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Pneumatic reduction of intussusception in children at Korle Bu Teaching Hospital: an initial experience
Yaw Boateng Mensah1, H Glover-Addy, Victor Etwire
1Department of Radiology, Korle Bu Teaching Hospital, Accra, Ghana. ybmensah@yahoo.com
Insights
Fluoroscopic-guided pneumatic reduction successfully treated 67% of pediatric intussusception cases in Ghana. This cost-effective, rapid method is recommended for intussusception management in the region.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Intussusception is a common pediatric surgical emergency requiring prompt intervention.
- Nonsurgical management, particularly fluoroscopic-guided pneumatic reduction, is increasingly favored globally.
- This study marks the first application of this technique in Ghana.
Purpose of the Study:
- To evaluate the initial experience and feasibility of fluoroscopic-guided pneumatic reduction for intussusception in Ghana.
- To assess the success rate and safety of this minimally invasive procedure in a Ghanaian setting.
Main Methods:
- Eighteen pediatric patients with intussusception were enrolled between August 2007 and February 2008.
- Air enema was administered under fluoroscopic guidance using locally assembled equipment.
- Intraluminal pressure was monitored, not exceeding 120 mmHg, with a maximum of three 3-minute attempts.
Main Results:
- The average patient age was 8.3 months, with a 2:1 male-to-female ratio.
- Successful reduction was achieved in 12 patients (67%), while 6 (33%) required alternative management.
- Bowel perforation occurred in three cases (16.7%), with delayed presentation noted in non-reduced cases.
Conclusions:
- Fluoroscopic-guided pneumatic reduction is a cost-effective and rapid treatment for intussusception with a high success rate.
- Potential limitations include bowel perforation risk and inability to identify lead points.
- The technique is recommended as a primary reduction method in Ghana and neighboring countries.
Background:
Intussusception is a common abdominal emergency in children which necessitates prompt diagnosis and management. Nonsurgical methods of managing this condition are rapidly gaining popularity with fluoroscopic-guided pneumatic reduction being one of such methods that has been used with great success in many countries. We present our initial experience with fluoroscopic-guided pneumatic reduction of intussusception at Korle Bu Teaching Hospital which is also the first time the technique has been used in Ghana.
Materials And Methods:
A total of 18 children were enrolled in the study between August 2007 and February 2008 at Korle Bu Teaching Hospital, Accra, Ghana. Patients were given air enema under fluoroscopic-guidance using locally assembled equipment. The intraluminal pressure was monitored with a pressure gauge and was not permitted to go above 120 mmHg. A total of three attempts of 3 min each were allowed.
Results:
There were 12 males and 6 females. The average age of the patients was 8.3 months (SD= 3 months). Twelve (67%) of the cases were reduced successfully while 6 (33%) failed to reduce. A majority of those that did not reduced had symptoms for at least 2 days. Bowel perforation occurred in three (16.7%) cases.
Conclusion:
Pneumatic reduction of intussusception is a cost-effective and rapid method of management of intussusception. It however has limitations like high reported rate of bowel perforation and limited ability to identify lead points. The benefits however seem to outweigh these challenges, such as fluoroscopic-guided pneumatic reduction has a very high success rate. Fluoroscopic guided pneumatic reduction should be considered as one of the primary modes of reduction in Ghana and other neighbouring countries that are yet to practice it.