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Childhood intussusception: a comparative study of nonsurgical management
1Department of Paediatric Surgery, Cairo University, Egypt.
Insights
Air reduction demonstrated the highest success rate (90%) and fewest complications for intussusception treatment compared to barium enema and ultrasound-guided saline reduction. Patient selection is key for optimal outcomes.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Radiology
Background:
- Intussusception is a common surgical emergency in children.
- Nonoperative reduction is the preferred initial management strategy.
- Various reduction techniques exist, each with potential benefits and risks.
Purpose of the Study:
- To compare the efficacy and safety of three intussusception reduction methods: air reduction (AR), barium enema reduction (BE), and ultrasound-guided saline reduction (US).
- To evaluate success rates and complication profiles of each technique in a prospective study of 147 pediatric patients.
Main Methods:
- A prospective study involving 147 patients with intussusception.
- Patients were randomized into three groups: AR (n=50), BE (n=50), and US (n=47).
- Nonoperative management criteria included <48 hours symptom duration and absence of severe clinical signs or electrolyte imbalance.
Main Results:
- Air reduction achieved the highest success rate (90%), significantly higher than BE (70%) and US (67%) (P=.01).
- No perforations occurred with AR, compared to three with BE and two with US.
- No mortality was observed in any group.
Conclusions:
- Air reduction appears to be the most effective and safest method for intussusception reduction.
- Careful patient selection is crucial for maximizing success rates and minimizing complications associated with intussusception treatment.
Purpose:
A prospective study was conducted comparing air reduction, barium reduction under fluoroscopy, and saline reduction under ultrasound guidance for diagnosis and treatment of intussusception involved in 147 patients.
Methods:
Fifty children received air reduction (AR group), 50 received barium enema reduction (BE group) and 47 received saline reduction under ultrasound guidance (US group). Nonoperative management was attempted if there was a history of less than 48 hours; absence of general or abdominal signs of toxicity, peritonism, or peritonitis, and reasonable blood electrolyte levels (K, 3 to 5 mmol/L; Na, 130 to 150 mmol/L).
Results:
Group AR had successful outcome in 45 of 50 children (90%); BE had successful outcome in 35 of 50 children (70%), and US had successful outcome in 32 of 47 children (67%). This 20% to 23% success rate difference between air reduction and the other two techniques (BE and US) was statistically significant (P = .01). There was no significant difference between BE and US saline (P > or = .05). There were no perforations encountered in AR patients, three perforations in BE patients, and two perforations in US patients. There was no mortality.
Conclusions:
Air reduction seems to be associated with fewer complications and the highest success rate. Proper selection of patients is crucial to achieve a high success rate and to minimise complications.