Reduction Of Intussusception Research Articles

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.

Laparoscopic reduction of intussusception in a 13-year-old girl with multiple intestinal polyps: A case report

Laparoscopic reduction of intussusception in a 13-year-old girl with multiple intestinal polyps: A case report

Ultrasound Guided Pneumatic Reduction of Intussusceptions: A Clinical Experience from Baghdad

Intussusceptions 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 & where facilities are available. Pneumatic reduction has become a popular therapeutic method for intussusceptions instead of surgery in many centers.

Ultrasound-guided reduction of intussusception in infants in a developing world: saline hydrostatic or pneumatic technique?

Saline hydrostatic reduction and pneumatic reduction of uncomplicated intussusception under ultrasound guidance in infants might have comparable outcomes. However, pneumatic reduction may be faster. • Ileocolic intussusception is the most common cause of intestinal obstruction in infants. • Ultrasonography is useful in the diagnosis and non-operative treatment of ileocolic intussusception. • Ultrasound-guided hydrostatic enema and ultrasound-guided pneumatic enema are similarly effective and safe techniques in the reduction of ileocolic intussusception. • Reduction of ileocolic intussusception under ultrasound guidance is a great technique that may prove useful in the developing world due to lower cost of required equipment.

Ultrasound Guided Hydrostatic Versus Open Reduction in Intussusception

The surgical and nonsurgical technique has been utilized to manage intussusception. Surgical management of intussusceptions involves open laparotomy along with manual reduction. The non-surgical technique, Ultrasound-guided hydrostatic reduction (USGHR) is a renowned alternative technique for intussusception reduction. Objective: To compare the ultrasound-guided hydrostatic reduction versus open reduction for the management of intussusception in terms of successful reduction, recurrence, and hospital stay. Methods: It was a randomized controlled trial in which 158 cases were admitted through the Emergency Department of Pediatric Surgery of The Children’s Hospital Lahore, from August 2018 to August 2019. These patients were divided into 2 groups (79 in each group), Group A (ultrasound-guided hydrostatic reduction) and group B (open reduction). Data were collected through a questionnaire, which was entered into the computer using SPSS version 24.0. Results: Among 79 patients treated in-group A, 54.4% were up to 12 months old, and 67.1% males, in this group the hospital stay for 74.7% was 1-2 days and 74.7% had a successful reduction. In group B; patients treated in group B, 77.2% were up to 12 months old, and 72.2% were males. The hospital stay for 59.5% of patients was 5-7 days, and 83.5% had a successful reduction of intussusceptions. The recurrence was only in group B (3.8%) after the reduction of intussusceptions. Conclusion: The study concluded that ultrasound-guided hydrostatic is effective in terms of successful reduction, recurrence and hospital stay and should be preferred among children due to its safety and effectiveness.

Adult intussusception: a challenge to laparoscopic surgery?

Intussusception can occur at any age and is common in children but less common in adults. This study aimed to evaluate our experience of 51 adult intussusception and study the etiology, clinical manifestations, diagnosis, and treatment. This analysis assessed the clinical manifestations, etiology, diagnosis, and treatment of adult intussusception in 51 adult patients at the Department of Gastrointestinal Surgery of China-Japan Union Hospital of Jilin University from January 2010 to December 2020. The mean age of the cohort was 54.43 ± 18.21 years, and 42 patients were diagnosed by abdominal ultrasonography and abdominal computed tomography (CT). Among them, 76.5% (39/51) had abdominal pain, 11.8% (6/51) had blood in stool, and 5.9% (3/51) had a palpable abdominal mass. Of these, 62.7% had tumors: malignant accounted for 39.2% (20/51) and benign accounted for 23.5% (12/51). CT is the preferred imaging method with a sensitivity of 92.2%, while colonoscopy provides a complementary diagnosis in patients involving the colon. All patients underwent surgical treatment, including 21.6% (11/51) laparoscopic surgery, 74.5% (38/51) open surgery, and 5.9% (3/51) intussusception reduction during the operation. The average operation time of the open group was 133.27 ± 43.75 min and the average hospital stay was 16.24 ± 12.55 days, while the average operation time of the laparoscopic group was 140.50 ± 46.15 mins, and the average hospital stay was 16.60 ± 16.98 days (P > 0.05). Adult intussusception is a rare disease in clinic. Laparoscopic surgery can be useful and safe for adult intussusception.

