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PNEUMATIC REDUCTION OF INTUSSUSCEPTION IN CHILDREN: EXPERIENCE AND ANALYSIS OF OUTCOME AT JUTH, JOS, A TERTIARY
E D Dung1, A H Shitta1, B T Alayande1
1Division of Paediatric Surgery, Department of Surgery, Jos University Teaching Hospital, Jos Nigeria.
Insights
Ultrasound-guided pneumatic reduction achieved a 60% success rate for childhood intussusception. Key predictors of success include abdominal mass presence and early presentation, with no reported complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Intussusception is a critical pediatric surgical emergency requiring prompt treatment to prevent severe morbidity and mortality.
- Ultrasound-guided pneumatic reduction is a leading non-operative approach, demonstrating high success and low complication rates.
Purpose of the Study:
- To assess the efficacy of ultrasound-confirmed pneumatic reduction for childhood intussusception within a local setting.
- To identify factors influencing the success rate of this non-operative intervention.
Main Methods:
- A retrospective analysis of children under two years with uncomplicated idiopathic intussusception from June 2012 to June 2017.
- Ultrasound confirmed diagnosis and pneumatic reduction using locally assembled equipment, with laparotomy reserved for failed cases after three attempts.
Main Results:
- A 60% success rate was observed in 25 selected children, with a mean age of 7.08 months.
- Presence of an abdominal mass significantly predicted success (OR 9.75), while rectal mass presence predicted failure (OR 0.16).
- Early presentation correlated with first-attempt success, and successful reductions led to shorter hospital stays (3.4 days vs. 8.0 days).
Conclusions:
- Ultrasound-confirmed pneumatic reduction is a safe and effective non-operative treatment for selected pediatric intussusception cases.
- Abdominal mass and absence of rectal intussusception apex are key predictors of successful reduction.
- Early presentation is associated with improved success rates, particularly for first-attempt reductions.
Context:
Intussusception is a common childhood abdominal surgical emergency worldwide resulting in considerable morbidity and mortality if not promptly treated. Ultrasound-guided pneumatic reduction has been proven to be the most reliable and successful non-operative management option with the least complication rate.
Aims:
To evaluate our local experience with the ultrasound-confirmed pneumatic reduction of childhood intussusception and to determine factors that predict successful outcome.
Settings And Design:
A retrospective study of children less than 2 years old who presented to our facility with uncomplicated idiopathic intussusceptions between June, 2012 and June, 2017.
Materials And Methods:
The clinical diagnosis was confirmed by abdominal ultrasonography. Pneumatic reduction with a locally assembled equipment was performed on selected and resuscitated patients; abdominal ultrasound scan was then performed to confirm successful reduction. The procedure was considered to have failed if unsuccessful after the third attempt. Laparotomy was performed on patients with failed procedure.
Statistical Analysis Used:
Statistical Package for Social Sciences version 24 was used for data analysis. Categorical variables were compared using Fisher exact test (with odds ratios and 95% confidence intervals where appropriate) and numeric variables compared using the student t-test. Statistical significance was set at p< 0.05.
Results:
Twenty five out of 36 children with intussusception were selected for the procedure with M:F ratio 1.8:1 and a mean age of 7.08 (SD 4.18) months. Only 9 (36%) presented early (ie within 24 hours). While non-bilious vomiting was the commonest symptom, blood-stained finger on rectal examination was the commonest sign in the patients. The overall success rate was 60% (15 patients). Early presentation accounted for only 5 (33%) of successful procedures. The presence of an abdominal mass was associated with increased likelihood of success (OR 9.75,[95% CI [1.38-68.78], p≥0.022), while the presence of a rectal mass was associated with a reduced likelihood of success (OR 0.16 95%CI [0.026-0.917], p≥0.042 ). Age, sex, and duration of symptoms before presentation did not influence outcome. Early presentation was however significantly associated with success at first attempt, compared to late presentation, in those with successful outcomes. Recurrence was observed in one (6.7%) of the successful cases. The mean duration of hospital stay in those that had successful outcome, 3.4(SD1.0) days was significantly shorter than that for those who had laparotomy for failed reduction, 8.0(SD3.1) days (p<0.001). There was no bowel perforation and no mortality recorded.
Conclusions:
The successful pneumatic reduction rate was 60%. The major predictors of success in this study were the presence of abdominal mass and the absence of intussusception apex in the rectum. Early presentation was significantly associated with success at first attempt, compared to late presentation, in those with successful outcomes. There was no bowel perforation or mortality. Ultrasound-confirmed pneumatic reduction of intussusception is a simple, easy, safe and effective non-operative management of uncomplicated intussusception in well selected children in our environment.
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