Related Experiment Video
Updated: Jul 11, 2026
Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
Published on: March 24, 2023
Pneumatic reduction of childhood intussusception. Is prediction of failure important?
Ana Catarina Fragoso1, Miguel Campos, Clara Tavares
1Division of Pediatric Surgery, Faculty of Medicine of Porto, Hospital S, João, 4200-319 Porto, Portugal.
Insights
Pneumatic reduction is effective for childhood intussusception. Delayed diagnosis and high neutrophil counts predict enema failure, but the predictive model lacks clinical relevance for stricter exclusion criteria.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Background:
- Intussusception is a common surgical emergency in children.
- Enema reduction is a standard treatment, but exclusion criteria remain debated.
- Identifying predictors of enema reduction failure is crucial for optimizing patient care.
Purpose of the Study:
- To identify risk factors for air enema failure in pediatric intussusception.
- To develop and validate a predictive model for enema reduction success.
- To evaluate the clinical relevance of stricter exclusion criteria for enema reduction.
Main Methods:
- A cross-sectional study of 164 children with intussusception treated with pneumatic reduction.
- Logistic regression analysis to assess clinical parameters predicting enema failure.
- Receiver operating characteristic (ROC) curve analysis to evaluate model discrimination.
Main Results:
- Overall pneumatic reduction efficacy was 85%, with 7.3% requiring manual reduction and 6.5% recurrence.
- Delayed diagnosis (>24 hours) and elevated neutrophils were significant predictors of enema failure (OR 11.52 and 1.06, respectively).
- The predictive model showed good discrimination (AUC 0.826) but limited positive predictive value for failure.
Conclusions:
- Pneumatic reduction is safe and effective for childhood intussusception.
- Delayed diagnosis and neutrophil count are key predictors of treatment outcome.
- The developed model, despite high negative predictive values, has low clinical utility for predicting enema failure, suggesting no need for stricter exclusion criteria.
Background/Purpose:
Exclusion criteria for enema reduction of intussusception are still a matter of debate. The current study aimed to search for risk factors and to design and evaluate a predictive model of air enema failure.
Methods:
The design was a cross-sectional study. The study was conducted at a tertiary university hospital. The participants were 164 children (mean [SD] age of 11.6 [10.7] months) with intestinal intussusception. The intervention done was pneumatic reduction only contraindicated in case of peritonitis and/or sepsis. For main outcome measures, logistic regression analysis was used to estimate the contribution of clinical parameters (age, sex, weight, clinical evolution, temperature, rectal bleeding, white blood cell count, and neutrophils) to predict the risk of enema failure. To evaluate the discriminating power of the model, a receiver operating characteristic curve was constructed, and the effectiveness at different cutoffs was calculated.
Results:
Overall efficacy was 85%; manual reduction was performed in 12 (7.3%) cases, and there were 9 (6.5%) recurrences. Multivariable analysis adjusted for age and sex revealed that delayed diagnosis (evolution >24 hours) and raised neutrophils (%) were associated with failure: odds ratio of 11.52 (95% CI, 3.73-35.54) and 1.06 (95% CI, 1.02-1.11), respectively. The area under the receiver operating characteristic curve was 0.826 (95% CI, 0.740-0.912). At the best cutoff (0.15), the positive predictive value was 35% and the negative 93%. At the cutoff of 0.50, the positive predictive value was 70% and the negative 87%; the sensitivity was 29%.
Conclusions:
The efficacy and safety of pneumatic reduction in childhood intussusception was confirmed. Delayed diagnosis and neutrophils significantly predict outcome. Despite consistent high negative predictive values, the model has low effectiveness in predicting enema failure and may not be clinically relevant; there is no rationale for stricter exclusion criteria.
Related Concept Videos
01:11Pyloric Obstruction
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:30Esophageal Strictures-I: Introduction
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...