Intestinal tumor lesions leading to intussusception in children: a report of four cases and literature review

BackgroundIntussusception is commonly idiopathic in children. Pathologic lead points (PLP) especially intestinal tumors (IT) are extremely rare. The diagnosis of intussusception secondary to pediatric IT is difficult due to the non-specific nature of symptoms. Its management remains a challenge. We report here four pediatric cases of intussusception secondary to IT lesions in order to analyze the clinical and therapeutic characteristics of this unusual condition.Case presentationsFour children were diagnosed and operated in our center for intussusception secondary to IT during the period from February 2017 to February 2021. Patients’ demographics, clinical presentations, investigations, operative data, and postoperative outcome were recorded and analyzed. There were three girls and one boy. Ages ranged between 1 and 8 years (average of 5.5 years). Intermittent abdominal pain with acute exacerbation and vomiting were the main clinical signs. Radiologic investigations showed the intussusception in all cases but the tumor lead point was evident only during the surgical exploration in most cases. All patients underwent surgical treatment with intussusception reduction and mass removal. Pathological examination of these masses revealed: submucosal intestinal lipoma (1 case), hamartomatous polyposis (2 cases), and Burkitt’s lymphoma (1 case). For this last case, adjuvant chemotherapy was also needed. The postoperative period was uneventful in all cases.ConclusionPediatric intussusception secondary to IT lesions is an unusual and challenging condition that requires high preoperative diagnostic suspicion, considerate intraoperative judgment, and appropriate postoperative follow-up for successful outcomes.These tumors should be considered by the pediatric surgeons as possible PLP for recurrent intussusception, especially in older children. Surgeons should be familiar with the various treatment options, because the real cause of the intussusception is often accurately diagnosed by laparotomy.

The Value of Rotavirus Vaccination in Europe: A Call for Action.

The severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) pandemic has pushed many healthcare systems into crisis. High vaccine coverage amongst children reduces emergency room presentations, hospital admissions and deaths due to vaccine-preventable diseases, freeing up healthcare resources including polymerase chain reaction testing for patients with SARS-CoV-2. In Europe, rotavirus gastroenteritis leads to 75,000-150,000 hospitalisations and up to 600,000 medical encounters annually. Nevertheless, in 2022, only 18 countries in Europe (out of 38) have a publicly funded routine universal mass immunisation programme against rotavirus gastroenteritis. Evidence available in the last few years re-emphasises that rotavirus vaccines currently available in Europe are highly effective, preventing up to 96% of rotavirus-related hospitalisations in children less than 1year of age (potentially 72,000-144,000 hospitalisations Europe-wide). Long-term surveillance indicates that rotavirus vaccination does not result in an overall increase in intussusception. On the contrary, increasing evidence suggests an overall reduction in intussusception in the first 12months of life when early, high rotavirus vaccine coverage is achieved. Prevention of rotavirus gastroenteritis has marked positive impacts on parental wages and government tax revenue, with benefits extending across the whole economy. In the SARS-CoV-2 pandemic setting there is a new imperative to achieve high levels of paediatric vaccination against vaccine-preventable diseases, including rotavirus gastroenteritis. The introduction of rotavirus universal mass vaccination can be expected to reduce the number of preventable illnesses, hospitalisations and deaths caused by rotavirus gastroenteritis. Reducing vaccine-preventable diseases is particularly urgent at this time when healthcare systems are preoccupied and overwhelmed with SARS-CoV-2. Graphical abstract available for this article.

Gertrude Herzfeld: The woman who dared to be a surgeon

Gertrude Marianne Amalia Herzfeld (1890–1981), the first practicing female surgeon in Scotland, overcame bias against women in medicine and pediatric specialists in surgery. After her graduation from the University of Edinburgh Medical School (1914), she became the first female house surgeon at the Royal Hospital for Sick Children, Edinburgh. In 1920, she became the first practicing woman surgeon to become a Fellow of the Royal College of Surgeons of Edinburgh.She left a handful of publications in pediatric surgery: a “radical cure” for inguinal hernia, i.e., early surgery (1925); a review of abdominal surgery in infancy and childhood (1937); surgery for the acute abdomen (1939); and intestinal obstruction (1945). They offer a twenty-year window into how children's surgery was once practiced, when operations were done in patients’ homes, and decisions for operation depended solely on the history and physical exam without laboratory testing and radiological imaging. As a series of snapshots over two decades, they reveal how her practice evolved in such areas as fluid resuscitation and radiological reduction of intussusception. She remained steadfast to a careful physical examination and early operation.While she did not document her practice in the care of children with ambiguous genitalia and intersex conditions, she approached the formidable anatomic, psychological, and social challenges of her patients and their families with patience and understanding. Herzfeld was devoted to the care of yet another marginalized population that today is subsumed by the acronym LGBTQIA, yet another area where she was far ahead of her time.Level of evidence: Level VII.

