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Gas reduction of intussusception
1Radiology Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Pneumatic reduction for childhood intussusception is a safe and effective non-surgical treatment. This study found a 75% success rate, making it a preferred alternative to traditional barium enemas.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Intussusception management focuses on non-surgical hydrostatic reduction.
- Improving selection criteria and enema techniques are key to successful outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of pneumatic reduction for childhood intussusception.
- To compare pneumatic reduction with traditional barium reduction.
Main Methods:
- A prospective evaluation of pneumatic reduction using oxygen at 2 L/min and 80 mm Hg.
- 114 out of 129 consecutive intussusception cases underwent attempted pneumatic reduction.
Main Results:
- Pneumatic reduction was successful in 85 (75%) of attempted cases.
- The overall success rate, including surgical cases, was 66% (85/129).
- Fifteen patients (8.6%) were deemed unsuitable for gas reduction and underwent surgery.
Conclusions:
- Pneumatic reduction is a simple, effective, and safe non-surgical treatment for intussusception.
- It has replaced barium reduction due to its improved success rate.
- Further research into selection criteria and technique may enhance outcomes.
Abstract:
Efforts to improve the non-surgical management of childhood intussusception centre around (a) reassessment of selection criteria used to ensure as many children as possible have the advantage of hydrostatic reduction, and (b) improvements and modifications of enema technique to ensure successful and safe reductions without increased morbidity. Reports that pneumatic reduction was highly successful in treating childhood intussusception prompted the authors to evaluate this technique over an 18 month period using our previously reported technique of oxygen at 2 litres/minute and a pressure of 80 mm Hg. Pneumatic reduction was attempted in 114 of 129 consecutive cases of intussusception, and was successful in 85 (75%). Fifteen patients (8.6%) were considered unacceptable risks for gas reduction using our current selection criteria and had primary surgery. The overall success rate considering all cases of intussusception managed at our institution over this period was 66% (85/129). As with any form of hydrostatic reduction, pneumatic reduction of intussusception requires careful selection of patients, meticulous technique, and awareness of complications and their appropriate management. Because of its simplicity and improved success rate, pneumatic reduction has replaced traditional barium reduction at our institution. It may be that with further evaluation of selection criteria, higher pressures, and prolonged attempts that results will improve further.