Hydrostatic Reduction Of Ileocolic Intussusception Research Articles

Ileocolic intussusception: Ultrasound-guided hydrostatic reduction with sedation and analgesia

IntroductionThe first-choice treatment for ileocolic intussusception is imaging-guided reduction with water, air, or barium. The objectives of the current study were to evaluate the efficacy and safety of ultrasound-guided reduction of intussusception using water in patients under sedation and analgesia. We compare this approach with our previous experience in reduction using barium under fluoroscopic guidance without sedation and analgesia and investigate what factors predispose to surgical correction. Material and methodsWe retrospectively reviewed cases of children with ileocolic intussusception treated in a third-level pediatric hospital during a 52-month period: during the first 24 months, reduction was done using barium and fluoroscopy without sedoanalgesia, and during the following 28 months, reduction was done using water and ultrasound with sedoanalgesia. A pediatric radiologist and a pediatrician reviewed the clinical history, surgical records, and imaging studies. ResultsIn the 52-month period, 59 children (41 boys and 18 girls; mean age, 16.0 months) were diagnosed with ileocolic intussusception at our hospital. A total of 33 reductions (28 patients and 5 recurrences) were done using barium under fluoroscopic guidance, achieving a 61% success rate. A total of 38 reductions (31 patients and 7 recurrences) were done using water under ultrasound guidance with patients sedated, achieving a success rate of 76%. No significant adverse effects were observed in patients undergoing ultrasound-guided hydrostatic reduction under sedation, and the success rate in this group was higher (p = 0.20). The factors that predisposed to surgical reduction were greater length of the intussusception (p = 0.03), location in areas other than the right colon (p = 0.002), and a greater length of time between symptom onset and imaging tests (p = 0.08). ConclusionUltrasound-guided hydrostatic reduction of ileocolic intussusception under sedoanalgesia is efficacious and safe.

Ultrasound-guided hydrostatic reduction of ileo-colic intussusception in childhood: first-line management for both primary and recurrent cases

Objective To evaluate the results of ultrasonography-guided hydrostatic reduction in primary and recurrent ileo-colic intussusception in children. Methods The children (<18 years of age) who were managed for ileo-colic intussusception between January 2015 and December 2018 were evaluated retrospectively. Age, gender, presenting complaints, length of the intussuscepted segment, presence of lead point, treatment modalities, recurrence rates and duration of recurrence were evaluated. Results 108 patients with ileo-colic intussusception were enrolled in the study; 59 were male and 49 were female with a mean age of 2.04 ± 1.71 years. Two patients underwent immediate surgery without any attempt of hydrostatic reduction. Nineteen patients (18%) were managed by conservative measures initially. Seventeen (89.5%) of them have recovered with expectant management and two patients required hydrostatic enema reduction during follow-up. In total, 89 patients underwent hydrostatic reduction; 48 were male and 41were female with a mean age of 1.9 ± 1.65 years. Twelve patients (13.5%) received surgery after failed hydrostatic reduction. In the patients with successful hydrostatic reduction, one more episode of intussusception is seen in 10 patients (13%) and 2 additional episodes in 2 (2.6%). Seven patients with relapse were male and 5 were female with a mean age of 1.16 ± 1.64 years. The median duration of the first relapse episode was 67.5 days (range 18–110 days). The ultrasound-guided hydrostatic reduction was also successful in patients with recurrence. Conclusion Ultrasound-guided hydrostatic reduction is a non-invasive treatment of ileo-colic intussusception with high success rates in childhood. It can be performed safely in both initial and relapse episodes of intussusception.

