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Risk factors for failure of hydrostatic reduction of intussusception in pediatric patients: A retrospective study
Xie Xiaolong1, Wu Yang, Wang Qi
1Department of Pediatric Surgery, West China Hospital, Sichuan University, China.
Insights
Younger age, prolonged symptoms, rectal bleeding, constipation, and palpable masses are key risk factors for failed pediatric intussusception reduction. Understanding these indicators improves treatment outcomes for intussusception.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes Research
Background:
- Intussusception is a common surgical emergency in infants and children.
- Hydrostatic reduction is a primary non-operative treatment, but failure necessitates surgical intervention.
Purpose of the Study:
- To identify significant risk factors associated with the failure of hydrostatic reduction in pediatric intussusception cases.
- To inform clinical decision-making and potentially improve success rates of non-operative management.
Main Methods:
- Retrospective analysis of pediatric patients (0-18 years) treated with hydrostatic reduction between 2010-2016.
- Exclusion of patients with contraindications like peritonitis or shock.
- Univariable and multivariable logistic regression analyses were performed on collected demographic, symptomatic, and clinical data.
Main Results:
- Significant risk factors for failure included: age under 1 year (OR=3.915), symptom duration ≥48 hours (OR=0.056), rectal bleeding (OR=0.283), constipation (OR=0.086), palpable abdominal mass (OR=0.370), and left-over-right mass location (OR=13.782).
- Multivariable analysis confirmed these factors' predictive value for hydrostatic reduction failure.
Conclusions:
- Age, symptom duration, specific clinical signs (rectal bleeding, constipation, palpable mass), and mass location are critical predictors of hydrostatic reduction failure in pediatric intussusception.
- Early recognition of these risk factors can guide timely surgical consultation and management planning.
Abstract:
The aim of this current study was to explore the risk factors associated with failure of hydrostatic reduction of intussusception in pediatric patients.Patients with intussusception treated with hydrostatic reduction from January 2010 to December 2016 were retrospectively analyzed. Candidates for inclusion in the study were children from 0 to 18 who were diagnosed with intussusception and treated with hydrostatic reduction. We excluded the patients who had contraindications for hydrostatic reduction, which included peritonitis, perforation signs, and non-responsive shock that required surgery. The data collected included: demographic data (sex, age, and bodyweight), symptoms (vomiting, abdominal pain, rectal bleeding, diarrhea, distention, constipation, and duration of symptoms), signs (temperature, palpable mass, and location of the mass), and other investigations (white blood cell counts, neutrophils, electrolytes, and ultrasound findings).The risk factors for failure of hydrostatic reduction of intussusception were analyzed using the univariable analysis and the multivariable analysis. In the univariable model, the significant risk factors for failure of hydrostatic reduction of intussusception analyzed were age, bodyweight, duration of symptoms, rectal bleeding, constipation, palpable abdominal mass, poor prognosis signs on ultrasound scans and location of mass (the P value for each parameter are stated in ). After the multivariable analysis was done, we found that the significant risk factors for failure of hydrostatic reduction of intussusception were an age of under 1-year-old (OR = 3.915, P = .027), duration of symptoms more than or equal to 48 h (OR = 0.056, P < .001), rectal bleeding (OR = 0.283, P = .003), constipation (OR = 0.086, P < .001), palpable abdominal mass (OR = 0.370, P = .010), and location of mass (left over right side) (OR = 13.782, P < .001).(Table is included in full-text article.)Our study found that an age of under 1-year-old, a duration of symptoms of more than or equal to 48 h, rectal bleeding, constipation, palpable abdominal mass and location of mass (left over right side) were risk factors for the failure of hydrostatic reduction of intussusception.
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