Ultrasound-guided Hydrostatic Reduction Research Articles

Epidemiological characteristics, treatment, and outcomes of 586 cases of intussusception: a 4-year retrospective study in China.

This study aims to retrospectively analyze the epidemiological and clinical characteristics of acute intussusception in a tertiary-care pediatric hospital in China over 4 years and evaluate the effectiveness and recurrence of fluoroscopy-guided pneumatic reduction (FGPR) and ultrasound-guided hydrostatic reduction (UGHR). This retrospective study was conducted from January 2019 to December 2022 involving children admitted and managed for acute intussusception in a tertiary-care pediatric hospital in China. The epidemiology, clinical features, and therapeutic effects were analyzed using IBM SPSS Statistics 20.0. The study included 401 boys (68.43%) and 185 girls (31.57%) aged from 2 months to 12 years. The most common symptoms reported were abdominal pain or paroxysmal crying (95.73%), vomiting (45.39%), and bloody stool (7.34%). Vomiting and bloody stool became atypical with increasing age (P < 0.001). The total success cases of reduction accounted for 563 cases (96.08%), and the recurrent cases accounted for 71 cases (12.12%). No significant difference was observed in the success or recurrence rates between FGPR and UGHR (P > 0.05). Abdominal pain was an independent protective factor for successful enema (P < 0.01, OR = 72.46), while bloody stool (P < 0.01, OR = 0.06) and older age were independent risk factors (P < 0.001, OR = 0.51). Of the 71 patients with recurrent intussusception, 29 were successfully reduced by enema, and the other 23 required surgical reduction. Twelve of the surgical cases were secondary intussusception, including three cases of Meckel's diverticulum, five cases of polyps, and four cases of non-Hodgkin lymphoma. The epidemiological characteristics of children with intussusception in Xiamen showed peculiarity with a higher male-to-female ratio, older age at diagnosis, and no significant seasonality. Both FGPR and UGHR were effective and safe for intussusception, and surgical reduction was essential for patients with failed enema reduction.

Comparative study between Ultrasound-guided hydrostatic reduction for ileo-caecal intussusception in pediatrics with versus without general anesthesia

Comparative study between Ultrasound-guided hydrostatic reduction for ileo-caecal intussusception in pediatrics with versus without general anesthesia

Air enema reduction versus hydrostatic enema reduction for intussusceptions in children: A systematic review and meta-analysis.

We conducted a comprehensive meta-analysis to compare the effectiveness and safety of fluoroscopy-guided air enema reduction (FGAR) and ultrasound-guided hydrostatic enema reduction (UGHR) for the treatment of intussusception in pediatric patients. A systematic review and meta-analysis were conducted on retrospective studies obtained from various databases, including PUBMED, MEDLINE, Cochrane, Google Scholar, China National Knowledge Infrastructure (CNKI), WanFang, and VIP Database. The search included publications from January 1, 2003, to March 31, 2023, with the last search done on Jan 15, 2023. We included 49 randomized controlled studies and retrospective cohort studies involving a total of 9,391 patients, with 4,841 in the UGHR and 4,550 in the FGAR. Specifically, UGHR exhibited a significantly shorter time to reduction (WMD = -4.183, 95% CI = (-5.402, -2.964), P < 0.001), a higher rate of successful reduction (RR = 1.128, 95% CI = (1.099, 1.157), P < 0.001), and a reduced length of hospital stay (WMD = -1.215, 95% CI = (-1.58, -0.85), P < 0.001). Furthermore, UGHR repositioning was associated with a diminished overall complication rate (RR = 0.296, 95% CI = (0.225, 0.389), P < 0.001) and a lowered incidence of perforation (RR = 0.405, 95% CI = (0.244, 0.670), P < 0.001). UGHR offers the benefits of being non-radioactive, achieving a shorter reduction time, demonstrating a higher success rate in repositioning in particular, resulting in a reduced length of postoperative hospital stay, and yielding a lower overall incidence of postoperative complications, including a reduced risk of associated perforations.

Predictors of Failure in Ultrasound-Guided Hydrostatic Reduction of Intussusception in Children: Retrospective Analysis in a Specialized Center in Ethiopia.

