Hydrostatic Reduction Of Intussusception Research Articles

A Study of Predictors of Failure of Nonoperative Management of Ileocolic Intussusception in Children.

Surgery remains the mainstay in treating intussusception in developing nations. A correspondingly high bowel resection rate exists despite a shift to nonoperative reduction in high-income countries. We aimed to study the clinical profile of the patients with intussusception presenting to our hospital and to assess the clinical and radiological predictors of success or failure of nonoperative management of intussusception. This prospective study was conducted in the Department of Pediatric Surgery over a period of 3 years and included a total of 118 patients who presenting to our emergency division with features suggestive of intussusception and were managed accordingly either with hydrostatic reduction or by surgical intervention. We observed that the majority of the patients were males (65.5%). The mean age was 13.54 months. Intermittent pain was the most common symptom. Both pain and vomiting did not affect the outcome. Lab parameters like raised total leukocyte counts (TLC), C-reactive protein (CRP) and lactate levels were significantly associated with failure of hydrostatic reduction. Patients with air fluid levels on X-ray were more likely to end up in surgery. Ultrasound findings of bowel wall edema, aperistaltic gut loops and a pathological lead point was associated with failure of hydrostatic reduction as well. The overall success rate of hydrostatic reduction was 85.5%. Hydrostatic reduction of intussusception is a safe and effective method of management of intussusception whenever indicated. Factors that might reduce the chance of its success include continuous pain, irritability, tenderness, deranged lab parameters like TLC, CRP and lactate levels, air fluid levels on X-ray, bowel wall edema, aperistalsis and the presence of a lead point. Shah JY, Banday I, Hamdani HZ, et al. A Study of Predictors of Failure of Nonoperative Management of Ileocolic Intussusception in Children. Euroasian J Hepato-Gastroenterol 2024;14(1):81-85.

Intussusception among Children Admitted in a Department of Pediatric Surgery of a Tertiary Care Centre: A Descriptive Cross-Sectional Study.

Intussusception is the second most common cause of acute abdominal pain in infants and preschool children. The aetiology for intussusception is idiopathic at this age. Hydrostatic reduction and exploratory laparotomy with proceed are the options for the management of intussusception. The aim of this study was to find out the prevalence of intussusception among patients admitted to the Department of Pediatric Surgery of a tertiary care centre. This is a descriptive cross-sectional study conducted among admitted patients in the Department of Pediatric Surgery of a tertiary care centre after ethical approval from the Ethical Committee (Reference number: A37-77/78). Data were collected from 1 January 2018 to 31 December 2020 from admitted children aged 6 months to 5 years of age. Data collection was done from the hospital record section using the convenience sampling method. Point estimate and 95% Confidence Interval were calculated. Among 1785 admitted patients, 267 (14.96%) (13.31-16.61, 95% Confidence Interval) were found to have intussusception. Among them, the hydrostatic reduction was successful in 246 (92.13%). Meanwhile, 21 (7.86%) of cases underwent laparotomy. The peak age of patients was seen in 148 (55.43%) in the age group of 1-3 years. Intussusception is one of the common surgical emergencies in children. Hydrostatic reduction of intussusception is a simple and effective method for the treatment of intussusception in children. intussusception; laparotomy; paediatrics; prevalence; ultrasound.

Role of Dexamethasone as an adjuvant in the treatment of intussusception: A prospective study

