Childhood intussusception: Ultrasound-guided Hartmann's solution hydrostatic reduction or barium enema reduction?

Non-surgical reduction of the intussusception is the first line treatment in children with intussusception. Among various radiological reduction techniques, barium enema reduction of the intussusception under fluoroscopy has been widely used in Thailand while pneumatic reduction under fluoroscopy has become popular in teaching hospitals. To our knowledge, ultrasound-guided hydrostatic reduction of the intussusception by saline enema (UGHSE) has never been used in Thailand. We reported 9 cases using UGHSE with 100% success rate without complication.

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Ultrasound-Guided Hydrostatic Reduction Versus Fluoroscopy-Guided Air Reduction for Pediatric Intussusception: A Multi-Center, Prospective, Cohort Study

10.21203/rs.3.rs-102625/v1 ◽

2020 ◽

Author(s):

Shu Ting Liu ◽

Xiao Bing Tang ◽

Huan Li ◽

Dong Chen ◽

Jun Lei ◽

...

Keyword(s):

Cohort Study ◽

Subgroup Analysis ◽

Prospective Cohort ◽

Success Rates ◽

Ultrasound Guided ◽

Perforation Rate ◽

Recurrence Rates ◽

Hydrostatic Reduction ◽

Stratified Analysis ◽

Enema Reduction

Abstract Background：Intussusception is the most common abdominal emergency in children. The first line treatment of uncomplicated pediatric intussusception is enema reduction. Until now, there have been no multi-center studies comparing the effectiveness and safety of UGHR and FGAR in the treatment of pediatric intussusception. The aim of this study was to compare the effectiveness and safety of the two most commonly used enema methods of pediatric intussusception: Ultrasound-guided hydrostatic reduction (UGHR) and Fluoroscopy-guided air reduction (FGAR).Methods: From November 1, 2017 to October 31, 2018, we conducted a multi-center, prospective, cohort study. Children diagnosed with intussusception in four large Children’s Medical Centers in China were divided into UGHR and FGAR groups. Stratified analysis and subgroup analysis were used for further comparison. The success and recurrence rates were used to evaluate the effectiveness of enema reduction. The perforation rate was used to evaluate the safety of enema reduction.Results: A total of 2,124 cases met the inclusion criteria (UGHR group: 1119 cases; FGAR group: 1005 cases). The success and recurrence rates in the UGHR group were higher than in the FGAR group (95.80%, 9.28% vs. 93.13%, 10.65%) (P<0.05, P>0.05), respectively. The perforation rate in the UGHR group was 0.36% compared with 0.30% in the FGAR group (P>0.05). Subgroup analysis showed the success rates in the UGHR group were higher than in the FGAR group of patients with onset time between 12h and 24h (95.56% vs 90.57%) (P<0.05). Of patients aged 4 to 24 months, the success rates in the UGHR group were also higher than in the FGAR group (95.77% vs 91.60%) (P<0.05). Stratified analysis showed the success rates in the UGHR group were higher than in the FGAR group in patients with the symptom of bloody stool (91.91% vs 85.38%) (P<0.05).Conclusions: UGHR and FGAR are safe, nonsurgical treatment methods for acute pediatric intussusception. UGHR is superior to FGAR, no radiation risk, its success rate is higher, without a difference in perforation rate, especially for patients aged 4–24 months.Level of evidence: Level II.

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Ultrasound-guided hydrostatic reduction versus fluoroscopy-guided air reduction for pediatric intussusception: a multi-center, prospective, cohort study

World Journal of Emergency Surgery ◽

10.1186/s13017-020-00346-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Shu Ting Liu ◽

Xiao Bing Tang ◽

Huan Li ◽

Dong Chen ◽

Jun Lei ◽

...