To identify factors predicting the failure of ultrasound-guided hydrostatic reduction of intussusception in children. The medical records of 174 children who underwent ultrasound-guided hydrostatic reduction of intussusception over four years were reviewed at Tikur Anbessa Specialized Hospital. Patient's demography, clinical data, and sonography findings (type of intussusception, length of intussusception, presence of lead point, trapped fluid, lymph node, and free peritoneal fluid) were entered into SPSS 25 (IBM) and analyzed using logistic regression. The overall success rate of ultrasound-guided hydrostatic reduction was 81.6%. The sex, presence of abdominal cramps, vomiting, diarrhea, trapped lymph nodes on ultrasound, or history of upper respiratory tract infection had no association with hydrostatic reducibility. Currant jelly stool (OR 0.128; 95% CI, 0.27-0.616; P=0.01), Ileo-ileo colic intussusception (OR 0.055; 95% CI, 0.005-0.597; P=0.017), pathologic lead point (OR 0.66; 95% CI, 0.01-0.447; P=0.005) and abdominal distention (OR 0.209; 95% CI, 0.044-0.998; P=0.048) showed significant association with failed hydrostatic reduction. The presence of currant jelly stool, ileo-ileo colic type intussusception, pathologic lead point, and abdominal distention are the most important predictors for failed ultrasound ultrasound-guided reduction intussusception in children.

Ultrasound-Guided Pneumatic Reduction of Intussusception in Children

Introduction: Intussusception, occurring most commonly in 6-month to 3-year-olds, involves bowel invagination with symptoms like abdominal pain, red currant jelly stool, and a palpable mass. The preferred treatment is non-operative, especially in stable cases without contraindications. Non-operative methods include ultrasound-guided hydrostatic and pneumatic reduction, as well as fluoroscopic-guided hydrostatic reduction with barium and pneumatic reduction with air enema. Methods: The prospective study took place at a specialized pediatric hospital over 36 months period. All children experiencing intussusception underwent abdominal sonographic assessment for diagnosis. Subsequently, an attempt was made to perform ultrasound-guided pneumatic reduction of the intussusception. Exclusions comprised hemodynamically unstable children, those displaying signs of peritonitis or bowel perforation, and those with sonographically identified pathological lead points. Results: A total of 98 children were treated with ultrasound-guided pneumatic reduction for intussusception.The average age of the patient was 11.38±9.24 months. Ileocolic intussusception was the most common finding in 98.9%. Around 80% of the patients was presented with complaints of severe abdominal pain. In 43.8% of the patients, the duration of symptoms was less than 24 hours. The mean length of intussusception was 3.64 cm. A total of 94 (96%) children had successful reduction of intussusceptions with recurrence found in only two of cases. Conclusion: Pneumatic reduction of intussusception is a highly effective procedure. It is associated with reduced morbidity and mortality and reduced risk of exploratory laparotomy. The main predictor for the outcome was the duration of symptoms before presentation to the institute, thus early use of pneumatic reduction is advisable.

Ileocolic Intussusception in Radiological Imaging: A Case Report

Ileocolic intussusception is an abdominal emergency in infants and toddlers that requires immediate diagnosis and treatment. Aims: The aim of this case report is to explain how cases of ileocolic intussusception can be diagnosed and treated quickly. Methodology: This research is a descriptive study with a case report design on a patient. Results: A baby girl, 3 months old, weighing 6 kg, was referred to the emergency unit with symptoms of vomiting, jelly-red stools, excessive crying, but not bloating. There was no history of fever, trauma, or previous eating. Found of decreased intestinal gas on plain abdominal radiographs, and the appearance of a target sign also known as the doughnut sign and sausage shape on ultrasound examination. Ultrasound-guided hydrostatic reduction has been attempted as a first-line non-operative treatment but failed. The results of the operation it was finally discovered that the cause of the ilecolic intussusception was a polyp. Scientific Novelty: Reliability of ultrasound in finding and diagnosing ileocolic intussusception in infants. Conclusion: Ultrasonography is the gold standard in finding and diagnosing ileocolic intussusception. Ultrasound-guided hydrostatic reduction is the first non-operative treatment before surgery becomes an option. Unsuccessful ultrasound-guided hydrostatic reduction may indicate that the ilecolic intussusception is caused by a polyp.

