Reduction Of Intussusception Research Articles

Midazolam premedication in ileocolic intussusception: a retrospective multicenter study.

Procedural sedation with MDZ for enema reduction of intussusception can increase the success rate and lead to a better management of patients. • Despite the evidence of the usefulness of sedatives in the reduction of intussusception, their use is still not a common practice. • Midazolam during enema reduction of intussusception can increase the success rate and consequently lead to better management of patients.

Laparoscopic versus Open Reduction of Intussusception in Infants and Children: A Systematic Review and Meta-analysis

We conducted a systematic review and meta-analysis to compare the efficacy and safety between laparoscopic reduction (LR) and open reduction (OR) of intussusception in infants and children. Literature searches were conducted to identify studies having compared LR and OR for children with intussusception failed to enema reduction. Parameters such as operative time, time to oral intake, length of hospital stay, overall postoperative complications, and recurrence were pooled and compared by meta-analysis. Among the 502 pediatric participants included in the 11 studies, 275 had received LR and 227 received OR. There were shorter length of hospital stays and time to oral intake with the LR approach compared with OR. However, no significant difference was found between LR and OR in the secondary outcome, such as the overall postoperative complications and recurrence. LR is a feasible, safe, and effective surgical procedure alternative to OR for pediatric intussusception. Compared with OR, LR has the advantage of shorter hospital stay and faster time to oral intake. Besides, the overall postoperative complications may be slightly lower in LR. We conclude that LR should be considered an acceptable option for children.

A novel dual balloon rectal catheter for use in the postoperative assessment of low rectal anastomoses following low anterior resection

Following low anterior resection (LAR) of the colon, an image-guided assessment of the anastomosis for leak is typically performed using an enema via a rectal catheter, whether by CT or fluoroscopy. However, there is potential for poor assessment due to inappropriate catheter positioning as well as potential risk that the anastomosis becomes compromised by the balloon inflation. This article discusses the adaptation of a novel double-balloon catheter (originally designed by a member of our institution for use in pediatric intussusception reduction) for assessment of low rectal anastomoses. The goal of this technical note is to demonstrate our experience with this catheter, primarily through example cases, and explain its potential for optimizing colon distension, minimizing improper catheter placement, and potentially reducing the risk of iatrogenic anastomosis disruption.

Comparative Study between Hydrostatic and Pneumatic Reduction For Early Intussusception In Pediatrics

Comparative Study between Hydrostatic and Pneumatic Reduction For Early Intussusception In Pediatrics

Colonoscopic reduction of atransanal prolapsed ileocolic intussusception.

Transanal protrusion of intussusception (TAPI; also known as prolapsed intussusception) is arare complication. Here, we present asuccessful colonoscopic reduction of ileocolic intussusception presented with transanal prolapse. An 8‑month male child, weighing 8 kg, was referred to our hospital presenting with amass in his anal canal, diarrhea and rectal bleeding for two days. The sonographic evaluation revealed an ileocolic intussusception in the rectosigmoid area. The patient was treated using colonoscopic reduction. To our knowledge, this is the first study reporting colonoscopic reduction for transanal prolapsed intussusceptions. Our study suggests gastroenterologists to consider colonoscopy as atherapeutic method for prolapsed intussusceptions and encourages them to attempt reducing the invagination using this method before laparotomy, especially in cases presenting within 48 h of onset of symptoms and no peritonitis symptoms.

Jejunal Intussusception Caused by a Nasointestinal Ileus Tube.

A 79-year-old man was admitted to our hospital due to pleural empyema. After 4 weeks of antimicrobial therapy and pleural drainage, he recovered but complained of new-onset abdominal pain. Abdominal computed tomography revealed adhesive small bowel obstruction and a nasointestinal ileus tube with intermittent suction was inserted. This procedure initially decreased his abdominal pain, but severe abdominal pain and vomiting developed 3 days later. Repeat abdominal computed tomography revealed jejuno-jejunal intussusception due to the nasointestinal ileus tube. Our patient was initially treated conservatively. However, he underwent surgical reduction due to clinical deterioration 1 day after diagnosis and died from a surgical complication 19 days later. Intussusception is a rare but fatal complication caused by placement of a nasointestinal ileus tube in the small intestine. Because urgent operative reduction is needed to avoid intestinal resection in most cases, early diagnosis and surgical reduction of intussusception are critical.LEARNING POINTSIntussusception is a rare but fatal complication caused by placement of a nasointestinal ileus tube.Intussusception should be suspected if abdominal pain and distention worsen after placement of a nasointestinal ileus tube.Urgent operative reduction is needed for intussusception due to a nasointestinal ileus tube.