Keyword(s):

Cohort Study ◽

Subgroup Analysis ◽

Prospective Cohort ◽

Success Rates ◽

Ultrasound Guided ◽

Perforation Rate ◽

Recurrence Rates ◽

Hydrostatic Reduction ◽

Stratified Analysis ◽

Enema Reduction

Abstract Background Intussusception is the most common abdominal emergency in children. The first line treatment of uncomplicated pediatric intussusception is enema reduction. Until now, there have been no multi-center studies comparing the effectiveness and safety of UGHR and FGAR in the treatment of pediatric intussusception. The aim of this study was to compare the effectiveness and safety of the two most commonly used enema methods of pediatric intussusception: ultrasound-guided hydrostatic reduction (UGHR) and fluoroscopy-guided air reduction (FGAR). Methods From November 1, 2017 to October 31, 2018, we conducted a multi-center, prospective, cohort study. Children diagnosed with intussusception in four large Children’s Medical Centers in China were divided into UGHR and FGAR groups. Stratified analysis and subgroup analysis were used for further comparison. The success and recurrence rates were used to evaluate the effectiveness of enema reduction. The perforation rate was used to evaluate the safety of enema reduction. Results A total of 2124 cases met the inclusion criteria (UGHR group: 1119 cases; FGAR group: 1005 cases). The success and recurrence rates in the UGHR group were higher than in the FGAR group (95.80%, 9.28% vs. 93.13%, 10.65%) (P < 0.05, P > 0.05), respectively. The perforation rate in the UGHR group was 0.36% compared with 0.30% in the FGAR group (P > 0.05). Subgroup analysis showed the success rates in the UGHR group were higher than in the FGAR group of patients with onset time between 12 and 24 h (95.56% vs. 90.57%) (P < 0.05). Of patients aged 4 to 24 months, the success rates in the UGHR group were also higher than in the FGAR group (95.77% vs. 91.60%) (P < 0.05). Stratified analysis showed the success rates in the UGHR group were higher than in the FGAR group in patients with the symptom of bloody stool (91.91% vs 85.38%) (P < 0.05). Conclusions UGHR and FGAR are safe, nonsurgical treatment methods for acute pediatric intussusception. UGHR is superior to FGAR, no radiation risk, its success rate is higher, without a difference in perforation rate, especially for patients aged 4–24 months. Level of evidence Level II.

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Ultrasound-guided water enema for reduction of childhood intussusception

Medicinski pregled ◽

10.2298/mpns0712605m ◽

2007 ◽

Vol 60 (11-12) ◽

pp. 605-609 ◽

Cited By ~ 1

Author(s):

Smiljana Marinkovic ◽

Svetlana Bukarica ◽

Mihajlo Jeckovic ◽

Svetlana Skoric ◽

Jelena Antic ◽

...

Keyword(s):

Phase I ◽

Success Rate ◽

Phase Ii ◽

Barium Enema ◽

Team Approach ◽

Ultrasound Guided ◽

Lower Quadrant ◽

Hydrostatic Reduction ◽

Abdominal Emergency ◽

Manual Pressure

Introduction. Intussusception is a common abdominal emergency in infants and children. Ultrasonography and barium enema are very useful in diagnosis and treatment of this condition. The aim of the study was to assess the accuracy of ultrasound-guided saline enema for intussusception and to determine if some factors may improve the outcome of this technique. Material and methods. Intussusception was diagnosed in 63 patients at the Clinic of Pediatric Surgery in Novi Sad. The study period was divided into two 2-year phases: phase I, from 2001 through 2002, and phase II, from 2003 through 2004. During phase I, besides barium enema and fluoroscopy, we started using ultrasonography and ultrasound-guided hydrostatic saline enema in the diagnosis and reduction of intussusception. In phase II, this method of reduction was routinely used in all cases. Our technique of ultrasonic reduction was similar to the conventional hydrostatic barium reduction, except the reservoir was higher than that of barium, analgosedation ot patients was performed and in case of difficult and prolonged reduction, gentle manual pressure to the abdomen at right lower quadrant was used. Results. In phase I the diagnostic accuracy of ultrasonography in detecting intussusception was 53.8% , and 100% in phase II. The success rate of ultrasound-guided saline enema was 55.5% in phase I, and 83.8% in phase II. Only 6 patients (16.2%) underwent operative manual reduction of intussusception in phase II. There were no cases with bowel gangrene or perforations in both groups. Conclusions. Ultrasonography is a useful screening tool in the diagnosis of intussusception. The main advantage of hydrostatic reduction with ultrasound guidance is avoidance of ionizing radiation. The success rate of this method of reduction may be increased with an integrated team approach to the management and with modifications of the technique.