Factors Associated with Success of Sonographically Guided Hydrostatic Reduction of Ileocolic Intussusception in Children

Factors Associated with Success of Sonographically Guided Hydrostatic Reduction of Ileocolic Intussusception in Children

Invaginación ileocólica: reducción hidrostática ecoguiada con sedoanalgesia

IntroductionThe first-choice treatment for ileocolic intussusception is imaging-guided reduction with water, air, or barium. The objectives of the current study were to evaluate the efficacy and safety of ultrasound-guided reduction of intussusception using water in patients under sedation and analgesia. We compare this approach with our previous experience in reduction using barium under fluoroscopic guidance without sedation and analgesia and investigate what factors predispose to surgical correction. Material and methodsWe retrospectively reviewed cases of children with ileocolic intussusception treated in a third-level pediatric hospital during a 52-month period: during the first 24 months, reduction was done using barium and fluoroscopy without sedoanalgesia, and during the following 28 months, reduction was done using water and ultrasound with sedoanalgesia. A pediatric radiologist and a pediatrician reviewed the clinical history, surgical records, and imaging studies. ResultsIn the 52-month period, 59 children (41 boys and 18 girls; mean age, 16.0 months) were diagnosed with ileocolic intussusception at our hospital. A total of 33 reductions (28 patients and 5 recurrences) were done using barium under fluoroscopic guidance, achieving a 61% success rate. A total of 38 reductions (31 patients and 7 recurrences) were done using water under ultrasound guidance with patients sedated, achieving a success rate of 76%. No significant adverse effects were observed in patients undergoing ultrasound-guided hydrostatic reduction under sedation, and the success rate in this group was higher (p=0.20). The factors that predisposed to surgical reduction were greater length of the intussusception (p = 0.03), location in areas other than the right colon (p = 0.002), and a greater length of time between symptom onset and imaging tests (p = 0.08). ConclusionUltrasound-guided hydrostatic reduction of ileocolic intussusception under sedoanalgesia is efficacious and safe.

The incidence of negative intraoperative findings after unsuccessful hydrostatic reduction of ileocolic intussusception in children: A retrospective analysis

BackgroundThere is a lack of studies addressing the occurrence of negative intraoperative findings (that is the absence of intussusception) after an unsuccessful hydrostatic reduction of an ileocolic intussusception. The aim of this study is to determine the incidence of negative intraoperative findings after unsuccessful hydrostatic reduction of ileocolic intussusception. MethodsWe conducted a multicentre retrospective study of all children aged 0–18 years treated for ileocolic intussusception from January 1, 2010 to December 31, 2015 in 9 Dutch hospitals. Primary outcome measure was the percentage of children without an intussusception during surgical exploration after unsuccessful hydrostatic reduction. ResultsIn the study period 436 patients were diagnosed with an ileocolic intussusception. Of these, 408 patients underwent hydrostatic reduction of an ileocolic intussusception. 112 patients (27.5%) underwent surgery after an unsuccessful hydrostatic reduction. In 13 (11.6%) patients no intraoperative evidence of intussusception was found. Patients who underwent surgical intervention after unsuccessful hydrostatic reduction were significantly younger than patients who had a successful hydrostatic reduction; there was no gender difference. ConclusionA substantial number of children (11.6%) underwent a laparotomy after unsuccessful hydrostatic reduction in whom no intussusception was found intraoperatively. We suggest initiating laparoscopy instead of laparotomy when surgery is necessary. Level of evidenceLevel II.

Hospital admission unnecessary for successful uncomplicated radiographic reduction of pediatric intussusception

PurposeAfter radiologic reduction, patients with ileocolic intussusception are often admitted. We hypothesize that discharge of stable patients after 4 h of emergency department (ED) observation does not result in an increase of adverse outcomes. MethodsWe retrospectively reviewed pediatric patients with ileocolic intussusception between 2011 and 2016, managed with either 24-h inpatient or 4-h ED observation. Outcomes included length of stay, adverse outcomes, and total hospital charges. ResultsFifty-one patients were managed with ED observation and 79 with inpatient observation. Recurrence rates, time to recurrence, and adverse outcomes were similar in both protocols. Total recurrence rates for ED observation was 15% versus 14% for inpatient observation. ED observation reduced time in the hospital by 26.8 h (4.9 versus 31.7 h). ConclusionDischarging patients following uncomplicated hydrostatic reduction of ileocolic intussusception after a 4-h observation period does not result in an increase in adverse outcomes.

