The effects of hydrostatic reduction and operative manual reduction on the success of intussusception reduction

Background and objectives: Intussusception is the commonest cause of bowel obstruction and is one of the common abdominal emergencies in children younger than 2 years of age.The objective of the study was to assess the clinical profile of intussusception in children and the management and the outcome and to assess whether the characteristics mentioned in clinical profile are predictive of subsequent management and outcome of the disease. Methods: A hospital based descriptive study conducted in a tertiary care centre in Kerala, using purposive sampling technique. 120 children admitted with diagnosis of intussusception fulfilling inclusion criteria and whose parents consented for study were included in the study population, during the study period from November 2018 to June 2020. Detailed history, clinical examination including per rectal examination and USG was done to make diagnosis of intussusception in suspected cases. Follow up is done at 72 hours,1 week after the admission and 1month later. To assess the clinical profile and outcome of patients, frequency and percentage is used. To obtain the association of clinical profile with outcome chi square test is applied. Results: Outcome of the problem was correlated with age, sex, symptoms, risk factors sonological findings treatment protocol and duration of hospital stay. Out of the 120 children in study population, majority were males(65.8%) with male to female ratio 1.9:1 and majority was in the age group 7- 12 months, which is similar to many other similar studies. Maximum number of cases were in the month of February(14.2%) and November(15%). Majority of the patients(57.5%) presented to healthcare facility within 24 hours of onset of first symptom.Irritability was the most common clinical symptom(62.5%) followed by vomiting(58.3%) and abdominal pain(49.2%). Ileocolic intussusception (96.7%) was the commonest type. Majority of the cases could be managed with hydrostatic saline reduction(73.3%) and significantly lesser number of patient went for surgical intervention(7.5%) and spontaneous resolution(19.2%). Conclusions: Incidence of intussusception is more common among males and more in the 7-12 month age group. Majority of the cases presented to health care facility within 24 hours of onset of symptom and could be managed with hydrostatic reduction technique and had a shorter duration of hospital stay compared to surgical reduction technique. Even recurrent cases could be managed with hydrostatic saline reduction. Keywords: Intussusception; Intestinal obstruction; Hydrostatic reduction; Spontaneous resolution

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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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A Case of Impacted Obturator Hernia Treated by Elective Laparoscopic Repair After Manual Reduction

JOURNAL OF THE JAPANESE ASSOCIATION OF RURAL MEDICINE ◽

10.2185/jjrm.70.402 ◽

2021 ◽

Vol 70 (4) ◽

pp. 402-406

Author(s):

Akira MIZUNO ◽

Shinya KOIKE ◽

Koichiro TAGAMI

Keyword(s):

Laparoscopic Repair ◽

Obturator Hernia ◽

Manual Reduction

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Evaluation of Four-Hand Reduction for Obturator Hernia with the Guidance of Sonography (FROGS) as a new treatment strategy for obturator hernia: A retrospective study

10.21203/rs.3.rs-447904/v1 ◽

2021 ◽

Author(s):

Yuki Togawa ◽

Kyohei Kamihata ◽

Yoshio Nagahisa ◽

Kazuyuki Kawamoto

Keyword(s):

Emergency Surgery ◽

Treatment Strategy ◽

Bowel Resection ◽

The Body ◽

Obturator Hernia ◽

Duration Of Symptoms ◽

Delayed Treatment ◽

Manual Reduction ◽

Lesion Side ◽

New Treatment

Abstract Purpose: Obturator hernias are uncommon but are important causes of intestinal obstruction. Delayed treatment can be fatal. Emergency surgery is considered the most effective treatment; however, patients with obturator hernia usually have comorbidities, and this precludes them from emergency surgery. This study aimed to evaluate the effectiveness of Four-hand Reduction for Obturator hernia with the Guidance of Sonography (FROGS) as a new treatment strategy for obturator hernia.Methods: Since November 2019, we have tried FROGS in all patients with obturator hernia at the emergency room. We retrospectively compared the clinical data of 14 patients who underwent FROGS (after-FROGS group) with those of 23 patients who did not (before-FROGS group).Results: All patients were females. There were no significant differences in age, lesion side, duration of symptoms, the diameter of the prolapsed bowel, and predisposing factors. The body mass index was significantly lower in the after-FROGS group than in the before-FROGS group. Manual reduction was successfully performed in all 14 patients in the FROGS group, whereas in the before-FROGS group, 14 patients underwent manual reduction, of whom only one was successfully treated using the non-FROGS method. Bowel resection was avoided in all 14 patients in the after-FROGS group, whereas 8 patients underwent bowel resection in the before-FROGS group. There were no significant differences in postoperative complications and mortality within 30 days after hernia presentation between the two groups.Conclusion: Manual reduction using the FROGS technique was found to be safe and reproducible and can be the first treatment choice for patients with obturator hernia.

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