Background: Intussusception is one of the most commonly encountered abdominal emergencies in children for which the preferred treatment modality has always been non operative hydrostatic reduction. Recurrence is a common concern after a successful hydrostatic reduction. Adjuvant treatment with pharmacological agents have been considered to reduce chances of recurrence. Aim: The study was conducted to examine the role of dexamethasone in decreasing early recurrent intussusception. Materials and methods: A prospective cohort study was conducted in a tertiary care center from June 2018- June 2022 on 51 pediatric patients, admitted with intussusception and divided into a dexamethasone and non-dexamethasone group. Data was collected regarding demography, rate of recurrences, duration of hospital stay, surgery performed if any including the intraoperative findings and associated complications. The level of significance was set at 5%. SPSS version 27 was used to perform the statistical analysis. Result: After ultrasound-guided hydrostatic reduction, the dexamethasone group showed significant reduction in recurrence, compared to the non-dexamethasone group. In this study, 7 cases showed recurrence despite three attempts of hydrostatic reduction and intraoperatively noted to have a pathological lead point. Conclusion: Dexamethasone is one of the greatest discoveries of the 20th century with its vast use in multiple diseases. The use of dexamethasone during hydrostatic reduction of intussusception in a pediatric population makes it a wonderful drug with remarkable results and patient outcome.

HYDROSTATIC REDUCTION OF ILEOCOLIC INTUSSUSCEPTION BY USING GASTROGRAFIN ENEMA IN PAEDIATRIC PATIENTS

Objective: To assess the effectiveness of fluoroscopic guided gastrografin solution enema in reducing idiopathic ileocolicintussusception.Materials and Methods: From January 2014 to June 2015, DHQ Hospital Timergara conducted this prospectiveobservational research. Based on the clinical history and ultrasound confirmation, the diagnosis was made. All patientsdiagnosed and brought in within 48 hours were included in the trial, while those who did not show up before 48 hourswere not. After passing a Foley’s catheter via the anus, the balloon was inflated. Gently injecting a diluted gastrografinsolution with normal saline under controlled pressure was done. Throughout the operation, many radiographs werecollected. When the contrast reached the small intestine, the process was stopped. Under fluoroscopy, we performedhydrostatic reduction in every instance of gastrografin enema. Using the gastrografin enema, the intussusception waseffectively decreased in 10 out of 14 instances. The same oncologist who previously performed the reduction used ultrasonography to check its success.Results: Our patients ranged in age from 4 to 12 years old. There were nine (75% of the total) men and five (25%)women. Twelve out of fourteen patients (85%) who had gastrografin enema guided by fluoroscopy saw a completedecrease. Eleven patients only needed one setting for a full reduction, and just one needed to have the surgery done twice.Four individuals had the surgery stopped due to failure. In 1/12 cases, recurrence after effective reduction was seen.There were no issues either during or after the surgery.Conclusion: Hydrostatic reduction of intussusception with gastrografin enema under ultrasound or fluoroscopicguidance is a very simple and safe nonoperative method for reducing intussusception in children.Key Words: Intussusception, Hydrostatic reduction, fluoroscopic guidance, gastrografin enema.

Ultrasound-guided hydrostatic enema reduction of intussusception and confirmation with single abdominal radiograph in children.

To detect false-positive reduction results after ultrasound (US)-guided hydrostatic intussusception reduction, we have incorporated water-soluble contrast material to the enema fluid and confirmed the reduction with a single abdominal radiograph. We present the results of the combined imaging method for the reduction of intussusception in children. The records of the patients who were treated for intussusception were analyzed retrospectively. Patients were divided into two groups: a US-guided reduction group and a US-guided reduction plus radiographic control group. The patient characteristics, symptoms, treatment methods, outcomes, and complications and follow-up were analyzed. A total of 164 intussusception episodes were treated in 153 patients. Hydrostatic reduction of intussusception was performed in 59 patients in the US-guided group and in 94 patients in the US-guided plus radiographic control group. Recurrence rate in the US-guided group was 15.7%, vs 3.5% in the US-guided plus radiography group (P = .029). In the US-guided plus radiographic control group, 5 (5.3%) false positive reductions under US guidance were determined by abdominal radiography. In order to decrease false positive reduction rate and early recurrence, US-guided intussusception reduction can be performed with saline plus water-soluble contrast material and confirmation of reduction obtained with a single direct abdominal radiograph.