Abdominal ultrasound in children - are we careful enough when it comes to lung bases?

Objective - To investigate the frequency of positive findings within the lung bases during abdominal ultrasound (US) examinations in children with referral diagnosis not suggesting pulmonary disease. Materials and methods - A retrospective study included all children with abdominal US performed within 2 years by a single pediatric radiologist in the regional children's hospital. Of all examined children, 22 (mean 7.4 y, SD=4.2 y) had pathological findings detected within the lung bases, without referral diagnosis suggesting a pulmonary pathology. Each abdominal US included a trans-abdominal (trans-hepatic and trans-splenic) approach to both lung bases. Results - While performing abdominal US a detected pulmonary pathology included: 19 pneumonias and 3 pleuropneumonias, with the most common referral diagnosis being abdominal pain (15 children), followed by nausea and vomitting (3 children), febrile convulsiones (2 children), exacerbation of juvenile arthritis (1), and a routine follow-up a day after hydrostatic reduction of ileocolic intussusception (1). In outpatients with referral diagnosis of abdominal pain, 0.95% had positive lung base US findings. Conclusion - Each radiologist should be aware of the potential pathological finding within the lung bases when performing abdominal ultrasound in children. Its detection might have a serious impact on the patient's treatment.

US-guided hydrostatic reduction of intussusception in children.

Over a period of 3 3/4 years, hydrostatic reduction of ileocolic intussusception was performed under sonographic guidance in 47 cases (a total of 41 consecutive patients). The enema consisted of a mixture of isotonic electrolyte solution and water-soluble contrast medium (9:1 ratio) and was given at a hydrostatic pressure of 80-100 cm water. Reduction was successful in 83% of cases (n = 39). Even initially remaining ileo-ileal intussusception could finally be reduced in two cases. No complications were observed. Since, in comparison with other conservative methods of reduction, the success rate was not substantially worse (versus that of pneumatic reduction) or was even higher (versus that of barium enema reduction), the method described can be recommended for wider use because of the substantial reduction in radiation exposure.

Hydrostatic reduction of ileocolic intussusception: A second attempt in the operating room with general anesthesia

Over a 3-year-period, standard treatment with hydrostatic pressure from a contrast enema failed to reduce ileocolic intussusception in 31 of 62 children. With the child anesthetized in the operating room, a second contrast enema was given before laparotomy. Of the 31 intussusceptions, 21 (68%) were reduced without complication, thereby avoiding the discomfort, longer hospitalization, complications, and expense of surgery. Nine of the remaining 10 intussusceptions were difficult to reduce manually during surgery or required resection. The overall nonoperative reduction rate for the 3-year period was 84%; for the last 2 years it was 90%. Success with the second enema may be related to the effects of general anesthesia. In addition, partial reduction with the first enema may improve blood flow from the intussusceptum so that it becomes smaller and easier to reduce with the second enema. Because it can easily be added to standard management protocols without increased risk, routine use of this second enema with anesthesia is recommended.

Analgesic Premedication in the Management of Ileocolic Intussusception

Hydrostatic reduction of ileocolic intussusception by barium enema is uniformly regarded as optimal management, with surgical treatment reserved for occasions when this is not successful and for other selected circumstances.1 In an attempt to maximize the success rate of hydrostatic reduction, we examined the effect of analgesic premedication on both the outcome for the barium study and the operative findings. MATERIALS AND METHODS The case records and radiographs of 76 children with ileocolic intussusception treated at the Yale-New Haven Hospital between Jan 1, 1974, and Dec 31, 1984, were reviewed for patient age, sex, seasonal incidence, presenting signs and symptoms, and results of hydrostatic reduction, as well as surgical treatment with operative findings, morbidity, and mortality.