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Predictors of failed enema reduction in childhood intussusception
Frankie B Fike1, Vincent E Mortellaro, George W Holcomb
1The Children's Mercy Hospital, Kansas City, MO 64108, USA.
Insights
Predicting failed enema reduction for intussusception is crucial. Key indicators include prolonged symptoms over 24 hours, bloody diarrhea, lethargy, and distal extent of the intussusception.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Intussusception is a common pediatric surgical emergency.
- Enema reduction is the primary treatment modality.
- Predictive factors for enema reduction failure are not well-established.
Purpose of the Study:
- To identify clinical and demographic factors associated with failed enema reduction in intussusception.
- To improve patient selection for successful enema reduction.
Main Methods:
- Retrospective review of 405 intussusception episodes over 10 years.
- Analysis of demographics, presentation variables, and colonic extent.
- Comparison of successful versus failed enema reduction groups using statistical tests.
Main Results:
- 371 enema reduction attempts resulted in 285 successes.
- Prolonged symptoms (>24 hours), bloody diarrhea, and lethargy predicted failure.
- Success rates decreased significantly with more distal intussusception extent (colorectal: 29%).
Conclusions:
- Symptom duration, bloody diarrhea, lethargy, and distal extent are significant predictors of failed enema reduction.
- These findings can aid in clinical decision-making for intussusception management.
Background:
Initial management of intussusception is enema reduction. Data are scarce on predicting which patients are unlikely to have a successful reduction. Therefore, we reviewed our experience to identify factors predictive of enema failure.
Methods:
A retrospective review of all episodes of intussusception over the past 10 years was conducted. Demographics, presentation variables, colonic extent of intussusceptions, and hospital course were collected. Extent of intussusception was classified as right, transverse, descending, and rectosigmoid. Episodes were grouped as success or failure of enema reduction and compared using the Student t test for continuous variables and χ(2) test for dichotomous variables. Significance was P less than .05.
Results:
We identified 405 episodes of intussusception and 371 attempts at enema reduction. There were 285 successful enema reductions. There was no difference between groups in age; sex; or the presence of emesis, fever, or abdominal mass. The failed enema group was more likely to have had symptoms over 24 hours before presentation (P = .006), bloody diarrhea (P < .001), and lethargy (P < .001). The chance of success diminished with colonic extent (right, 88%; transverse, 73%; left, 43%; colorectal, 29%; P < .001).
Conclusion:
Predictors of failed enema reduction of intussusception include presence of symptoms over 24 hours, diarrhea, lethargy, and distal extent of intussusception.
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