Use of Plane X-Ray for Nonoperative Treatment of Intussusception at Resource Limited Settings in Low-and Middle-Income Countries

Objective: To report an easy and feasible technique of hydrostatic reduction of intussusception using plane x-ray in resource limited setting and summarize the radiological findings. Method: Records of all patients of hydrostatic reduction between May 2015 and April 2020 were retrospectively evaluated to document patient demography, seasonal variations, type of intussusception, duration of procedure, number of x-ray exposures, reflux of contrast through ileocecal valve, location of intussusception mass, presence of redundant colon and outcome. Hydrostatic reduction was performed with water soluble contrast using intermittent shots of plane x-ray, instead of ultrasound (US) or fluoroscopy guidance. Results: Among a total of 204 patients, male to female ratio was 1.7:1. Age ranged from 5 days to 16 years (median 10 months). There were more cases during Winter and Spring (110, 53.9%). Right hepatic flexure was the commonest (115, 56.4%) site of obstruction. Hydrostatic reduction was successful in 172 (84.3%) patients. Median duration of the procedure was 27 minutes and, on an average, 8.4 ± 1.7 exposures were needed for one hydrostatic reduction. There was no significant relation of age group and sex with successful hydrostatic reduction but site of obstruction was significantly related with success (p=0.00). There was one (0.5%) recurrence and no mortality. Conclusion: Hydrostatic reduction using contrast enema under x-ray guidance is a rational alternative to US or fluoroscopy guided reduction in resource limited settings.

Hydrostatic reduction of intussusception in children: a single centre experience.

Introductionintussusception is a common surgical emergency in children especially in infants. Treatment of intussusception could be non-operative or operative. Non-operative treatment (hydrostatic reduction) of intussusception is increasingly being practiced in developing countries.Methodsthis was a review of our experience in the hydrostatic reduction of intussusception in children at a teaching hospital in Enugu, Nigeria. This study covered an 18-months period, October 2017 to March 2019. Patients on presentation were resuscitated, appropriate investigations done and prepared for surgery before the hydrostatic reduction (using normal saline) was carried out. Patients with features of peritonitis and marked abdominal distension were excluded from hydrostatic reduction.Resultstwenty patients who had 21 episodes of intussusception were analyzed. One patient had a recurrence that necessitated repeat hydrostatic reduction. Eighty percent of the patients were male. The mean and peak age of the patients was 8 months and 6 months respectively. Significant number of the patients presented after 48 hours of onset of their symptoms. Abdominal pain was the predominant presenting symptom. Twenty percent and fifteen percent of the patients had a history of preceding gastrointestinal and respiratory infections preceding the intussusception respectively. Ileocolic intussusception was the most common type and the most distal end of the intussusception was at the transverse colon. Hydrostatic reduction was successful in 13 patients (65%).Conclusionhydrostatic reduction is a simple and effective method of treatment of intussusception. However, early presentation and proper patient selection is necessary for optimal outcome.

Ultrasonographic diagnosis and ultrasonic reduction of intussusception in Nnewi, South-East Nigeria

Background: Intussusception is a common cause of intestinal obstruction among infants. Delayed diagnosis and treatment worsen the outcome with possible mortality. At present, ultrasonography is the preferred tool for both diagnosis and treatment for select cases. It is also useful in the diagnosis of comorbidities and as a guide to pneumatic and hydrostatic reduction of intussusception. Aim: The aim of this study is to evaluate the ultrasound features of intussusceptions and to correlate its findings with surgical findings at a tertiary health-care facility. Materials and Methods: This is a retrospective study carried out at Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-east Nigeria, between 2014 and 2016. Data were extracted from case notes, theater records, and radiology, and the following domains were explored: sociodemographic data, ultrasound findings, and intraoperative findings. The data obtained were recorded in an Excel Spreadsheet and were analyzed using the SPSS software version 20, and the results were reviewed in tables and charts. Results: A total of 15 patients that met the inclusion criteria were used for this study. There were more males than that of females, and the peak age was between 4 and 6 months. Most of the patients were scanned and operated after 24 h from the onset of symptoms. The most common presenting symptom was vomiting, and most of the masses were in the right hemiabdomen. Conclusion: The sensitivity of ultrasound in our study was 100%, and this correlates with the findings in other studies. The use of ultrasound early in patients with increased clinical suspicion will, therefore, help to reduce the unnecessary delays in intervention and therefore reduce the complications.