61 Analgesia and sedation for pediatric ileocolic intussusception: a global, multicenter, cross-sectional study (PAINT)

Abstract Background Ileocolic intussusception requires timely reduction to prevent complications. Reduction can be distressing. Sedation is uncommon due to controversial beliefs surrounding an increased risk of perforation. Analgesia and sedation practices for children undergoing reduction of intussusception remain largely unknown. Objectives To characterize global practice patterns of analgesia and sedation for reduction of intussusception. Design/Methods We conducted a global, cross-sectional study involving 84 centres in 14 countries. We included children 4 to 48 months with a sonographic or radiographic diagnosis of ileocolic intussusception and attempted reduction between January 1, 2017, and December 31, 2019. The primary and secondary outcomes were analgesia and sedation, respectively, prior to reduction. An a priori explanatory analysis was performed to explore the association of sedation with (i) adverse events, (ii) perforation, and (iii) failed reduction. Results We included 3203 children [2054/3203 (64.1%)] males, with median (IQR) age of 17 (9,27) months. Suspected abdominal pain was present in 2283/3187 (71.6%) children. At triage, a pain assessment tool was documented in 1859/3112 (59.7%) and analgesia was administered to 305/3171 (9.6%) children. After triage, pain was reassessed in 1448/3169 (45.7%) and analgesia was administered to 552/3158 (17.5%) children. Prior to reduction, 550/3161 (17.4%) children were sedated. Non-opioid and opioid analgesia were administered to 183/2945 (6.2%) and 560/3134 (17.9%), respectively. Reduction was performed using air enema in 2372/3184 (74.5%) children and 2700/3184 (84.8%) of all reductions were successful. Reduction related adverse events [65/3166 (2.1%)] were reported in 59 patients, most commonly vomiting [31/3166 (1.0%)] and perforation [13/3166 (0.4%)]. In the bivariate analyses, sedation was not associated with an increased odds of adverse events [OR: 1.1; 95% CI: 0.6-2.1; p=0.79] or perforation [OR: 2.1; 95% CI: 0.7-6.9; p=0.21]. Sedation was associated with an increased odds of failed reduction [OR: 1.4; 95% CI: 1.1-1.7; p=0.01], but this became non-significant in the multivariable analysis [OR: 1.1; 95% CI: 0.8-1.6; p=0.53] after adjusting for age and premorbid gastrointestinal anomaly. Conclusion Although more than 2/3 of children with intussusception present with pain, less than 10% were administered analgesia at triage. Prior to reduction, analgesia or sedation was administered to less than 1/5 of children. Adverse events, including perforation were uncommon. Sedation was not associated with adverse events or an increased odds of failed reduction in the adjusted analysis. Our findings suggest that analgesia should be considered in children with suspected abdominal pain and sedation should be routinely considered for children undergoing reduction of intussusception.

S2202 A Rare Case of Colonic Intussusception After Self Expandable Metal Stent Placement

Introduction: Endoscopically placed colonic stenting is a palliative measure that can be used for unresectable etastatic colon cancer. It is a relatively safe procedure with a low mortality rate of about 1%. Intussusception is a rare complication of colonic stenting that occurs when the bowel telescopes about itself, possibly leading to obstruction or ischemia. Here we present a patient with intussusception 6 days after placement of a self-expandable rectosigmoid metal stent. We demonstrate successful reduction of rectosigmoid intussusception through a colonoscopy with air insufflation. Case Description/Methods: A 35-year-old female presented with 3 days of constant and progressively-worsening rectal pain, bloody rectal discharge, and thin stool. Her past medical history was significant for metastatic colon cancer treated with sigmoid colectomy and chemotherapy 2 years prior, with recurrence of disease requiring palliative self-expandable rectosigmoid metal stent placement 6 days prior to arrival. Vital signs were normal. She did not appear in acute distress and was hemodynamically stable. Pertinent examination findings included lower abdominal tenderness, normal bowel sounds, and normal rectal tone. Labs revealed WBC 12.4, Hgb 13.2, Plt 443, AST 14, ALT 8, ALP 77, total bilirubin 0.7, and a lactate of 0.9. CT scan of the abdomen and pelvis revealed intussusception at the proximal sigmoid colon without evidence of bowel obstruction. Colonoscopy revealed ball-shaped mucosa with a dusky appearance at the proximal end of the stent, consistent with intussusception and ischemic colitis. The intussusception was successfully reduced with air insufflation through colonoscopy. The patient tolerated the procedure well and was started on a diet the next day with an improvement in her rectal pain and resolution of rectal discharge (Figure). Discussion: Endoscopic colonic stenting remains a valuable palliative treatment for metastatic colon cancer. Survival rates of metastatic colon cancer do not significantly differ between palliative colonic stenting and colonic resection. However, there are fewer complications with colonic stenting than colectomy, making palliative stenting a preferred option. Intussusception is a rare complication of colonic stenting that is often treated surgically in adults. Here we demonstrate successful reduction of intussusception through colonoscopic air insufflation. We hope to bring awareness of this complication and consideration to air insufflation as first-line therapy.Figure 1.: A. A view of the distal aspect of the rectosigmoid stent revealing adequate translocation of tumor mass without evidence of obstruction. B. A view of the proximal aspect of the rectosigmoid stent revealing a dusky appearance,with thickening of the bowel. C. A view of the proximal aspect of the stent with the ball-shaped mass in a dusky appearance consistent with intussusception, as seen by arrows.

