Results:The success rate for air enema reduction with the new device was 88.2%. The mean pressure required to achieve complete reduction was 100 mmHg. The insufflation pressure never exceeded the preset value (120 mmHg). Of the successful cases, 58.3% were reduced from the first attempt while 36.1% required a second insufflation. Only 5.55% required a third insufflation to complete the reduction. In cases with unsuccessful pneumatic reduction attempt (18.1%), surgical treatment was required. Surgery ranged from simple reduction to resection with a primary end to end anastomosis. No complications from air enema were recorded.Conclusions:The authors recommend adding pressure release valves to ensure safety by avoiding pressure overshoot during the procedure.

Predictors of Successful Air Enema Reduction of Intussusception in Infants Younger Than 4 Months

Intussusception is rare in infants younger than 4 months, and the use of air enema for reduction of intussusception has been limited. In this retrospective study, we analyzed the predictors of successful reduction of intussusception using air enema in infants younger than 4 months. This is a retrospective chart review of 97 intussusception patients of younger than 4 months between January 2008 and December 2012. Demographic data, clinical presentation, and outcomes of air enemas were collected and analyzed. We used univariate and multivariate logistic regression analyses for significant predictors of successful reduction of intussusception using air enemas. Of the 97 infants younger than 4 months (median age 97.6 days, age range 41-119 days), 63 (65%) were boys and 34 (35%) were girls. The duration of symptoms ranged from 5 to 53 hours, with a median of 16.3 hours. The clinical features included paroxysmal crying (75%), vomiting (68%), bloody stools (61%), and palpable abdominal masses (32%). The duration of symptoms, bloody stools, and the shape of the intussusceptum were found to be significantly predictive of the outcome of air enema reduction of intussusception. The rate of successful reduction of intussusception using air enemas in infants younger than 4 months is low. Factors such as the duration of symptoms, bloody stools, and the shape of the intussusceptum are predictive of the outcome of air enema reduction of intussusception.

Air enema reduction of intussusception: a registrar-led, protocol-driven service is safe and effective

In the UK, air enema reduction of intussusception is predominantly performed by consultant radiologists. At our institution, it is usually performed by a team involving radiology and surgical registrars. The purpose of this study was to assess who performs air enemas in the UK and the efficacy and safety of our registrar-led service. A telephone survey of paediatric surgical centres in the UK was performed asking who performs air enema in these institutions. Following this, a retrospective review of all air enemas at our institution between January 2005 and 2011 was performed. Cases were identified from radiology databases and reviewed for grade of radiologist, perforation and outcome. At all 25 centres, consultant radiologists performed air enemas. At our institution 145 enemas were performed in 6years. 141 were analysed (54 girls, 87 boys). Median age was 9months (range 3-107months). 82% were performed by the registrar-only team. Over 6years the registrar-led reduction rate was 77.5% and in the last 3years 84%. The perforation rate was 0.9%. A paediatric surgical registrar-led service for air enema reduction can be safe and effective ensuring a team approach is adopted, equipment is efficient and a strict protocol is applied.

