Treatment Strategies for Recurrent Ileocolic Intussusceptions and a Novel Operative Procedure

Background Intussusception is the most common cause of intestinal obstruction between 6 months and 36 months of age. There is no defined etiology in at least 75-90% of patients. Recurrent intussusception occurs in 5-16% of all intussusceptions and the treatment strategy is controversial in this patient group. Treatment of continued recurrent intussusception is a challenging problem when no lead point is revealed despite recurrence. We aimed to review our 10 years of experience in recurrent intussusception and describe a new operative technique for recurrent intussusception cases without any lead points. Results We retrospectively reviewed the data of patients with recurrent intussusception in our referral pediatric surgery clinic between 2007 and 2017. Ultrasound-guided hydrostatic reduction was performed on all patients. Surgery was performed on those patients who had findings of acute abdomen and complete intestinal obstruction or 2 failed attempts of UGHR for diagnostic purposes if a pathologic lead point was suspected based on patient findings and age. Laparoscopy or laparotomy was performed according to surgeon preference and experience. A total of 87 UGHRs were performed. Thirty-three patients were admitted to our clinic due to recurrent intussusception. The mean age was 12.75±14.14 (6 -84) months, and 19 were males and 14 were females. Abdominal pain, agitation and vomiting were common symptoms. UGHR was performed on all 33 patients on at least 2 different occasions. The time between the first and second UGHR treatments was 42.6 ± 186.19 (0-899) days. The success rate of the second UGHR was 27 out of 33 patients (81.8%). Surgery was performed on 6 patients. Manual reduction was performed on 5 patients and one was operated by the laparoscopic reduction of intussusception and Meckel’s diverticulum resection. Conclusions Surgeons should try to find permanent solutions for patients with multiple recurrent intussusceptions that are resistant to treatment. Surgical excision of the lead point will help prevent recurrent intussusception. Satisfactory results can also be obtained by ultrasound-guided hydrostatic reduction even in patients with recurrences. Laparoscopy is helpful in diagnosis, detection of lead points and treatment of irreducible intussusception. This new operative technique can be satisfactory for recurrent intussusceptions without any lead points.

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

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.

Effectiveness and safety of ultrasound-guided hydrostatic reduction for children with acute intussusception

Objective This study aims to explore the effectiveness and safety of the new-type ultrasound-guided hydrostatic reduction for children with acute intussusception. Methods The clinical data of 364 children with primary acute intussusception who underwent nonsurgical reduction in our hospital between January 2016 and May 2019 were retrospectively analyzed. Among the 364 children, 119 formed the hydrostatic reduction group. There were 89 males and 30 females, and the average age of admission was 25.13 ± 1.43 months. Among the pneumatic reduction group of 245 patients, there were 163 males and 82 females. The average age of admission was 22.47 ± 1.52 months. The reduction rate, length of stay, and perforation rate were compared between the two groups. Results Univariate analysis showed that the reduction rate in the hydrostatic group (94.96%) was higher than in the pneumatic group (85.31%) ( p = 0.007), and the hospital stay (2.76 ± 0.15 days) of the hydrostatic reduction group was shorter than that of the pneumatic reduction group (3.56 ± 0.35 days) ( p = 0.038). In children with intussusception time >48 h, the reduction rate was 95.45% in the hydrostatic reduction group and 86.20% in the pneumatic reduction group. Conclusion The new-type ultrasound-guided hydrostatic reduction has a higher reduction rate in the treatment of acute intussusception in children results in a shortened hospital stay, It is effective, safe, and avoids radiation exposure.

Shear wave elastography evaluation in predicting the success of ultrasound-guided saline enema hydrostatic reduction technique in ileocolic intussusception

Background Intussusception is the invagination of the proximal intestinal segment into the distal portion. Reduction procedures with fluid or air have been used as the primary treatment of choice in clinically stable children. Purpose To evaluate the role of intestinal wall elasticity measurements by shear wave elastography (SWE) to predict the success of ultrasound-guided saline enema (USGSE) reduction. Methods USGSE was performed, if not contraindicated otherwise, after the diagnosis of ileocecal intussusception via the ultrasound (US). The length and diameter of the intussusception and the median stiffness of the intestine were measured before USGSE. Results Seventeen children were diagnosed with ileocolic intussusception via grayscale US assessment. Two children whose SWE images became artifacts due to inadaptability were excluded from the study. Thus, the study involved 15 patients (9 boys, 6 girls; age range = 11–48 months). There was no statistically significant association between age and median stiffness measurement in kilopascal (kPa). ( P > 0.05). A moderate positive correlation was observed between the median stiffness measurement (kPa) and the length of intussusception (r = 0.547; P = 0.035). There was no statistically significant relationship between median stiffness measurement (kPa) and short-axis diameter of intussusception ( P > 0.05). Conclusions Stiffness assessment of the intestinal wall in ileocolic intussusception during the US examination, which is the gold standard in the intussusception assessment, can be used as a new criterion for predicting the performance of the USGSE technique and might be useful in making decisions regarding the clinical management of ileocolic intussusception.

Profile of Children Treated for Uncomplicated Intussusception in a Tertiary Hospital in Enugu, Nigeria

Background: Intussusception is a common cause of intestinal obstruction in infants. The aim of study was to evaluate our experience in the management of children who presented with uncomplicated intussusception. Materials and Methods: This was a retrospective study of children (12 months and younger) who were treated for uncomplicated intussusception (ultrasound confirmed) between January 2014 and December 2018, at the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH) Enugu, Nigeria. Results: There were 255 cases of intussusception seen during the 5-year study period. Out of this number, 85 (33.3%) patients had uncomplicated intussusception. There was male predominance and the ages of the patients ranged from 4 to 12 months with a mean age of 6 months. Abdominal pain was the most common symptom in the patients. On the average, one-fifth of the patients had a preceding history of respiratory and enteral infection. Half of the patients had a hemoglobin level of less than 10g/dl at presentation. Abdominal ultrasound was the imaging modality of choice and was diagnostic in all the patients. Three-quarters of the patients were successfully treated by hydrostatic reduction and there was recurrence of intussusception in 2 patients. There was no mortality. Conclusion: Only one-third of our patients present with uncomplicated intussusception during the study period. Non-operative (hydrostatic reduction) treatment is an effective modality of treatment for uncomplicated intussusception.