Surgical treatment and pneumatic reduction for intussusception in a pediatric patient with blue rubber bleb nevus syndrome

Blue rubber bleb nevus syndrome is a congenital disorder characterized by the presence of venous malformations in the skin and gastrointestinal tract. On rare occasions, these venous malformations can cause intussusception. We present a case of a child known with Bean syndrome who arrived with intestinal occlusion requiring emergency laparotomy. Surgical findings included four intussusception zones through the jejunum and ileum, meriting ileum resection and primary anastomosis. During the next month he presented on two occasions with intussusception symptoms, requiring fluoroscopy-guided pneumatic reduction.

Making intussusception reductions easier: use of medical air in lieu of manual pump.

Pneumatic reduction of ileocolic intussusception is commonly performed with manual insufflators. The challenge of operating a handheld device while controlling the fluoroscope and monitoring the reduction could be obviated if the manual insufflation could be eliminated. The aim in this retrospective study was to describe and evaluate the use of medical wall air in intussusception reduction. We retrospectively reviewed all intussusception reductions over a period of years: from 2015 to 2018 using the manual insufflator and from 2018 to 2021 using medical air. We compared success rates, complication rates and time to reduction as documented on fluoroscopic image time stamps. Demographic data were obtained from the medical record. Attending radiologists and fluoroscopic technologists indicated their preference between methods, ease of use, perceived duration of reduction and perceived difference in success rates through an anonymous internal survey. There were 179 first reduction attempts in 167 patients (93 attempts during the period using the manual insufflator and 86 after converting to wall air). There was no difference in reduction duration (8:23 min for insufflation, 8:22 min for wall air, P=0.99) and no statistically significant difference in success rate (66.8% for insufflation and 79.1% for wall air, P=0.165). All survey respondents preferred the wall air method. The vast majority (93%) perceived that the wall air method was faster. Hospital wall air can be used to successfully reduce intussusceptions without incurring time burden or loss of effectiveness. The method leads to a perception of increased efficiency.

EP-555 The telescoping sigmoid – a rare presentation of acute large bowel obstruction

Abstract Background Adult bowel intussusception is a rare cause of bowel obstruction (1–5%) and requires urgent treatment, usually emergency surgery. Aim We wish to highlight the diagnosis and management of the rare entity of acute bowel obstruction secondary to intussusception with our adult patient with sigmoid colon intussusception. Case presentation We present a 65 years old male who attended with constipation, abdominal discomfort and per-rectal bleeding. Clinical examination revealed multiple subcutaneous lipomas, mild LUQ tenderness and large ‘lump’ 10 cm from anal verge on rigid sigmoidoscopy. CT abdomen/pelvis showed intussusception of the sigmoid into the rectum with a large ‘polyp’ as the lead point. On- table Flexible sigmoidoscopy was unsuccessful in reducing the intussusception. We proceeded to laparotomy with reduction of intussusception, high anterior resection with end- to- end stapled anastomosis. He made an excellent recovery. Post-operative histology which was reviewed in detail in MDT did not reveal any neoplastic/lipomatous lesion to account for the intussusception. The patient was very well on outpatient review. Conclusion Adult bowel intussusception is rare (5% of all intussusceptions), especially in the left colon. When it does occur, it is usually secondary to lipoma, neoplasm, or nodal mass acting as a lead point. These patients can be diagnostically challenging due to lack of clear obstructive symptoms on presentation. Early diagnosis (via a CT scan) and treatment of adult colonic intussusception (usually via surgery) is necessary to avoid serious complications such as bowel perforation/peritonitis. Postoperative histology review is also imperative to plan any appropriate further management.