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Indications for repeated enema reduction of intussusception in children

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1406320v ◽

2014 ◽

Vol 142 (5-6) ◽

pp. 320-324 ◽

Cited By ~ 5

Author(s):

Dragana Vujovic ◽

Marija Lukac ◽

Aleksandar Sretenovic ◽

Tamara Krstajic ◽

Vesna Ljubic ◽

...

Keyword(s):

Operative Treatment ◽

Therapeutic Option ◽

Operative Procedure ◽

Predictor Variable ◽

Symptom Duration ◽

Ultrasound Guided ◽

Abdominal Emergency ◽

Presenting Symptoms ◽

Intussusception Reduction ◽

Enema Reduction

Introduction. Intussusception is a common abdominal emergency in early childhood. It is idiopathic in more than 90% of cases with incidence of 1.5-4 per 1,000 live births. The treatment of choice is nonoperative hydrostatic or air enema reduction. Objective. The aim of the study was to evaluate the influence of clinical presentation and symptom duration in non-operative treatment, considering the indications for delayed enema reduction and its efficacy. Methods. From the total number of 107 patients with intusussception, aged from 2 months to 14 years (median 9 months), 102 (95%) patients with ileo-colic intussusceptions were treated initially by ultrasound guided saline enema. Records were reviewed for patients with failed initial treatment and delayed repeated enemas or operative procedure. The predictor variable included duration of presenting symptoms. Results. Successful treatment by hydrostatic saline enemas had 58/102 (57%) patients. Success in reduction was greater if symptom duration was <24 hours (54/62 cases; 87%, p<0.001), compared with >24 hours, (4/45 cases; 9%). Despite failed initial attempts, enema reduction was reattempted in 12 patients, with success in 7/12 (60%) patients. Children with symptom duration >24 hours had a greater risk of requiring surgery (41/45 cases; 91%, p<0.001), including 5 (5%) patients with ileo-ileal intussusceptions. Conclusion. The accuracy of ultrasound guided saline enema in intussusception reduction is high. Delay in presentation decreases success of non-operative treatment. Delayed enema reduction is important therapeutic option for intussusceptions. Surgical treatment is indicated in cases of complications.

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MANAGEMENT OF INTUSSUSCEPTION IN INFANTS AND CHILDREN: A SURVEY BASED ON 288 CONSECUTIVE CASES

PEDIATRICS ◽

10.1542/peds.50.4.535 ◽

1972 ◽

Vol 50 (4) ◽

pp. 535-546

Author(s):

Jan Gierup ◽

Håkan Jorulf ◽

Alexander Livaditis

Keyword(s):

Intestinal Obstruction ◽

Barium Enema ◽

Reduction Rate ◽

Accurate Diagnosis ◽

Infants And Children ◽

Consecutive Series ◽

Duration Of Illness ◽

Organic Lead ◽

Enema Reduction ◽

In Infants And Children

A consecutive series of 288 patients with intussusception is presented. It is shown that radiologic examination, including barium enema, is necessary to establish an early and accurate diagnosis. Barium enema reduction was the preferred therapeutic method. The reduction rate in relation to symptoms, duration of illness, type and site of intussusception, intestinal obstruction, and organic lead points is appraised. The reduction rate during the last decade was 87%.

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