Laparoscopic approach for managing intussusception in children: Analysis of 65 cases.

BACKGROUNDIntussusception can be managed by pneumatic reduction, ultrasound-guided hydrostatic reduction, open or laparoscopic surgery, but laparoscopy in such cases remains controversial. AIMTo explore the clinical characteristics, effectiveness, and complications of surgical reduction for intussusception using laparoscopy in children. METHODSThis study was a retrospective case series of pediatric patients with intussusception who underwent surgical reduction by laparoscopy from May 2011 to April 2016 at Taizhou Hospital of Zhejiang Province. Clinical characteristics (operation time, intraoperative blood loss, conversion rate of laparotomy, reasons for conversion, postoperative hospital stay, and adverse events) were described.RESULTSThe 65 patients included 45 boys and 20 girls. The average age was 2.3 years (27.5 ± 24.5 mo). Of the 65 patients, 61 underwent surgical reduction by laparoscopy after a failed enema reduction of intussusception, and four underwent the procedure directly. All patients were treated successfully and 57 (87.7%) patients underwent successful laparoscopic surgery, two of which had a spontaneous reduction. Among the remaining cases, one was converted to open surgery via right upper quadrant incision, and seven required enlarged umbilical incisions. Intestinal resection was performed in 5 patients because of abnormal bowel lesions. There were no complications (intestinal perforations, wound infections, or intestinal adhesions) during the follow-up of 3 years to 8 years. Two patients experienced a recurrence of intussusception; one was resolved with pneumatic reduction, and the other underwent a second laparoscopic surgery. CONCLUSIONLaparoscopic approach for pediatric intussusception is feasible and safe. Bowel resection if required can be performed by extending umbilical incision without the conventional laparotomy.

Clinical Features and Outcome of Saline Hydrostatic Reduction in Patients with Intussusception in a Tertiary Care Centre

Background: Intussusception is one of the most frequent causes of acute bowel obstruction in infants and toddlers. Abdominal sonogram is highly specific, accurate and is the first line diagnostic modality. The primary treatment options are non-operative hydrostatic or pneumatic reduction. In our institution, we use normal saline for reduction of intussusception under ultrasound guidance (USGR). The aim of the study is to analyse the clinical pattern and treatment outcome of intussusception. Methodology: Retrospective analysis of all cases admitted with intussusception in our department during 2014-2018 was done. Results: 785 cases (527 males: 258 females) with a mean age of 25 months and median of 16 months had abdominal pain (92.5%), vomiting (59%) and blood in stools (32%) as the predominant symptoms. 710/785 cases (90.4%) underwent successful USGR and 75/785 of the failed cases underwent surgery. Age group < 12 months, presence of blood in stools irrespective of its duration and prolonged vomiting >48 hours were found to be significant factors for failed USGR. Vomiting and blood in stools were found to be significantly higher in children <12 months of age (p<0.005), whereas pathological lead points were more frequent in children >3 years of age. Conclusion: With a high success rate and no significant complication rate, USGR is an effective non-operative treatment modality for intussusception. Age group <12 months, prolonged vomiting and presence of blood in stool were found to affect the success rate of hydrostatic reduction. Keywords: Intussusception, saline, ultrasound, hydrostatic reduction.

Laparoscopic versus open reduction of idiopathic intussusception in children: an updated institutional experience

BackgroundIn the reduction of intussusception, due to the lack of randomized, controlled, and prospective clinical trials to confirm the superiority of the laparoscopic approach over open surgery, more evidence was needed. This study aimed to compare the results of laparoscopy and open reduction of idiopathic intussusception in children as well as to illustrate some skills for the reduction of intussusception laparoscopically.MethodsA retrospective review was performed to evaluate outcomes for patients with idiopathic intussusception who were treated laparoscopically (LAP group) from January 2015 to December 2019 and to compare the outcomes with laparotomy (OPEN group) during the same period.ResultsDuring the period studied, there were 162 patients treated surgically for intussusception: 62 LAP and 100 OPEN. No statistical differences were found in demographic data, clinical symptoms and signs, duration of symptoms, location and types of intussusception between the two groups. Conversion to open procedure was required for 11 patients in the LAP group. The operation time and time to oral intake were shorter in the LAP group while the difference was not significant. If the 11 conversion cases were excluded, the operation time and time to oral intake were significantly shorter (P < 0.05) in the LAP group. The length of stay was significantly shorter in the LAP group (P < 0.05). Intraoperative and postoperative complication rates between the two groups were comparable (P = 1.0).ConclusionLaparoscopy was safe and effective in the treatment of pediatric idiopathic intussusceptions. Pediatric surgeons with sophisticated minimally invasive skills should choose laparoscopy as the first choice in the treatment of idiopathic intussusceptions.