How Does the COVID-19 Pandemic Affect Pediatric Patients with Intussusception Treated by Ultrasound-Guided Hydrostatic Enema Reduction?

Background: The pandemic of COVID-19 has significantly influenced the epidemiology of intussusception. Nevertheless, the effects of the COVID-19 pandemic on the operation of ultrasound-guided hydrostatic enema reduction (USGHER) for intussusception have been largely unknown. Methods: The data of pediatric patients with intussusception who were treated by USGHER from January to March of 2019 (Control Group), 2020 (Study Group 1), and 2021 (Study Group 2) in a large Chinese medical institution were retrospectively collected and analyzed. Results: We enrolled 246 patients, including 90 cases in Control Group, 70 in Study Group 1, and 86 in Study Group 2 (p = 0.042). The time from the onset of symptoms to the hospital visit and the time from the hospital visit to performing the ultrasound in Study Group 1 was significantly longer than that in Control Group and Study Group 2 (p = 0.036, p = 0.031, respectively). The number of patients with bloody stool and the longest invaginated length of intussusception in Study Group 1 increased significantly compared with patients in the other two groups (p = 0.007, p = 0.042, respectively). Comparisons of neither the pressure of enema nor the time of duration when performing USGHER present statistical significance among the three groups (p = 0.091, p = 0.085, respectively). For all enrolled pediatric patients, there was no perforation case involved, and recurrence of intussusception occurred in few cases. Conclusions: Besides the negative impacts on the incidence of intussusception, the COVID-19 pandemic might have led to the diagnostic delay of intussusception and the deterioration of patients’ clinical manifestations, but it did not significantly affect the operation of USGHER and patients’ clinical outcome.

Outcomes in pediatric patients with documented delays between ileocolic intussusception diagnosis and therapeutic enema attempt: evaluation of reduction efficacy and complication rate.

Ileocolic intussusception is considered a pediatric emergency, with concerns for risk of significant morbidity in children with a prolonged intussusception state. Emergent therapy is standard of care, as prior studies have shown poor outcomes in patients with long delays (> 24h) before intervention. Various factors can result in shorter delays, and there are limited studies evaluating outcomes in these patients. This study aimed to determine if there were differences in reduction success rates associated with short in-hospital time delays. This study is to determine enema success rate and morbidity in patients with documented time delays between intussusception diagnosis and therapeutic enema. A retrospective evaluation of pediatric patients with intussusception at a single children's hospital between 2007 and 2019 was performed. Patient's records were reviewed for time of symptom onset, radiologic diagnosis, and attempted enema. Ultrasounds and radiographs were reviewed for bowel obstruction, free peritoneal fluid, trapped fluid around the intussusceptum, and absent bowel wall perfusion. Patients were evaluated for efficacy of reduction attempt, requirement for surgical reduction, and complications including bowel resection and bowel perforation. There were 175 cases of ileocolic intussusception requiring enema reduction. Successful reduction occurred in 72.2% (13/18) of cases performed within 1h of diagnosis; 74.3% (78/105) between 1 and3 h; 73.2% (30/41) between 3 and 6h; and 81.2% (9/11) with greater than 6h. Need for bowel resection was not associated with short delays between diagnosis and reduction attempts (p = .07). There was no difference in intussusception reduction efficacy or complication rate in patients with increasing time between imaging diagnosis of ileocolic intussusception and reduction attempt, including delay intervals up to 8h.

Jejunal intussusception on jejunostomy tube: A rare cause of occlusion in adults.

IntroductionAcute intestinal intussusception (AI) in adults secondary to jejunostomy is a rare complication and a surgical emergency requiring early diagnosis and treatment.Presentation of caseWe report the case of a 44-year-old patient, without medical history, who presented dysphagia after caustic ingestion. The patient underwent a Witzel feeding jejunostomy. The evolution was marked by the installation of abdominal distension with vomiting and alteration of the general state, the diagnosis of an intussusception in the jejunostomy tube was made in the abdominal CT scan, which required a surgical intervention, and reduction of intussusception, with simple after effects.DiscussionAcute intestinal intussusception (IIA) secondary to jejunostomy tube placement is a rare abdominal emergency. It manifests with signs of upper gastrointestinal obstruction. Diagnosis is based on abdominal imaging by ultrasound or CT scan. Treatment is most often surgical (Chavrier et al., 1992) [1].ConclusionWe present a very rare example of acute intestinal intussusception in adults, complicating jejunostomy, with non-specific clinical signs, which needed an early radiological diagnosis for adequate management.