Clinical and radiological predictors of the outcome of hydrostatic reduction of primary intussusception in childhood

Introduction Success of hydrostatic reduction of intussusception using saline enema could be affected by several factors. Aim This study aimed to detect the clinical and radiological predictors of successful hydrostatic reduction of primary intussusception. Patients and methods This retrospective cross-sectional study included all patients with primary intussusception from the age of 6 months to 3 years. Patients with signs of peritonitis or bowel perforation were excluded from the study. Patients’ age, sex, duration and type of symptoms, general, abdominal, and digital rectal examination findings as well as findings in ultrasound of the abdomen (the presence and the site of an abdominal mass) and plain radiograph (PXR) of the abdomen standing (air fluid levels) were recorded and analyzed by appropriate statistical tools with the software SPSS version 10.0. Results Factors that affected the success of hydrostatic reduction significantly included age at presentation (Student’s t test: 3.46, P=0.001), BMI (Student’s t test: 2.383, P=0.019), long duration of symptoms (Student’s t test: 8.812, P=0.000), passage of red currant jelly stools (χ2-test: 91.777, P=0.000), presence of palpable abdominal mass (χ2-test: 55.813, P=0.000), on the left side of the abdomen (χ2-test: 52.439, P=0.000), and positive findings in PXR abdomen standing (χ2-test: 59.911, P=0.000). Conclusion Primary intussusception in patients with younger age group, low BMI, long duration of symptoms, passage of red currant jelly stool, palpable abdominal mass on the left abdominal side being confirmed by ultrasound of the abdomen, and the presence of air fluid levels in PXR abdomen standing have a lower rate of successful hydrostatic reduction.

Intussusception: Single Center Experience of 10 Years

To analyze the association between the clinical presentation, clinical course, management and outcome in intussusception with emphasis on safety of saline hydrostatic reduction. This retrospective study included 375 patients of intussusception diagnosed between March 2007 to February 2017. Symptoms at presentation, mode of reduction of intussusception and associated complications were recorded. 336 (89.6%) patients were aged below 3 years. Classical triad of abdominal pain, vomiting and red stools was present in 111 (29.6%) patients. While 64 (17.1 %) patients had spontaneous resolution, hydrostatic reduction and surgery cured 283 (75.5 %) and 28 (7.4 %) patients, respectively; overall recurrence rate was 13.1%. Among the patients who underwent operative reduction, blood in stools was present in 15 (53.6%) patients. Hydrostatic reduction of intussusception is effective irrespective of duration of symptoms and number of recurrences.

Efficacy of Ultrasound Guided Hydrostatic Reduction of Intussusceptions in Children

Efficacy of Ultrasound Guided Hydrostatic Reduction of Intussusceptions in Children

Variables determining the success of ultrasound-guided hydrostatic reduction of intussusception in infants: a tertiary center experience

Background: Intussusception represents one of the most common urgent surgical admissions during early infancy and childhood period. It’s a form of intestinal obstruction which is manifested by colicky abdominal pain, red current jelly stool and abdominal mass. Abdominal Ultrasound is the method of choice for diagnosis. Treatment of intussusception ranged from simple non operative reduction either by pneumatic or hydrostatic enema to surgical exploration. There multiple variables that may affect the result of of non operative management.Aim: We tried to study them to know whom patient would pass without surgery.Patients and methods: Two hundred patients diagnosed with intussusceptions included in this study. All of them received ultra sound guided hydrostatic reduction using warm saline. The maximum number of attempts of reduction was three times. We used intrvenous sedation in irritable infants.Results: 2 hundred cases with intussusception were treated in this study. One hundred forty were reduced (group A) and 60 cases (group B) required surgical exploration. The mean body weight in group A was 7.3 Kg while in group B 9.3Kg. seventy five cases from both groups were operated.Conclusion: Several factors affect the result of hydrostatic reduction as total leukocytic count, CRP and duration of symptoms. In addition the size of the mass and the presence or absence of free peritoneal fluid affects the non operative management.Keywords: hydrostatic, intussusception, ultrasound

Effects of esketamine sedation compared to morphine analgesia on hydrostatic reduction of intussusception: A case-cohort comparison study.

