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Intussusception: evolution of current management
1Department of Pediatric Surgery, Children's Hospital of Buffalo, NY 14222.
Insights
Hydrostatic reduction for intussusception in children significantly lowered mortality rates compared to surgery. This shift in management improved outcomes, with no deaths in successful barium enema reductions.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Intussusception is a common surgical emergency in infants and children.
- Historically, operative reduction was the primary treatment for intussusception.
Purpose of the Study:
- To evaluate the impact of a management change from operative to hydrostatic reduction on intussusception treatment outcomes.
- To compare recurrence rates and mortality between operative and hydrostatic reduction methods.
Main Methods:
- Retrospective review of 583 pediatric intussusception cases treated between 1930-1985.
- Analysis of treatment outcomes before and after a 1970 management shift favoring barium enema reduction.
Main Results:
- Mortality decreased from 3.9% (operative) to 1.3% (hydrostatic reduction).
- Successful barium enema reduction had zero mortality.
- Recurrence rates were 8.5% overall, with 66% following barium enema and 33% after surgery.
Conclusions:
- Hydrostatic reduction via barium enema is a safer and effective treatment for pediatric intussusception.
- The shift in management significantly improved patient survival rates.
- While recurrence can occur, hydrostatic reduction offers a lower-risk approach.
Abstract:
The records of 583 children who were treated for intussusception at the Children's Hospital of Buffalo in the period 1930-1985 were reviewed. Following a change in management in 1970 from operative treatment to hydrostatic reduction of the intussusception by barium enema, two main groups are defined. In earlier years 95% of patients underwent operative reduction whereas in the latter period 92% had barium reduction attempted. The remaining 8% in this group had clinical contraindications for hydrostatic enema attempt. Ten percent had pathological lead points. Recurrent intussusception occurred in 50 cases (8.5%), 66% following barium enema reduction and 33% after surgery. The mortality in the earlier group was 3.9% and 1.3% in the latter group. No deaths occurred in patients treated successfully with barium enema reduction, and there were no deaths in the children with simple uncomplicated intussusception requiring surgery.