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Delayed repeat enemas are safe and cost-effective in the management of pediatric intussusception

Timothy B Lautz1, Cary W Thurm2, David H Rothstein3

  • 1Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago and Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Journal of Pediatric Surgery
|March 10, 2015
PubMed

Insights

Delayed repeat enemas for pediatric ileocolic intussusception improve nonoperative reduction success. This approach reduces bowel resection rates, hospital stays, and costs compared to immediate surgery.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Medical Interventions

Background:

  • Ileocolic intussusception is a common surgical emergency in children.
  • Initial enema reduction is attempted but may fail.
  • Management strategies for failed reduction include immediate surgery or delayed repeat enema.

Purpose of the Study:

  • To compare outcomes of delayed repeat enema (DRE) versus immediate surgery (IS).
  • To evaluate the efficacy of DRE in children with ileocolic intussusception who fail initial enema reduction.

Main Methods:

  • Retrospective cohort study using the Pediatric Health Information System (PHIS) database (2008-2012).
  • Included children under 6 years old with ileocolic intussusception.
  • Outcomes analyzed: bowel resection, length of stay (LOS), and adjusted hospital costs (AHC).

Main Results:

  • Delayed repeat enema (DRE) was used in 26.3% of patients after failed initial reduction, while immediate surgery (IS) was performed in 73.7%.
  • Bowel resection rates were significantly lower with DRE (11.8%) compared to IS (26.4%) (p<0.001).
  • DRE was associated with shorter LOS (3.2 days vs 4.4 days) and lower AHC ($9205 vs $14,422) compared to IS.

Conclusions:

  • Delayed repeat enemas are effective in increasing nonoperative reduction success for ileocolic intussusception.
  • DRE significantly decreases the need for bowel resection.
  • This strategy leads to reduced hospital length of stay and healthcare costs.
Abstract

Keywords:
Bowel resectionIntussusceptionRepeat enema

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