Current diagnosis and image-guided reduction for intussusception in children.

Intussusception involves an invagination of the proximal bowel into the distal bowel, with ileocolic intussusception being the most common type. However, a diagnostic delay can lead to intestinal ischemia, bowel infarction, or even death; therefore, its early diagnosis and management are important. The primary role of abdominal radiography is to detect pneumoperitoneum or high-grade bowel obstruction in cases of suspected intussusception, and ultrasonography is the modality of choice for its diagnosis. Nonoperative enema reduction, the treatment of choice for childhood intussusception in cases without signs of perforation or peritonitis, can be safely performed with a success rate of 82%. Enema reduction can be performed in various ways according to image guidance method (fluoroscopy or ultrasonography) and reduction medium (liquid or air). Successful enema reduction is less likely to be achieved in children with a longer symptom duration, younger age, lethargy, fever, bloody diarrhea, unfavorable radiologic findings (small bowel obstruction, trapped fluid, ascites, absence of flow in the intussusception, intussusception in the left-sided colon), and pathological lead points. This review highlights the current concepts of intussusception diagnosis, nonsurgical enema reduction, success rates, predictors of failed enema reduction, complications, and recurrence to guide general pediatricians in the management of childhood intussusception.

Fluoroscopic criteria for on-site evaluation of failed intussusception reduction during air enema technique

There is no reliable fluoroscopic criteria for failed intussusception reduction during air enema technique. This retrospective case-control study included 373 episodes of ileocolic intussusceptions who had undergone air enema under fluoroscopy. All procedures were initially classified by conventional fluoroscopic criteria: presumptive successful procedures (PSP) vs. presumptive failed procedures (PFP). PFP were divided into true failure, false failure, and undetermined groups. The configuration and size of the residual mass were evaluated on fluoroscopic images. Statistical analyses included Mann-Whitney U-test, Fisher's exact test, receiver operating characteristic (ROC) analysis, logistic regression analyses, and Kruskal-Wallis rank sum test with a post hoc Tukey test. PSP was 264 episodes (71%) and PFP was 109 episodes (29%). The true failure was 40 (37%) and false failure was 48 (44%). The true failure group commonly showed a larger size and round configuration for the residual mass than false failure (P<0.001). Multivariable analysis revealed configuration (P=0.004) and transverse diameter (P=0.007) as significant parameters that differentiated true and false failure. The optimal cut-off value of the transverse diameter of the residual mass was 2.3 cm. The sensitivity and specificity of conventional fluoroscopic criteria for failed reduction was 100% and 85%, respectively. The combination of new fluoroscopic findings and conventional criteria increased the specificity to 100%. Fluoroscopic finding of round-shape and larger size residual mass combined with conventional criteria may be useful for differentiating false failure from truly failed enema reduction in children with intussusception.

SONOGRAPHIC GUIDED HYDROSTATIC REDUCTION OF INTUSSUSCEPTION-OUTCOME AND ITS DETERMINANTS

Objective: The objective of this study was to determine the success rate of hydrostatic reduction of intussusception and its determinants by using saline enema under ultrasound guidance.&#x0D; Study Setting: Department of Pediatric Surgery, Khyber Teaching Hospital, Peshawar.&#x0D; Study Design: Descriptive study.&#x0D; Material and methods: A total no of 55 patients meeting the inclusion criteria were included in the study and sonographic guided reduction was attempted with a saline enema. The outcome was labeled successful in cases where intussusception got reduced without complications and unsuccessful in case of failure or complications. Age, duration of symptoms, procedure time, number of attempts being continuous data were reported as mean and standard deviation. gender, palpable abdominal mass, bleeding per rectum, air-fluid levels on x-rays, was expressed in frequencies and percentages.&#x0D; Results: In this study mean age was 1 year with SD of ± 1.24. Sixty-two percent of patients were male and 38% of patients were female. Moreover, the success rate of hydrostatic reduction of intussusception by using saline enema was 78%. &#x0D; Conclusion: In selected patients, the success rate of hydrostatic reduction of intussusception is a non-invasive acceptable option to be widely practiced.