Hydrostatic or pneumatic reduction of intussusception is an invasive procedure that is stressful and may be painful for a child. Resistance of the child may increase the duration of the procedure and decrease success rate of reduction. Analgesia can help to reduce pain, but not necessarily resistance. General anesthesia increases success rate of reduction. However, it requires the presence of an anesthesiologist, and may lead to anesthesia-related complications. Procedural sedation with esketamine could be a safe alternative. The aim of this study was to compare hydrostatic reduction using morphine analgesia compared to procedural sedation with esketamine in terms of success rate, adverse events, and duration of reduction. A retrospective case-cohort comparison study was performed with two groups of patients who had undergone hydrostatic reduction for ileocolic intussusception and received morphine analgesia (n=37) or esketamine sedation (n=20). Until July 2013, reduction was performed after intravenously administered morphine. Hereafter, a new protocol for procedural sedation was implemented and reduction was performed after administration of esketamine. Cases were matched for age and duration of symptoms. No adverse events requiring intervention other than administration of oxygen were reported for either group. Success rate of reduction using esketamine sedation was 90% vs 70% using morphine analgesia, risk ratio (RR) 1.29, 95% CI[0.93-1.77]. Recurrence rate using esketamine sedation was 10% vs 15% using morphine analgesia, RR 0.67, 95% CI[0.12-3.57]. Reduction time was shorter using esketamine sedation (Median 5minutes, IQR 9minutes) vs morphine analgesia (Median 8minutes, IQR 16minutes, P=.04, Median difference 3, 95% CI[-1.50-8.75]). Median hospital stay in the esketamine group was 1.5days (IQR 1.8) vs 2days (IQR 5.3) in the morphine group. No serious adverse events were recorded. In comparison to morphine analgesia, with esketamine there was weak evidence for a higher success rate, lower recurrence rate, shorter duration, and shorter length of hospital stay.

Hydrostatic Reduction of Intussusception under Ultrasound Guidance in Children

Hydrostatic Reduction of Intussusception under Ultrasound Guidance in Children

Variables determining the success of ultrasound-guided hydrostatic reduction of intussusception in infants

Background: Intussusception represents one of the most common urgent surgical admissions during early infancy and childhood period. It’s a form of intestinal obstruction which is manifested by colicky abdominal pain, red current jelly stool and abdominal mass. Abdominal Ultrasound is the method of choice for diagnosis. Treatment of intussusception ranged from simple non operative reduction either by pneumatic or hydrostatic enema to surgical exploration. There multiple variables that may affect the result of of non operative management. Aim: We tried to study them to know whom patient would pass without surgery. Patients and methods: Two hundred patients diagnosed with intussusceptions included in this study. All of them received ultra sound guided hydrostatic reduction using warm saline. The maximum number of attempts of reduction was three times. We used intrvenous sedation in irritable infants. Results: 2 hundred cases with intussusception were treated in this study. One hundred forty were reduced (group A) and 60 cases (group B) required surgical exploration. The mean body weight in group A was 7.3 Kg while in group B 9.3Kg. seventy five cases from both groups were operated. Conclusion: Several factors affect the result of hydrostatic reduction as total leukocytic count, CRP and duration of symptoms. In addition the size of the mass and the presence or absence of free peritoneal fluid affects the non operative management. Keywords: hydrostatic, intussusception, ultrasound

A comparison of hydrostatic reduction in children with intussusception versus surgery: Single-centre experience