The success of ultrasound-guided hydrostatic reduction in managing delayed presentation of childhood intussusception: A single center experience

BackgroundChildhood intussusception is a common surgical emergency. The current practice for non-operative management in Sri Lanka is ultrasound-guided hydrostatic reduction (USGHR). This retrospective study aims to demonstrate the efficacy and safety of this procedure even in a setting of delayed presentation. MethodWe explore outcomes of USGHR in the management of intussusception in children presenting to a single tertiary care center in Sri Lanka, between November 2019 and March 2021. Hydrostatic reduction was performed in patients with radiologically confirmed intussusception in the absence of contraindications. In failed attempts or early recurrences, USGHR was repeated for a maximum of 2 more attempts. ResultsOur study included 135 participants. Of the patients for which data on symptom duration was available 31.5% (n = 41) presented delayed (t>48 hrs). Hydrostatic reduction showed an overall success rate of 86.4%. No association was seen between time since onset of symptoms and success of USGHR (p<0.05). In 19 patients (14.1%) operative intervention was required. The rates of operative intervention were comparable between those presenting within (12.4%) and after 48 h (12.2%). One case (0.7%) of bowel perforation and 1 case of peritonitis (0.7%) occurred in those presenting within and after 48 h respectively. ConclusionThe success rate of USGHR was high despite delays in patient presentation. Thus, hydrostatic reduction is a safe, effective procedure to be performed as the first-line management option in childhood intussusception even in a setting of delayed presentation. Overall success increases with repeat reduction. Level of evidenceRetrospective study comparative – level III

Ultrasound guided hydrostatic enema reduction of ileocolic intussusception: a safe and effective technique.

Currently, the primary management of ileocolic intussusception in children is usually by non-operative image-guided enema reduction. In most centres around the world especially in Australasia the predominant technique is the pneumatic reduction under fluoroscopic guidance. At our institution, we have been performing ultrasound-guided hydrostatic reduction since 2012.This is an audit to determine the efficacy and safety of ultrasound-guided hydrostatic reduction for intussusception. Following ethics approval, a retrospective review of all patients presenting to our institution with intussusception and subsequently undergoing hydrostatic reduction over a period of 9 years (2012 to-2020) was performed. The parameters studied included (i) successful reduction, (ii) recurrence, (iii) need for surgery and (iv) lead point at surgery. The mean age at presentation was 12 months. One hundred and eight children were diagnosed to have ileocolic intussusception. One hundred and six underwent ultrasound-guided hydrostatic reduction with successful reduction in 96 (90.5%) patients. Reduction was unsuccessful in 10 patients (9.5%). Of these eight were noted to have a pathological lead point (four-Meckel's diverticulum and four-Lymphoma) at the time of the surgery. The intussusception recurred in six patients (6.25%) within 24 h. No reduction related perforation occurred during the study period. Ultrasound-guided hydrostatic reduction is a safe and effective technique for managing intussusception as it allows continuous monitoring of the reduction of the intussusception without exposing the children to ionizing radiation.

Ultrasound-guided hydrostatic reduction of intussusception: comparison of success rates between subspecialized pediatric radiologists and non-pediatric radiologists or radiology residents

Ileocolic intussusception is the most common cause of intestinal obstruction in children under two years of age. Treatment in most cases is radiologically guided reduction. In Slovenia, ultrasound (US)-guided hydrostatic reduction is currently the standard of care. The purpose of this study was to compare the success rate of US-guided hydrostatic reduction when performed by subspecialty-trained pediatric radiologists, non-pediatric radiologists, or radiology residents. We retrospectively analyzed medical records of patients with ileocolic intussusception who underwent US-guided hydrostatic intussusception reduction at University Medical Centre Ljubljana between January 2012 and December 2022 (n = 101). During regular daily working hours, the reduction was performed by pediatric radiologists. After hours (evenings and overnight), pediatric radiologists, non-pediatric radiologists, or radiology residents performed the reduction procedure. Patients were divided into three groups based on the operator performing the procedure. Data was analyzed using the chi-square test. Pediatric radiologists had thirty-seven (75.5%) successful first attempts, non-pediatric radiologists had nineteen (76.0%), and radiology residents had twenty (74.1%). There was no statistically significant difference in the success rate of ileocolic intussusception reduction depending on the operator who performed the procedure (p = 0.98). No perforation was observed in either group during the reduction attempts. Conclusion: Our results demonstrate that US-guided hydrostatic reduction is a reliable and safe procedure that achieves good results even in the hands of less experienced, however appropriately trained, radiologists. The results should encourage more medical centers to consider the implementation of US-guided hydrostatic reduction of ileocolic intussusception.What is Known:• US-guided hydrostatic reduction is a well-established method of treatment for ileocolic intussusception in children.• The results regarding the influence of operator’s experience with the procedure on its success rate are scarce and contradictory.What is New:• US-guided hydrostatic intussusception reduction is a reliable and safe technique that achieves similar success rates when performed by experienced subspecialized pediatric radiologists or less experienced but trained operators such as non-pediatric radiologists and radiology residents.• The implementation of US-guided hydrostatic reduction in general hospitals without subspecialized pediatric radiologists could improve patient care by increasing access to radiologically guided reduction and simultaneously decreasing the time to reduction attempts.