Spontaneous Reduction of Intussusception in Infants: Is the Glass Half Empty or Half Full?

Background: Intussusception is not an uncommon abdominal surgical emergency in children. However, spontaneous reduction of intussusception is possible, though uncommon. Materials and Methods: This was a retrospective study of the characteristics of infants who had spontaneous reduction of intussusception at a tertiary hospital in Enugu, Nigeria. The study covered a 5-year period. Diagnosis of intussusception was made and confirmed based on clinical features and imaging (ultrasound) findings respectively. Results: A total of 383 cases of intussusception in infants were confirmed during the study period. Out of this number, 12 infants had spontaneous reduction. These gave a spontaneous reduction rate of 3.1% and form the basis of this report. The mean age of the patients was 6 months and there was male predominance. Abdominal pain was the most common symptom and the patients had abdominal ultrasound scan. Majority of the patients had normal serum electrolyte values. Two-thirds of the spontaneous reduction occurred preoperatively while one-third of the reductions were noticed intra-op. No definitive operative procedure was performed because the intussusception had resolved spontaneously. www.wjclinicalsurgery.com 1 Conclusion: Spontaneous reduction of intussusception is an uncommon event that may occur without stimulation. This study has shown that about 3 in 100 cases of intussusception in infants may reduce spontaneously. However, it must be emphasized that all efforts should be geared towards nonoperative or operative treatment of intussusception, as spontaneous reduction is not an option of treatment.

The syringe technique for ultrasound-guided hydrostatic intussusception reduction

ABSTRACTBackground:Ultrasound-guided hydrostatic reduction (UGHR) is a well accepted and widely used method of paediatric intussusception reduction, with the saline drip technique being the most commonly employed.Aims and Objectives:In this study we aimed to assess the outcomes of a novel technique of UGHR.Materials and Methods:Data was obtained from a 15 year retrospective chart review of paediatric intussusceptions. Following resuscitation, UGHR was performed for uncomplicated intussusceptions using a 50cc syringe to infuse saline into the colon. It was performed in the ultrasound suite without sedation and time taken was monitored. A maximum of 3 attempts were done to achieve reduction.Results:UGHR was attempted in 66 of 93 intussusceptions. The commonest type of intussusception was ileo-colic(91%) and the commonest symptom was vomiting(70%). Surgery was performed only when there was shock, peritonitis or repeated failed reductions. The median time taken for reduction was 4.9 minutes. The overall success rate was 83% with 89% of these requiring only a single attempt. There were no deaths or procedure related complications.Conclusions:The syringe technique for intussusception reduction is a safe, effective, and time-saving technique. Additionally, it offers the advantages of simplicity and rapidity of reduction and in experienced hands may not require pressure monitoring

Laparoscopic Right Hemicolectomy of a Low-Grade Appendiceal Mucinous Neoplasm Causing an Ileocolic Intussusception: A Case Report

IntroductionIntussusception, although common in the pediatric population, rarely occurs in adults. Furthermore, patients often show nonspecific symptoms. Most adult patients with intussusception have a surgical lead point, a well-defined pathological abnormality, often accurately diagnosed after surgery. A low-grade appendiceal mucinous neoplasm (LAMN), often misdiagnosed as acute appendicitis, is rarely associated with the development of intussusception. Here we report a case of LAMN-related ileocolic intussusception that was histologically diagnosed after laparoscopic right hemicolectomy.Case presentationA 58-year-old woman visited our emergency department because of intermittent episodes of epigastric pain with periumbilical tenderness. These symptoms persisted intermittently for 2 weeks. The pain was moderate in severity, colicky in nature, and sometimes shifted to the lower abdominal region. Abdominal computed tomography indicated intussusception with ileocecal and mesenteric telescoping into the transverse colon. Complete colonoscopy with reduction of intussusception was performed, revealing a ball-like mass protruding and occupying the entire cecum lumen. Laparoscopic right hemicolectomy was then performed. Macroscopically, a dilated appendix was revealed with mucin content, along with hyalinization and fibrosis of the appendiceal wall. Microscopically, a tumor exhibiting villous and flat proliferation of mucinous epithelial cells with low-grade nuclear atypia was seen. However, there was no infiltration growth of the tumor cells, thereby demonstrating LAMN. Postoperative recovery was uneventful, and the patient was discharged on the 8th postoperative day without surgical complications.ConclusionThe differential diagnoses of chronic and colicky abdominal pain should be expanded to include intussusceptions as they can be severe, although cases in adults are rare.