Background:Intussusception is the most common cause of bowel obstruction in infancy and childhood. Early diagnosis and effective management have reduced its morbidity and mortality in developed countries. Non-surgical reduction remains the first-line treatment of choice for intussusception. The major complication of air enema reduction is bowel perforation and portal venous gas. In recent years, several techniques have been recommended for intussusception treatment. In this study, an evaluation was made of intussusception cases that presented at our clinic and had reduction applied together with saline under ultrasonography and cases, which were surgically treated. Our aim of this study is to evaluate the results of hydrostatic reduction under ultrasound guided and to compare the results with patients treated by surgery for the management of intussusception.Patients and Methods:A retrospective study was done of the records of 100 cases treated for a diagnosis of intussusception between April 2011 and April 2013, in Department of Paediatric Surgery, Zagazig University Hospital. Patients were evaluated demographics, clinical presentation and management strategy, during the hospitalisation and outcome.Results:This study includes 100 patients diagnosed with intussusception, sixty males and forty females, the age ranged between 1 month and 7 years old. Ultrasound was applied for all patients as a part of diagnosis. Hydrostatic reduction under ultrasound guide was applied to fifty patients, successful hydrostatic reduction was seen in thirty patients and unsuccessful hydrostatic reduction was seen in twenty patients which admitted for surgery, we did not do another chance of hydrostatic reduction for unsuccessful patients, open surgery was done for seventy patients, during surgery, we found ileocolic intussusception in forty patients, ileoileal in twenty patients and colocolic intussusception in ten patients. Leading point of intussusception was seen in 22 patients, Meckel's diverticulum in ten patients, polyp in five patients and lymphoma in seven patients. Manual reduction was done in forty patients and resection anastomosis was done in thirty patients. No mortality in any case.Conclusion:Ultrasound-guided hydrostatic reduction of intussusception is a safe technique which reduces the duration of hospitalisation and treatment costs.

Hydrostatic Reduction With Barium Enema Is A Preferred Treatment Option for Uncomplicated Intussusception : Five Years Experience in Cmch

Intussusception is a common cause of intestinal obstruction in young children and is a common emergency in infants and children. Hydrostatic reduction of intussusception is a less invasive procedure for both diagnosis and treatment of it. We describe our experience with hydrostatic reduction of intussusception. A retrospective review of the patients of Intussusception admitted in the department of Pediatric Surgery Chittagong Medical College Hospital (CMCH) Chittagong, Bangladesh from January 2009 to December 2013 was done. Patients underwent hydrostatic reduction were evaluated separately. Data were analyzed with regard to success and failure of hydrostatic reduction, necessitating laparotomy, complication and mortality. There were 231 patients of Intussusception. Age range was lmonth to 15 years with median age of 8 months. Male to Female ratio was 2.9:1. Mean duration of presentation was 40 hours after onset of symptoms. Hydrostatic reduction was attempted in 142 patients and was successful in 107 patients, 35 patients needed surgery in whom per-operative manual reduction was done in 28 patients and intestinal resection anastomosis was done in in 7 patients. There were 2 cases of recurrence following hydrostatic reduction and no case of perforation due to hydrostatic reduction. 2 patients died following
 JCMCTA 2015 ; 26 (1) : 9-13

Radiation dose in pneumatic reduction of ileo-colic intussusceptions--results from a single-institution study.

Air enema under fluoroscopy is a well-accepted procedure for the treatment of childhood intussusception. However, the reported radiation doses of pneumatic reduction with conventional fluoroscopy units have been high in decades past. To compare current radiation doses at our institution to past doses reported by others for fluoroscopic-guided pneumatic reduction of ileo-colic intussusception in children. Since 2007 radiologists and residents in our department who perform reduction of intussusceptions have received a radiation risk training. We retrospectively analyzed the data of 45 children (5 months-8 years) who underwent a total of 48 pneumatic reductions of ileo-colic intussusception between 2008 and 2012. We analyzed data for screening time and dose area product (DAP) and compared these data to those reported up to and including the year 2000. Our mean screening time measured by the DAP-meter was 53.8 s (range 1-320 s, median 33.0 s). The mean DAP was 11.4 cGy ∙ cm(2) (range 1-145 cGy ∙ cm(2), median 5.45 cGy ∙ cm(2)). There was one bowel perforation, in a 1-year-old boy requiring surgical revision. Only three studies in the literature presented radiation exposure results on children who received pneumatic or hydrostatic reduction of intussusception under fluoroscopy. Screening times and dose area products in those studies, which were published in the 1990 s and in the year 2000, were substantially higher than those in our sample. Low-frequency pulsed fluoroscopy and other dose-saving keys as well as the radiation risk training might have helped to improve the quality of the procedure in terms of radiation exposure.