Is enema reduction in pediatric intussusception with a history of over 48 h safe: A retrospective cohort study

BackgroundIntussusception is one of the most common acute abdominal diseases in children. Enema reduction is the first-line treatment for intussusception in good condition. Clinically, a history of disease over 48 h is usually listed as a contraindication for enema reduction. However, with the development of clinical experience and therapy, an increasing number of cases have shown that the prolongation of the clinical course of intussusception in children is not an absolute contraindication for enema treatment. This study aimed to analyze the safety and efficacy of enema reduction in children with a history of disease longer than 48 h. MethodsWe conducted a retrospective matched-pair cohort study of pediatric patients with acute intussusception between 2017 and 2021. All patients were treated with ultrasound-guided hydrostatic enema reduction. According to the length of history, the cases were classified into two groups: history <48 h (<48 h group) and history greater than or equal to 48 h (≧48 h group). We generated a 1:1 matched-pair cohort matched for sex, age, admission time, main symptoms, and concentric circle size on ultrasound. Clinical outcomes were compared between the two groups, including success, recurrence, and perforation rates. ResultsFrom January 2016 to November 2021, 2701 patients with intussusception were admitted to the Shengjing Hospital of China Medical University. A total of 494 cases were included in the ≧48 h group, and 494 cases with a history of <48 h were selected for matched comparison in the <48 h group. The success rates of the ≧48 h and <48 h groups were 98.18% vs. 97.37% (p = 0.388), and the recurrence rates were 13.36% vs. 11.94% (p = 0.635), showing no difference according to the length of history. The perforation rate was 0.61% vs. 0%, respectively, with no significant difference (p = 0.247).The comparison of the different history groups showed that in patients with bloody stools, the length of history had no significant effect on the enema reduction outcome(94.90% vs. 86.76%, p = 0.064). ConclusionsUltrasound-guided hydrostatic enema reduction is safe and effective for pediatric idiopathic intussusception with a history of ≧48 h.

Management of intussusception in children: A comparative study of hydrostatic reduction with saline under ultrasound guidance versus laparoscopic assistance.

Intussusception is a common cause of intestinal obstruction in infants and children. Ultrasound-guided hydrostatic reduction (USGHR) with saline is considered the gold standard with a success rate of more than 90%. Hydrostatic reduction with laparoscopic assistance has its own advantage of direct visualisation, assessment of bowel vascularity and controlled distension. The choice of procedure depends on available resources and surgeon's preference. This study aims to compare the outcomes of the two methods, i.e., laparoscopic-assisted hydrostatic reduction (LAHR) and USGHR under general anaesthesia (GA). This was a prospective study carried out at two different centres over a 3-year period. All patients of intussusception were managed by either hydrostatic reduction with saline under ultrasound guidance or hydrostatic reduction with laparoscopic assistance. Both the procedures were done in operation theatre under GA. The operating time and amount of fluid used for reduction were noted. There were 27 patients in Group 1 (USGHR) and 20 patients in Group 2 (LAHR). The two groups were similar in terms of demographic parameters. The various outcomes such as number of attempts for reduction, fluid required for reduction, time to start oral feeds, complication and length of stay were similar in both the groups. The mean operating time for Group 1 was 19.4 ± 4.5 min and for Group 2 was 34.9 ± 4.8 min (P < 0.001). Both the procedures fare equally in terms of outcome except mean operating time, therefore, LAHR is a good alternative to USGHR in resource-poor nations where logistics of intraoperative ultrasound may not be present.

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.

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.

Risk Factors of Nonsurgical Management Failure in Pediatric Intussusception Patients With Delayed Presentation.