Successful colonoscopic decompression of colocolic intussusception with polypectomy in a five-year-old

The incidence of colocolic intussusception is rare in the pediatric population. When it is encountered, there should be a high index of suspicion for colonic neoplasm acting as the lead point. Our case involves a 5-year-old male who presented with left-sided colocolic intussusception secondary to multiple colonic polyps. He underwent colonoscopy with successful reduction of the intussusception in addition to endoscopic removal of multiple colonic polyps. The use of endoscopy to resolve the intussusception proved to be a valuable tool for our patient as it avoided subjecting the patient to an operation and allowed for surveillance of the remainder of the colon. IV. • Colocolic intussusception is rare in children. • Management frequently includes air enema, but open or laparoscopic surgical resection has also often been reported. • We introduce the use of colonoscopy for reduction of colocolonic intussusception, which has not previously been described.

Bedside hydrostatic saline enema reduction of pediatric intussusception: Our experience

Bedside hydrostatic saline enema reduction of pediatric intussusception: Our experience

Neonatal intussusception secondary to intestinal duplication cyst: A case report

Background: Intussusception is a rare cause of bleeding per rectum in neonates. Duplication cyst as a pathological lead point for intussusception is rarer too. Case Presentation: A female neonate presented with bilious vomiting and bleeding per rectum. Ultrasonography diagnosed it as intussusception. Intraoperatively, on reduction of intussusception, a mass was found which on histopathological examination (HPE) revealed a duplication cyst. Conclusion: A high index of suspicion is required for an early diagnosis of neonatal intussusception, which is essential for preventing complications and mortality.

Outcome of ultrasound guided reduction of intussusception in children by saline enema

Background: Intussuception is a common cause of acute intestinal obstruction in children and contributor of morbidity and mortality in children. The purpose of this study was to evaluate efficacy of hydrostatic reduction of intussusception over operative reduction using normal saline enema in children and to identify procedure related complications.Methods: All patients presenting to us with features of intussusception clinically and confirmed by ultrasonography between June 2015 to November 2017 were included in study. Depending on haemodynamic stability of patient and surgeon’s preference, patients were subjected to trial of hydrostatic reduction by normal saline enema or operative procedure. Patients with failure or partial reduction were taken for surgery.Results: The mean age was 21.07 months with a male preponderance. Of 53 patients attending the institute, 32 were given a trial of hydrostatic reduction which was successful in 28. Thus success rate was 87.5%. 1 patient succumbed resulting in 1.4% mortality rate after the procedure. It was observed that longer duration of symptoms reduced chances of reduction. 88%patients with successful hydrostatic reduction were discharged within 4 days of admission.Conclusions: We conclude that ultrasound guided saline enema is simple ,safe and effective method of treating intussusception in children with low rate of complications and can be strongly recommended as first line of treatment of intussusception in select group of paediatric patient, especially those reporting early to the hospital.

SP3.2.6 Success of Ultrasound-Guided Reduction of Intussusception Using Normal/Saline And Factors Resulting In Failure of the Procedure