Problem Oriented Imaging of Gastrointestinal Tract (GIT); "News and Views"

: The anatomic and functional abnormalities of GI-tract can be divided into congenital disorders to be observed in early life and acquired diseases which manifest themselves later on. The clinical symptoms in both groups are generally; vomiting or gastric retention, abdominal distention, pain, failure to pass meconium or abnormal defecation and others depending on severity and location of such disorders. An imaging approach has to be related to the clinical finding and it should be problem orientated. The available modalities for evaluation of different GIT abnormalities include abdominal plain film, ultrasound, CT, MRI, endoscopy and nuclear scanning. Abdominal plain film and ultrasound can be considered as the first step in most of the emergency cases. The use of GI series with contrast media is a golden standard in a large number of upper and lower GI abnormalities. The technique and the manner of examination are reported differently in literature and textbooks. The diagnostic approach in GI-series needs an appropriate technique depending on the age and condition of the patient to avoid the risk of aspiration and other complications. Endoscopy and MR enteroclysis are the first choice in evaluation of colitis and Crohn' s disease. Only in exceptional cases are GI-series with contrast agent indicated. Because of the high radiation dose of the CT, it is to be reserved for complicated cases of intestinal disorders, such as complex intestinal infection with abscesses and detection of sonographic unrecognizable appendicitis, tumors and others. Nuclear scanning is frequently needed for detection and localization in occult gastro-intestinal bleedings especially when there is clinical suspicion of Meckel's diverticula and intestinal duplication; ectopic gastric tissue shows intense uptake of radio nuclide if gastric tissue exists. The aim of this workshop is to show my own experiences and practical new techniques in evaluation of GI abnormalities. Special attention should be paid to diversities of sonographic finding in appendicitis and appropriate techniques in hydrostatic reduction of intussusceptions. Additionally, special methods in the diagnosis of Hirschsprungs disease and anorectal malformation with contrast media will be shown.

Recurrent Intussusception in Infants

Background: The majority of intussusceptions, between 2 months and 2 years, are idiopathic. Indication of surgery in infants with recurrences is still matter for debate. The aim of our study was to review our experience to better define the management of recurrent intussusceptions (RIs). Methods: A retrospective study was conducted involving all patients treated for intussusception at the Department of Pediatric Surgery “A” of Tunis Children’s Hospital, over a 5-year period, going from 2008 through 2012. Patients admitted for more than one episode of intussusception were further investigated. Results: During the 5-year period, 170 infants and children younger than 2 years were diagnosed as having ileocolic intussusception. There were 10 patients with 12 recurrences. Overall recurrence rate was 6%. RI occurred in all cases following successful hydrostatic reduction. Nine infants underwent a second hydrostatic reduction of intussusception. The reduction was successful in all cases. The other infant was taken directly to the operating room because it was too sick to undergo enema. No lead point was found at surgery. The two patients who presented a second recurrence had a successful non-operative reduction. Subsequent laparoscopic exploration was normal in both cases. Conclusion: Based on our experience and on reviewing the literature, we recommend radiological reduction for more than the third episode of intussusceptions but we must take into consideration the socio-economic level of the parents. Surgery should be reserved for irreducible recurrences and in patients with a suspected pathologic lead point. Int J Clin Pediatr. 2014;3(4):105-107 doi: http://dx.doi.org/10.14740/ijcp175w