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Pneumatic reduction of intussusception: 5-year experience
M Stein1, D J Alton, A Daneman
1Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Ont, Canada.
Insights
Pneumatic reduction successfully treated 80.9% of pediatric intussusceptions. This method is a viable alternative to barium reduction, though predictors of failure and perforation were identified.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Intussusception is a common surgical emergency in infants and children.
- Traditional barium reduction carries risks and limitations.
- Pneumatic reduction offers a potentially safer and effective alternative.
Purpose of the Study:
- To evaluate the efficacy and safety of pneumatic reduction for pediatric intussusception.
- To identify predictors of successful reduction, failure, and complications.
- To compare pneumatic reduction with barium reduction in managing intussusception.
Main Methods:
- A retrospective review of 246 pneumatic reduction attempts in 219 pediatric patients over 5 years.
- Analysis of patient demographics, procedure outcomes, fluoroscopy times, and complications.
- Logistic regression analysis to identify independent predictors of reduction failure and bowel perforation.
Main Results:
- Successful reduction was achieved in 80.9% of cases.
- Complications included bowel perforation in 2.8% of cases.
- Recurrence occurred in 11% of cases. Predictors of failure included ileoileocolic intussusception, prolonged symptoms, rectal bleeding, and prior failed barium reduction. Younger age and prolonged symptoms predicted perforation.
Conclusions:
- Pneumatic reduction is an effective and safe primary treatment for pediatric intussusception.
- Long duration of symptoms is the most significant predictor of poor outcomes.
- Pneumatic reduction serves as a valuable substitute for barium in managing pediatric intussusception.
Abstract:
Pneumatic reduction of 246 intussusceptions was attempted in 219 patients over a 5-year period. The mean age of the patients was 15.4 months. Successful reduction was achieved in 199 cases (80.9%). Bowel perforation occurred in seven cases (2.8%), requiring needle decompression of tension pneumoperitoneum in one case. Recurrence of intussusception occurred in 27 cases (11%). The mean fluoroscopy time was 3.5 minutes +/- 0.2 in successful reductions and 9.3 minutes +/- 0.9 in failed reductions (P less than .001). Logistic regression analysis helped identify four independent predictors of failure, as follows: (a) ileoileocolic intussusception (P less than .001), (b) long duration of symptoms (P less than .001), (c) rectal bleeding (P less than .01), and (d) failed reduction with barium at another institution (P less than .05). Predictors of bowel perforation were a younger age (P less than .05) and long duration of symptoms (P less than .05). Surgery was performed in 48 cases (19.5%), 16 of which required bowel resection. Transmural necrosis of bowel wall was found in nine specimens. The most important predictor of outcome in this series was a long duration of symptoms. Pneumatic reduction is a useful substitute for barium in the management of pediatric intussusception.