Interloop fluid in intussusception

Sir, We read with interest the recent article by Gartner et al. [1] in the June edition of this journal titled “Interloop fluid in intussusception: what is its significance?” The authors report an association between the presence of interloop fluid, particularly if its maximum dimension measured more than 9 mm, and an increase in the failure rate of pneumatic reduction. Their success rate was 87.6% in children without trapped fluid and 58.3% in those with trapped fluid. We have also reviewed the ultrasound examinations performed on 135 children with a total of 143 intussusceptions in our hospital over a period of 5 years. The results were presented at the ESPR meeting in 2004. The mean patient age was 11 months and 68% of infants were younger than 1 year of age. Two experienced paediatric radiologists reviewed all sonographic studies performed prior to the reduction, blinded to its outcome. Trapped fluid was present inside the intussusception at ultrasound in 33 children (23%), similar to the paper sample. The twodimensional size of the fluid ranged from 5×2 mm (10 mm sq) to 12×10 mm (120 mm sq). Results were analysed using a two-tailed Fisher exact test. The overall success rate of air enema in our group was 91% (130 intussusceptions) compared with 81% in Gartner’s paper. Of the 33 children with trapped fluid, 27 (82%) intussusceptions were reducible, compared with 58% in his paper. We did not find any association between the presence of trapped fluid or its dimensions and reducibility (P = 0.14). The pneumatic reduction was complicated by bowel perforation in 2 patients, one without trapped fluid and one with trapped fluid measuring 18×4 mm (72 mm sq) and a clinical history of symptoms for 3 days. Our study is also a retrospective study but has the advantage of being limited to one institution. An additional advantage is that all ultrasound examinations and pneumatic intussusception reductions were performed by one of three experienced paediatric radiologists. We agree with the conclusion of the authors of this paper that the presence of interloop fluid is not a contraindication to attempting pneumatic reduction, but we do not alter our approach or technique when performing the reduction in young children. We attempt air enema reduction of intussusception in every patient unless there is evidence of perforation.

Pneumatic Reduction Of Intussusception In Children At The Komfo Anokye Hospital, Kumasi, Ghana

To evaluate the role of pneumatic reduction in the management of intussusception in children in the setting of a sub-Saharan African nation. Prospective case series. Tertiary care teaching hospital in Kumasi, Ghana. Forty four children, aged 4 months to 13 years, 28 boys and 16 girls, were admitted with a clinical diagnosis of intussusception and confirmed by ultrasonography. Twenty two children had air enema reduction of the intussusception attempted in the operation theatre under general anaesthesia. The average pressure used for air enema reduction of the intussusceptions was 110.4 mm Hg. Success of pneumatic reduction, morbidity and mortality. Overall air enema reduction of intussusception was successful in 59.1% of children who underwent this procedure. There were no deaths among children who had a successful air enema reduction of intussusception. One child (11.1%) out of nine who had laparotomy done after a failed pneumatic reduction died. The average length of hospital stay was shorter in those with successful air enema reduction (3.8 +/- 2.3 days, 95% Confidence Interval [CI] = 2.4 to 5.2) than those who had a laparotomy performed for manual reduction of the intussusception after a failed pneumatic reduction (6.7 +/- 5.1 days, 95% CI = 33 to 9.9). Although the sample size is small, pneumatic reduction of intussusception in children without peritonitis is possible, practical, and reliable and must be tried first, preferably under general anaesthesia in our sub-region before proceeding to laparotomy in case of failure.

Role of Surgery in the Era of Highly Successful Air Enema Reduction of Intussusception

Despite routine use of air enema reduction in childhood intussusceptions, some still require operative management. This study evaluated the role of surgery and identified factors associated with failed air enema reduction and bowel resection. We reviewed 24 patients who underwent laparotomies for intussusception between 1 July 1999 and 31 July 2002. Demographic data, clinical presentations, investigations, surgical interventions and their outcomes were reviewed. Twenty-four (14.5%) of 166 patients treated for intussusceptions between 1 July 1999 and 31 July 2002 underwent laparotomies. A significant proportion (45.8%) was younger than 3 months and older than 36 months of age. Intussusception was diagnosed on ultrasonography in 21 patients. Eighteen underwent attempted air enema reduction. Ileocolic intussusceptions occurred in 54.2% of patients. Five patients had small bowel intussusceptions, all of whom required bowel resection. Seven patients (29.2%) had pathological lead points. Presence of pathological lead points and intussusceptions occurring outside the ileocolic region strongly predicted the need for bowel resection. Air enema reductions are less likely to succeed in patients less than 3 months old and those more than 3 years old. Bowel resection is most likely required when pathological lead points are present and when intussusceptions occur outside the ileocolic region. Early surgical intervention may obviate the need for bowel resection in selected patients, thereby reducing surgical morbidity.