Abstract Intussusception is one of the common pediatric surgical emergencies in age less than one year. The initial radiological study for detection of intussusception is ultrasound. Treatment of choice of intussusceptions has remained controversial and varies from center to center. Surgical exploration was the main treatment in the past and still practiced as first-line treatment in some centers. However, in the past few decades, there is a trend to reduce intussusception under radiological guidance. This study aims to determine the success rate of ultrasound-guided hydrostatic reduction of intussusception using normal saline and determination of possible factors that result in failure of the procedure. Methods This prospective study was conducted in the Pediatric Surgery department of Khyber Teaching Hospital, Peshawar from Jan 2018 to Sept 2018. All patients aged between 3 months to 24 months with clinical signs and symptoms and confirmatory sonographic evidence of intussusception were included in this study. The procedure was then carried out under ultrasound guidance using normal saline as a medium for reduction. Findings A total of 80 patients were included in this study. Successful reduction was achieved in 66 (82.5%) patients while in 14(17.5%) patients the procedure failed to reduce the intussusceptions. No mortality is reported in our study There were 6 recurrences 4 of which were managed by ultrasound guidance reduction while 2 underwent laparotomy. Conclusion Ultrasound-guided hydrostatic reduction of intussusception is an effective way to reduce the intussusception. It must be adopted as the primary procedure for the reduction of intussusception.

Діагностика та лікування інвагінації кишечника в дітей

Інвагінація кишок є найбільш частою формою набутої непрохідності шлунково-кишкового тракту в дітей. Метою роботи є вивчення особливостей клінічного перебігу та тактики лікування інвагінації кишечника в дітей і проведення аналізу можливостей діагностичних, клінічних та спеціальних методів обстеження. Матеріали та методи дослідження. Проведено аналіз результатів лікування 272 дітей у клініці дитячої хірургії з 2004 по 2015 рік. Розроблені об’єктивні критерії оцінки стадій інвагінації, що корелюють зі ступенем ендотоксикозу, змінами функції дихання та кровообігу, порушеннями перистальтики кишечника, а також даними ультразвукового дослідження органів черевної порожнини. Результати та обговорення. У хворих з І стадією інвагінації (233 дитини) ознаки ендотоксикозу не виявлені або вони були невиражені. У 10 дітей здійснене оперативне лікування, у 4 випадках — лапароскопічно. 32 пацієнти мали ІІ стадію інвагінації, у 8 випадках інвагінація розпрямлена консервативно з першої спроби. Другої спроби в дітей з ІІ стадією інвагінації не робимо. Оперативне розпрямлення здійснене 24 хворим. ІІІ стадія інвагінації кишечника в дітей (7 хворих) мала прояви ендотоксикозу 3-го ступеня. Усім хворим з ІІІ стадією інвагінації виконана серединна лапаротомія. У 5 випадках виявлений некроз інвагінату, цим дітям виконана резекція кишки з подальшим накладанням кінцевої ілеостоми та інтубацією тонкої кишки. У решти (2) хворих інвагінат вдалося розпрямити, і кишка була визнана життєздатною. Накладання первинного анастомозу після резекції кишки в умовах перитоніту вважаємо недопустимим. Висновки: 1. Комплексне обстеження дітей з використанням лабораторних і інструментальних методів стало підставою для виділення 3 стадій інвагінації кишечника, що корелювали зі ступенем ендотоксикозу та порушеннями функції кишечника: I стадія — компенсована; II стадія — субкомпенсована; III стадія — декомпенсована. 2. Об’єктивна оцінка стадій інвагінації дозволяє диференціювати обсяг заходів на етапах лікування залежно від стадії захворювання, що значно спрощує вирішення тактичних завдань, які стоять перед хірургом та анестезіологом, до, під час і після дезінвагінації.

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.

Nonsurgical reduction of prolapsed colocolic intussusception in 2 puppies.

To describe the nonsurgical management of prolapsed colocolic intussusception in 2 puppies. Two 3-month-old male intact puppies (Pug and Labrador Retriever) developed intussusceptions that had prolapsed from the anus after they had suffered from tenesmus with soft feces or diarrhea. Reduction of the prolapsed tissue was performed and colocolic intussusception was diagnosed ultrasonographically in 1 dog. Rectal manipulation and saline enema were performed in both dogs, and reduction of the intussusception was confirmed endoscopically or ultrasonographically. Bupivacaine and prednisolone foam enemas were administered to reduce tenesmus. Abdominal ultrasonography the following day in 1 dog confirmed a normal appearing colon. No further tenesmus was noted in 1 dog; the other had a brief rectal prolapse after an episode of tenesmus that was manually reduced. Intussusception had not recurred 4 months and 1 year following manual reduction procedures. This is the first report of successful nonsurgical management of colocolic intussusception in a companion animal. Nonsurgical management is a first-line treatment of intussusception in children and could be considered in dogs with colocolic intussusception. Further investigation is required to define specific aspects, including rectal manipulation, saline enema, or anesthesia, that aid in resolution of this type of intussusception.