The present study aimed to investigate the time-related predicting factors of the ultrasound-guided hydrostatic reduction (USGHR) failure in pediatric patients with ileocolic intussusception and delayed presentation. The present retrospective study included pediatric patients diagnosed with ileocolic intussusception who presented to our hospital with the related symptoms started 48 hours ago or greater duration during 2018-2020. The patients with spontaneous reduction were excluded from the study. Afterward, the participants with failed and successful USGHR were compared in terms of age, sex, symptom duration, and ultrasound findings using the χ 2 and logistic regression tests. A total of 103 children were included in the present study. The mean symptom duration was 4.13 ± 2.39 days, with a range of 2-14 days. Moreover, 47.6% of the patients had a successful reduction. In addition, there was a significant relationship between failed USGHR and the factors of symptom duration, free peritoneal fluid, entrapped fluid between intussuscepted loops, the size of the invaginated segment, and malperfusion of the intussuscepted bowel loops detected using the Doppler ultrasound ( P < 0.05). However, there was no significant relationship between failed USGHR and the factors of the primary location of intussusception and the presence of intussuscepted lymph nodes ( P > 0.05). The presence of entrapped fluid between the intussuscepted loops, free peritoneal fluid, and the length of the intussuscepted segments were all associated with USGHR failure in our study. Therefore, determining these predictors may help anticipate failure of reduction.

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.

Significance of MCP-1 in predicting the short-term recurrence of primary intussusception in children: An observational study.

To evaluate the relationship between the expression level of (MCP-1) in peripheral blood and the short-term recurrence of primary intussusception in children, a retrospective analysis of children with primary intussusception under ultrasound-guided hydrostatic reduction in our hospital from June 2019 to June 2021, a total of 412 cases, 37 cases of short-term recurrence. Enzyme-linked immunosorbent assay was used to detect the expression of MCP-1 in peripheral venous blood; receiver operating curve (ROC) was utilized to evaluate the diagnostic efficacy of MCP-1 in predicting short-term recurrence; logistic regression analysis of risk factors for recurrence. MCP-1 increased in the peripheral blood of children with short-term recurrence (P < .05). Logistic regression analysis found that increased MCP-1 was a risk factor for recurrence; ROC showed that 23.24 ng/mL was used as a cut-off value. The sensitivity of MCP-1 for predicting the recurrence of intussusception in children is 82.14%, and the specificity is 75.67%. In primary intussusception, the expression of MCP-1 in the peripheral blood of children with short-term recurrence is raised. Elevated expression of MCP-1 is a risk factor for predicting short-term intussusception recurrence and has certain clinical significance.

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.

Prediction of Outcomes of Ultrasound-Guided Saline Enema in the Treatment of Pediatric Intussusception: A Retrospective Case-Control Study.

Outcomes of ultrasound-guided saline enema include successful treatment, unsuccessful treatment, or recurrence. This study aimed to investigate the value of ultrasonic parameters of the ileocecal region during hydrostatic reduction to predict enema outcomes. Ultrasound images of patients diagnosed with ileocolic intussusception and treated with ultrasound-guided saline enema at two different institutions between January 2019 and April 2021 were retrospectively analyzed to assess ileocecal-valve diameter (ICVD), intussusceptum thickness (IT), and the ratio of IT to ICVD (I/I). Logistic regression analysis was used to explore correlations between ICVD, IT, I/I, and patient characteristics (sex, age, symptom duration, and enema outcome). Of 291 patients with ileocolic intussusception (207 boys; mean ICVD, 8.6 [SD: 0.1]mm; mean IT, 26 [SD: 0.2]mm; mean I/I, 3.0 [SD: 0.01]), 268 had first successful reduction; 23, first failed reduction; 7, final failed reduction; and 41, early recurrence. Significant risk factors for failed reduction included symptom duration >24 hours (odds ratio [OR]=10, P=.012), ICVD≤ 8.5 mm (OR=8, P=.01), and I/I > 3.25 (OR=16, P < .001). Significant risk factors for early recurrence post-enema included age>1 year (OR=10, P=.028), ICVD > 8.5 mm (OR=4, P=.003), and I/I≤ 2.95 (OR=6, P < .001). ICVD and IT measured during ultrasound-guided hydrostatic reduction can predict enema outcomes. The mismatch between IT and ICVD is the primary cause of poor outcomes.

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.

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